Archive for March, 2009

« Older Entries

A Patient-Centric View of ARRA: Title XIII-Health Information Technology: Part 2, Subtitle C

March 31st, 2009 | Popularity: 23%
0 comments | Leave a reply

Continuing on my review of ARRA Title XIII from a patient-empowerment perspective…

SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ASSISTANCE

Patient input in the creation of a Health Information Technology Research Center is alluded to…sort of…

‘‘(2) INPUT.—The Center shall incorporate input from— ‘‘(A) other Federal agencies with demonstrated experi- ence and expertise in information technology services such as the National Institute of Standards and Technology; ‘‘(B) users of health information technology, such as providers and their support and clerical staff and others involved in the care and care coordination of patients, from the health care and health information technology industry; and ‘‘(C) others as appropriate.

Health Information Technology Regional Extension Centers

Could a center be affiliated with a patient and family based organization, to provide assistance related to patient and family access to HIT?

‘‘(2) AFFILIATION.—Regional centers shall be affiliated with any United States-based nonprofit institution or organization, or group thereof, that applies and is awarded financial assist- ance under this section. Individual awards shall be decided on the basis of merit.

SEC. 3013. STATE GRANTS TO PROMOTE HEALTH INFORMATION TECHNOLOGY

Under use of state grant funds, #6:

‘‘(6) assisting patients in utilizing health information technology;

Under required consultation, patients included, #3:

‘‘(g) REQUIRED CONSULTATION.—In carrying out activities described in subsections (b) and (c), a State or qualified State- designated entity shall consult with and consider the recommenda- tions of— ‘‘(1) health care providers (including providers that provide services to low income and underserved populations); ‘‘(2) health plans; ‘‘(3) patient or consumer organizations that represent the population to be served; ‘‘(4) health information technology vendors; ‘‘(5) health care purchasers and employers; ‘‘(6) public health agencies; ‘‘(7) health professions schools, universities and colleges; ‘‘(8) clinical researchers; ‘‘(9) other users of health information technology such as the support and clerical staff of providers and others involved in the care and care coordination of patients; and ‘‘(10) such other entities, as may be determined appropriate by the Secretary.

SEC. 3015. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION TECHNOLOGY INTO CLINICAL EDUCATION

I have a soft spot for clinical education as a great place to teach patient centered care and patient and family inclusion. So maybe when we say “EHR” below, we could substitute “EHR and PHR,” after all, do do the things that the plan is being asked to do requires patient and family involvement.

‘‘(2) submit to the Secretary a strategic plan for integrating certified EHR technology in the clinical education of health professionals to reduce medical errors, increase access to prevention, reduce chronic diseases, and enhance health care quality;

Use of grant funds to require more than one discipline may also promote patient centered approaches, based on the disciplines involved, I am thinking osteopathic medicine and nursing…

‘(1) IN GENERAL.—With respect to a grant under subsection (a), an eligible entity shall— ‘‘(A) use grant funds in collaboration with 2 or more disciplines; and ‘‘(B) use grant funds to integrate certified EHR tech- nology into community-based clinical education.

SEC. 3016. INFORMATION TECHNOLOGY PROFESSIONALS IN HEALTH CARE

An emphasis on short term programs, and as with above, people may need to be thinking in an expanded way to include training in patient and family access in new environments, such as inpatient or long term care…

‘‘(a) IN GENERAL.—The Secretary, in consultation with the Director of the National Science Foundation, shall provide assist- ance to institutions of higher education (or consortia thereof) to establish or expand medical health informatics education programs, including certification, undergraduate, and masters degree pro- grams, for both health care and information technology students to ensure the rapid and effective utilization and development of health information technologies (in the United States health care infrastructure).

‘‘(c) PRIORITY.—In providing assistance under subsection (a), the Secretary shall give preference to the following: ‘‘(1) Existing education and training programs. ‘‘(2) Programs designed to be completed in less than six months.

No comments »

Posted in Updates

Tags:

Primary Care Improvement is Not Static – Summit on Redesigning the Office Practice, Vancouver, BC

March 26th, 2009 | Popularity: 26%
2 comments

Canada Place, VancouverDenverHealth teaching LEANTeaching LEAN at IHI in VancouverKellie Takashima, NP, Leslie Francis, Michael Pate, Kathleen Mayer, MD

I recently returned from Vancouver, BC, where I was able to attend the International Summit on Redesigning the Office Practice , hosted by the Institute for Healthcare Improvement. I tended to drift toward the sessions that focused on LEAN transformations in primary care, with a lot of impressive teaching about impressive work in a host of organizations.

