Home Forums Discussions General Discussion I Updated the "What's Wrong with HIT?" Slideshow

It's been a very busy month of February. Lots of EMR news that has forced me to update the "What's Wrong with HIT?" lecture slides. The link for the newest slideshow is http://www.box.net/shared/static/jw5jf4v0gk.ppt. Here are the changes-

- added pages 28 and 29 ("2/15/08, Metanalysis: P4P Programs May Not Improve Quality of Care")
- added page 30 ("2/18/07, Update: Health Care Reform Is Being Decided Behind Closed Doors")
- added page 31 ("2/26/08, Another Study Shows EMR, Quality Connection Still Weak")
- page 32 has been updated ("What the Timeline Shows")
- updated page 39 and added extra page 40 showing EHR stocks (the CCHIT certified "big boy" competitors to Amazing Charts ALL seem to be in a free fall!)

These developments are really good news!

Cheers,
Al

Al,
Kind of busy catching up today but as always thanks for your "fighting the good fight" my friend. (do I sound too much like a certain right wing Presidential candidate? "My friends, my friends...") I will try to email it around to some interested parties. Thanks again.
Paul

The whole point of a true cost effective software like AC is that it does what it is supposed to do- organize, improve workflow, and generally help the physician. It doesn't promise to bail out Medicare, be a good tool for the P4P initiatives, or bring on CCHIT bloat.

Quality will always be determined by physicians, not by machines.

I am very excited about the prospect of bringing the new found power of a 'database' into my practice. On January 11, a Friday, I finished seeing patients and was clearing my desk. I was pitching the 'throw aways' in the trash when "Cortlandt Forum" caught my eye. "A deadly diabetic complication" was an article about subclinical presentation of Lactic Acidosis. In elderly patients with impaired renal function this may go unrecognized as weight loss or weakness. Of course this could be a large number of my patients.
So I began my first introduction to the "search" function in AC. Out of 5,300 active charts I found 242 patients taking metformin, and then I manually opened those, beginning with the oldest, and reviewed 5 criteria. (CC, graph of weight, Dx, labs, and absence of Labs in the past year) I forwarded about 22 patients to my associates or myself, and of mine, I called two that night to have them stop the drug.
When speaking with Doctors at the state Osteopathic meeting I encouraged them to move into the EMR, and to imagine the DATABASE as a large lump of clay, sitting off to the side. Face to face time with patients is really only impacted in a business sense, (filing is complete, records are accessible and legible), but the dramatic change to me is this database, this lump of clay that you can return to when you have new or better knowledge and you can mold or shape into a better, healthier practice.
Coming to understand this vision of the future of my practice I have been enable to infect the director of the IPA which handles all of our managed care patients. He is willing to talk with me about a joint effort to make the practice healthier, and of course more profitable for the IPA. If we succeed, we will have demonstrated value added, (sculpting that lump of clay) and they will reward us with a higher capitation rate. Time will tell if any of this can work, but my optimism is extremely high.

DocM,
First off, I am your friend so please don't get offended here. Let me relate a story about being a "union" and "non-union" worker in the same industry.

I was a stagehand for many years and I started working in a local college theater. As the head Audio Engineer, part of my job involved my sitting in the Audience behind the Main house console to do the "house Mix" that you the audience heard. Usually when I did the house mix I simply wore my same dirty jeans and black tee shirt that I wore to work to set-up the gear and the stage in.

A year or two later I started splitting my time by also working at a larger "Union" house, the famous Brooklyn Academy of Music or BAM that many of you may have heard about. It is America's oldest performing art center. Anyway, at this higher level house that is where some of the best of off-Broadway is first performed and developed, the house Audio engineers would bring a clean pair of black jeans and a button down shirt and sometimes even a tie to wear during the performance while sitting at the main console in the house.

Well, I was trying to get paid better and treated with more respect back at that first college theater back up in the Bronx. So after working at a more professional level out at BAM, I decided if I wanted to be treated like a better proffesional I better act like one, and then I could certainly and rightly be treated and compensated as one. So I started bringing a better change of clothes with me on performance days for a number of months all while I could not seem to get them to budge on giving me a modest raise.

Well one night "Ray Charles" came to our theater. Great show and a pleasure to work with him and his crew. But anyway, I was told by my direct superior, Frank the Stage Manager, that I would not be "flying" the console that night as Ray's manager always flies it for them, both monitors for the performer as well as the house mix. So I simply came dressed in my dirtier work clothes with no change on hand. This was a one day in and out sort of a show, so we loaded them in that morning, set them up that afternoon, and held our show that same night.

Well come show time, Ray's manager and sound man looks at me and says, he wanted me to fly the console and that he would simply act as a sort of "producer" standing next to me, directing me as what he was looking for in the mix. This was fine my me, I knew the sound of my house and my gear best (console was garbage, an old EV. I did my best work with the choice and placement of my mics which some were actually pretty good, work with the laws of physics not against them), and this is how it is usually done at the higher levels on the recording side anyway, and that is where I had originally started.

Well, need I tell you that the man who was the director of the entire theater comes backstage after the show and starts giving me and Frank hell, because I was in the house that night dressed in my regular stagehand clothes instead of a shirt and tie. This was never the policy there only a few months earlier as it was me that started such a thing and it was never formally written out anywhere either. This conflict lead to my leaving that theater for good and almost never taking another "non-union" assignment again in any theater. I had personally raised the bar and acted more proffessional and now they simply wanted it from then on for free.

I bring up this tale from long ago because this is how I see P4P going especially since we are up against the gov't and the carriers that have an anti-trust waiver who have both proven they will take and take without ever returning a gosh darn thing to you or us. Be careful about giving the camel an inch and letting him stick his head in the tent; he will certainly come into the tent all the way and you will end up sleeping with him in your bed.

This is why I still feel that the only way for our side of this industry to be treated fairly is to be granted the right to organize and strike. The side with the stronger hand, the carriers and the gov't which controls your access to your own "end retail customers of your services" and sets the rates that you will be paid for your services, will simply continue to take and take, coming up with scheme after scheme, to get more from you for less. P4P is nothing more and nothing less. What conditions one works under, what tasks they need to perform, that rate at which they will be compensated, the equipment they will or won't use to perform such tasks, are all issues for collective bargining. And one is certainly an employee when one no longer has direct access to that end retail customer of their end services. If we don't work for the carrier or the gov't (contract with them) then we can't have free and open access to our customers of our services.

Those that don't learn from history are damned to repeat it. Please learn from this little tale. Thanks for listening.....

In the recent 2 weeks alone there have been so many developments on the EHR solvency issue, that I had to update the "What's Wrong with the HIT in the USA" slideshow, especially page 40:

"Of the 89 products certified with the 2006 criteria, 11 have had some financial issues, with:

- 1 going bankrupt (AcerMed),
- 2 cutting back on employees and reorganizing to stay alive (OmniMD, Misys),
- Greenway is still functioning without demonstrating a profit,
- On 3/17/2008 Misys and Allscripts announced a plan to merge their operations,
- On 3/17/2008 Bond Technologies was purchased by MediNotes Corporation,
- On 3/18/2008 Medcomsoft admits an inability to significantly penetrate the EHR market, and declares a revamping of its marketing strategy,
- 6 publicly traded stocks (QSII/NextGen, Cerner, QuadraMed, Athenahealth, Allscripts, Medcomsoft) have seen their stock prices slide 30-75% in the past 6 months."

That's 12% of expensive CCHIT-certified EHRs!

The time line area has also been updated with several HIT 3/2008 news.

URL: http://www.box.net/shared/static/635k5hf4s8.ppt

Cheers,
Al