Wednesday, December 30, 2009

Meaningful Use Final Matrix Posted

HHS has issued proposed final regulations that list the "meaningful use" criteria which healthcare providers must meet in order to quality for the HITECH incentive payments. This story from Health Data Management has a good breakdown of the Matrix, starting on page 26:

Quick impression is that the bar is set low in some areas, but higher in other areas. Also, it is not fully clear how to fulfill the criteria. For example, one "box" says to have drug-drug interaction checking (which is pretty routine), but in the same box it says to also have drug-formulary checking... that is much more complex, and involves extra fees to the EMR vendor, as well as an assumption that the system allows for input of a patient's drug benefit plan (which is often different from their insurance).

Other confusing things include allowing patients "timely access" to their healthcare data, and something that says "Reminder sent to at least 50% of all unique patients seen by the EP that are age 50 or over" - reminder about what exactly, and does it matter how/when/where we remind them? But it's a start and I assume there is clarification in the other 553 pages of this document, but I'm just looking at the Matrix for now.

Other good links
* Dr. Blumenthal's summary of all the HITECH monies are going:

* MU summary from Mr. HISTalk:

* An MU Excel Spreadsheet created by Mr. HISTalk:

* Dr. John Halamka's MU Summary:

* Matrix of Numerators and Denominators

Top Medical Advances of the Decade

I was recently asked to comment on my thoughts about the "Top Medical Advances of the Decade". Clearly, I'm biased towards the Use of Information Technology in Healthcare – but this made me put down my reasons on paper, which was a good exercise. Here is what I wrote:

Although it has not yet met its potential, HIT has created the ability for patients to have the following:
- Widespread health-based communities to develop online, supporting research, care, education and social support
- Online management of health, from ordering medications to tracking blood pressure, to communicating with your physician
- Transparency with respect to quality, cost, and other metrics

For physicians, the age of Electronic medical records is upon us and have an increasingly profound impact on how we as physicians manage patient care. Although not fully adopted yet, there are pockets of excellent use creating improved quality and efficiency – via a combination of better access, improved legibility, point of care decision support and the ability to do retrospective data analysis to support process improvement projects. But there is a long way to go, as robust adoption is still under 10% of physicians, and many implementations still do not show significant care improvements. Future systems need to be easier to use, cheaper to implement, and they need to truly meet the needs of the end-users.


Let's hope the new year and decade brings with it the full potential of all HIT can do!

FYI- Here is the eventual article that was published about these advances. Besides HIT, the other nine were: Human Genome Decoded, Anti-Smoking Laws, Heart Disease drops by 40%, Stem Cell Research, Targeted Cancer Therapies (eg HER-2), HIV Therapy, Minimally Invasive Surgical Techniques, HRT Controversy, and Functional Brain MRIs.

Wednesday, December 16, 2009

The Inflection Navigator Project

A lot of my effort in the past 1-2 years with the Szollosi Healthcare Innovation Program ( has focused on making the experience easier and better for patients dealing with an "acute inflection point" in their healthcare, such as the new diagnosis of cancer or a heart problem. Working with a great team at Northwestern University and Northwestern Memorial Hospital, we created "The Inflection Navigator" project, which brings together physician-friendly ordering workflows, system level protocols, care coordinators ("Navigators") and a web-based tool we developed to tie it all together.

We went live in April with a Hematuria Pathway, and then launched the Atrial Fibrillation Pathway in June, and finally the Cancer Pathway in September. We believe this combination of people, process and technology improves both the quality and efficiency of these situations, and does so in a cost-effective manner.

This recent article further explains our system and how we developed a web tool called "iNav", working with Northwestern University Biomedical Informatics Center (NUBIC):

Mike Gurley led the software development of iNav. Since it as based on open source code already developed for the cancer Biomedical Informatics Grid (caBIG), he posted the code and architecture online:

Sunday, December 06, 2009

More Money for Early EMR Adopters

More Money for Early EMR Adopters (appropriately so)
ONCHIT Czar Dr. David Blumenthal announced a new round of HIT monies for those who are successfully using EMRs:

I am a fan since I do think that early adopters should get some credit, and the government thinking and reasoning on this appears very sound. Of course, they are not just giving the money away - they are providing it to those EMR adopters who will use it to show specific benefits or integration abilities. Here is what they specifically said:

"Why invest in health communities that are already well ahead in their adoption and use of health IT, when we still have so many communities that are just getting started? Simply put, because it’s sound planning and program management. Together with the Medicare and Medicaid program, we are investing billions of dollars in creating a nationwide interoperable private and secure health information system across all communities. We recognize that throughout our country we have different levels of health IT adoption and varied capabilities to establish EHR systems. Because of this diversity in adoption levels and capabilities, we want an opportunity to peer into the future, to demonstrate the benefits of health IT concretely, and to learn valuable lessons about how American communities can transform their health systems through the use of health IT. Given the pressure to improve our health system, we want to learn these lessons quickly – in a few years if possible – and we think the best way to do that is to accelerate the progress of diverse communities that are leading the way."

Can't wait to see who they choose for this!

Thursday, December 03, 2009

Patient Safety: Slow but Steady Progress

Dr. Robert Wachter is a UCSF "hospitalist expert" who has a great blog talking about quality, safety, and health policy.

He recently published an article in Health Affairs:
"Patient Safety At Ten: Unmistakable Progress, Troubling Gaps", which reviews how well (or not so well) we have done in improving patient safety since the famous IOM report ten years ago. Although not IT/EMR specific, it does stand in contrast to recent papers saying that EMRs have not improved quality significantly. This parallels increasing thoughts around the fact that process innovation is more important than product innovation. It is well worth a read.

December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are
finally grappling with balancing “no blame” and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B−, a modest improvement since 2004.