At very large conferences like this one is, it’s useful to spend time with innovation happening within your own organization, which is the case with the session called “New Challenges, New Tools, New Work, and New Outcomes,” facilitated by Leslie Francis, MBA/MHA, and taught by Kathleen Mayer, MD and Michael Pate from Kaiser Permanente, Colorado, and Kellie Takashima, NP, Kaiser Permanente, Hawaii. Jack Cochran, MD, CEO of The Permanente Federation, was also present with us and added insights for the audience.

I’m glad I attended because the talk was a reminder that visiting any organization at a point in time is just that – a point in time. See for yourself in the slides below – the problems that we thought were problems the last time we checked in may have been solved the day after we left….

New Challenges New Tools New Work New Outcomes KP - 01New Challenges New Tools New Work New Outcomes KP - 02New Challenges New Tools New Work New Outcomes KP - 03New Challenges New Tools New Work New Outcomes KP - 04New Challenges New Tools New Work New Outcomes KP - 05New Challenges New Tools New Work New Outcomes KP - 06New Challenges New Tools New Work New Outcomes KP - 07New Challenges New Tools New Work New Outcomes KP - 08New Challenges New Tools New Work New Outcomes KP - 09New Challenges New Tools New Work New Outcomes KP - 10New Challenges New Tools New Work New Outcomes KP - 11New Challenges New Tools New Work New Outcomes KP - 12New Challenges New Tools New Work New Outcomes KP - 13New Challenges New Tools New Work New Outcomes KP - 14New Challenges New Tools New Work New Outcomes KP - 15New Challenges New Tools New Work New Outcomes KP - 16New Challenges New Tools New Work New Outcomes KP - 17New Challenges New Tools New Work New Outcomes KP - 18

2 comments »

Posted in Updates

Tags:

D.C. Homeless People Use Cellphones, Blogs and E-Mail to Stay on Top of Things – washingtonpost.com

March 26th, 2009 | Popularity: 24%
0 comments | Leave a reply

No comments »

Posted in del.icio.us bookmarks

Tags:

Health Affairs — Selected Abstracts on Accountable Care Organizations

March 26th, 2009 | Popularity: 22%
0 comments | Leave a reply

No comments »

Posted in del.icio.us bookmarks

Tags:

Photo Friday: Consumer Reports Health Best Drugs for Less, Union Station, Washington, DC

March 23rd, 2009 | Popularity: 19%
1 comment

Consumer Reports Health Best Drugs For Less

I know, it’s Monday, not Friday, but better late….

This week’s photograph was taken at Washington, DC’s Union Station, where Consumer Reports Health was unveiling its publication “Best Drugs for Less,” with a cute display including people wearing pill costumes. The event was also covered on the Consumer Reports blog, which you can view here.

I think our current economic climate will contribute to efforts like this, designed to educate patients about their options in using medications successfully.

1 comment »

Posted in Photo Friday

Tags:

A Patient-Centric View of ARRA: Title XIII-Health Information Technology: Part 2, Subtitle A & B

March 19th, 2009 | Popularity: 22%
0 comments | Leave a reply

Continuing on my review of ARRA Title XIII from a patient-empowerment perspective…

Part 2-Application and Use of Adopted Health Information Technology Standards; Reports

Section 13113. Study and Reports.

Looking at reimbursement, which in some respects all of this rolls up to. If managing blood pressure is only paid for if a patient physically walks into a doctor’s office, it’s hard to imagine how HIT will get adopted….

(b) REIMBURSEMENTINCENTIVESTUDYANDREPORT.— (1) STUDY.—The Secretary of Health and Human Services shall carry out, or contract with a private entity to carry out, a study that examines methods to create efficient reimburse- ment incentives for improving health care quality in Federally qualified health centers, rural health clinics, and free clinics. (2) REPORT.—Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to the appropriate committees of jurisdic- tion of the House of Representatives and the Senate a report on the study carried out under paragraph (1).

Aging Services Technology Study – this is useful in getting us to the idea that every patient in every care system can participate in their care, as can those who support them.

(1) IN GENERAL.—The Secretary of Health and Human Services shall carry out, or contract with a private entity to carry out, a study of matters relating to the potential use of new aging services technology to assist seniors, individuals with disabilities, and their caregivers throughout the aging process. (2) MATTERSTOBESTUDIED.—The study under paragraph (1) shall include— (A) an evaluation of— (i) methods for identifying current, emerging, and future health technology that can be used to meet the needs of seniors and individuals with disabilities and their caregivers across all aging services settings, as specified by the Secretary; (ii) methods for fostering scientific innovation with respect to aging services technology within the business and academic communities; and (iii) developments in aging services technology in other countries that may be applied in the United States; and (B) identification of— (i) barriers to innovation in aging services tech- nology and devising strategies for removing such bar- riers; and (ii) barriers to the adoption of aging services tech- nology by health care providers and consumers and devising strategies to removing such barriers. (3) REPORT.—Not later than 24 months after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of jurisdiction of the House of Rep- resentatives and of the Senate a report on the study carried out under paragraph (1). (4) DEFINITIONS.—For purposes of this subsection: (A) AGINGSERVICES TECHNOLOGY.—The term ‘‘aging services technology’’ means health technology that meets the health care needs of seniors, individuals with disabil- ities, and the caregivers of such seniors and individuals.

Subtitle B-Testing of Health Information Technology

Section 13202 Research and Development Programs

New multidisciplinary Centers for Health Care Information Enterprise Integration will be created in institutions of higher education (should these Centers, though, collaborate with health care enterprises that do this integration in the way they are structured?)

(4) RESEARCHAREAS.—Research areas may include— (A) interfaces between human information and commu- nications technology systems; (B) voice-recognition systems; (C) software that improves interoperability and connectivity among health information systems; (D) software dependability in systems critical to health care delivery; (E) measurement of the impact of information tech- nologies on the quality and productivity of health care; (F) health information enterprise management; (G) health information technology security and integ- rity; and (H) relevant healmedical errors.

Subtitle C – D is tomorrow…

No comments »

Posted in Updates

Tags:

A Patient-Centric View of ARRA: Title XIII-Health Information Technology: Part I

March 18th, 2009 | Popularity: 28%
4 comments
Title XIII - Page 112

Full Text, ARRA

My approach to regulations and legislation in health care is to enjoy and savor them by reading the actual text. For me, summaries tend to obscure the problems that people who create these are trying to solve. This is what makes this part of the job fun.

I’ve read Title XIII-Health Information Technology with an eye toward the things I am most interested in and will quote those passages below, for informational purposes. Remember that this is a blog which means that corrections and improvements are welcome in the comments. And I’m not an attorney, this is for informational purposes only, and there’s good information in here.

Subtitle A – Promotion of Health Information Technology

Section 3000 Definitions

Health Information Technology includes uses by patients:

‘‘(5) HEALTHINFORMATIONTECHNOLOGY.—The term ‘health information technology’ means hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information

Section 3001 Office of the National Coordinator For Health Information Technology

Support for patient/consumer groups

‘‘(7) ASSISTANCE.—The National Coordinator may provide financial assistance to consumer advocacy groups and not-for- profit entities that work in the public interest for purposes of defraying the cost to such groups and entities to participate under, whether in whole or in part, the National Technology Transfer Act of 1995 (15 U.S.C. 272 note).

Section 3002 HIT Policy Committee

The sections of this Committee’s charge that cover things like patient access and empowerment are listed in “Other Areas For Consideration.” At least they are there at all.

‘(iii) Telemedicine technologies, in order to reduce travel requirements for patients in remote areas. ‘‘(iv) Technologies that facilitate home health care and the monitoring of patients recuperating at home. ‘‘(v) Technologies that help reduce medical errors. ‘‘(vi) Technologies that facilitate the continuity of care among health settings. ‘‘(vii) Technologies that meet the needs of diverse populations. ‘‘(viii) Methods to facilitate secure access by an individual to such individual’s protected health information. ‘‘(ix) Methods, guidelines, and safeguards to facili- tate secure access to patient information by a family member, caregiver, or guardian acting on behalf of a patient due to age-related and other disability, cog- nitive impairment, or dementia. ‘‘(x) Any other technology that the HIT Policy Com- mittee finds to be among the technologies with the greatest potentiof health care.

There is support for patient involvement on the HIT Policy Committee (nominees were sought recently for this Committee):

‘‘(G) 13 members shall be appointed by the Comptroller General of the United States of whom— ‘‘(i) 3 members shall advocates for patients or con- sumers; ‘‘(ii) 2 members shall represent health care pro- viders, one of which shall be a physician; ‘‘(iii) 1 member shall be from a labor organization representing health care workers; ‘‘(iv) 1 member shall have expertise in health information privacy and security;

Section 3003 HIT Standards Committee

Membership to include consumers:

‘‘(2) M.—The membership of the HIT Standards Committee shall at least reflect providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and information.

Tomorrow, Part II of Title XIII


4 comments »

Posted in Now Reading

Tags:

21st Century Blood Pressure Diagnosis and Treatment: Workflow, in Cartoon, Bonus Workflow

March 17th, 2009 | Popularity: 29%
0 comments | Leave a reply

Employer Workflow

(click image to enlarge)

This is the final, “bonus,” workflow, created to answer the question – “Could an employer be the driver, rather than a physician, of changing the locus of control closer to the patient?”

I think the answer is yes, and given that employers bear most of the cost (along with patients) of chronic illness, there would be incentive for them to do so.

An employer is not a physician so she/he cannot render the diagnosis of high blood pressure, but they can facilitate identification and ongoing management that includes the physician (the physician is included, this is not about removing the physician from a patient’s care, just amplifying everyone’s contribution).

Enjoy, comments welcome as always.

No comments »

Posted in Updates

Tags:

Now Reading: Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care. Health Affairs. 2009 Mar 1

March 13th, 2009 | Popularity: 50%
15 comments
Take 2 Aspirin and Tweet Me in the Morning

Hawn C. Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care [Internet]. Health Aff. 2009 Mar 1;28(2):361-368.

Note: the article no longer requires a subscription for access (3/14/09)

The much anticipated health information technology issue of Health Affairs, and in it is an article written by Carleen Hawn about Social Media in Health Care. The links above to to the Health Affairs site, but it appears a subscription will be required to view it, so hopefully readers have access to an institutional or other subscription to read it.

The genesis of this article was a discussion that was started in July, 2008, at the American Board of Internal Medicine’s forum on Patient Centered Care, where i presented about some of these concepts. This was followed up with discussions with myself and other leaders in the field, such as Jay Parkinson, MD, from HelloHealth, Bob Coffield, a well known legal expert in the area of social media, as well as real patients.

I actually attended the briefing announcing the release of this issue in Washington, DC, and was pleasantly surprised to see that the article is billed on the front cover of a very full catalog of scholarly works. Who would have thought 4 years ago that an article about social networking/media would be front cover material for the Health Affairs issue on Health Information Technology. This says a lot about the impact that social media, or perceived impact, in this area of health care! At the same time, I think Matthew Holt correctly points out that there’s a part two (and three and four) to be written covering what’s below the tip of the iceberg.

In addition to the information mentioned in the article, Carleen Hawn also consulted with some of my favorite innovators in health care, including Scott Shreeve, MD, and the team at the Kaiser Permanente Sidney Garfield Center for Health Care Innovation.

In addition to these contributions, I would also mention the contribution of the California Healthcare Foundation, whose leaders, including Veenu Aulakh, MPH, Sophia Chang, MD, MPH and Sam Karp, stimulated the development of the crowdsourced definition of Health2.0 mentioned the article with a simple question to me: “Ted, what is Health2.0?” (my answer was, “I don’t know, let’s ask the crowd.”)

And, I would also like to mention that innovation like this comes from health care organizations and systems that are able to say,”Not everything has been tried before,” and in my case this is/was Group Health Cooperative, who have learned from our early blogging experience and now bring their physicians and staff online for the world to learn about what they are doing to reinvent primary care. I’ve been engaged in maybe a few conversations over the past few years about why health care organizations should be transparent and it’s helpful for everyone to have an example of why this works well for everyone.

Thanks again to Carleen Hawn, The Health Affairs Team, and The American Board of Internal Medicine Foundation for taking the time to explore this topic for America’s patients (that’s all of us).


15 comments »

Posted in Now Reading

Tags:

Op-Ed Contributor – The Computer Will See You Now – NYTimes.com

March 11th, 2009 | Popularity: 19%
0 comments | Leave a reply

No comments »

Posted in del.icio.us bookmarks

Tags: