APA Annual Meeting in New Orleans 2010 #apanola2010

Lots of discussion about EHRs at this year's American Psychiatric Association meeting in New Orleans. Other topics of interest to me included TMS (transcranial magnetic stimulation for the treatment of depression), social media, and about the APA's role in helping its members adopt certified electronic health records.

Today at 11am the Committee on Electronic Health Records is presenting in Room 340 at the Convention Center: The Train Has Left the Station: National Incentives and Developments in Electronic Health Records.

Other IT talks were listed in John Luo's article, Your Annual Meeting IT Guide.

HIMSS EMR Adoption Model: 2009 Level 4 (CPOE) Only 14%

Hospitals in 2009 continued to have low CPOE adoption (Level 4), but they did manage to jump from 5.8% to 13.5% having CPOE (Computerized Provider Order Entry) from 2008 to 2009.

Looking at the HIMSS EMR Adoption Model trends, you can see how the 5000+ hospitals in the US are gradually moving up the electronic evolutionary ladder towards Level 7, which is full implementation of a completely interoperable, paperless, electronic medical record (note that HIMSS differentiates an "EMR" (within a single organization) from an "EHR", which it defines to specifically be a "subset of each care delivery organization's (CDO) EMR, ... owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state...").

As a reminder, here are the definitions of the levels (from HIMSS):

It'll be interesting to see how the HITECH Act's financial incentives accelerates adoption of the higher levels (4 and up). Looking at the cumulative adoption percentages below, I'd expect Level 4 to take off in the same way that Level 3 has over the past several years. But that is the hardest transition to achieve due to the dramatic changes in physician workflow required. This is easier to achieve in hospitals where the majority of the physicians are employed by the hospital; however, physicians at most hospitals (especially community hospitals) are not employed, so these hospitals have less fortitude in requiring them to enter their own orders.

Any guesses as to what the 2010 adoption numbers will be?

Snow Storm Good Advertisement for the Need for Telepsychiatry

Two feet of snow and Baltimore comes to a screeching halt. How to get the doctors to the hospital? This is where telepsychiatry can be very helpful. However, there are still so many impediments to using telemedicine (billing, liability, documentation, technical) that we are *still* unable to use it when we need it. Like today, where the hospital will have to send a 4x4 to pick up Dr Chandran to get him to the hospital.

A broader term for distance mental health services is Telemental Health services, or TMH. Proposed new regulations were released last week that would permit and regulate TMH under the public mental health system (aka Medicaid) in Maryland. Unfortunately, the way it is currently written would not permit me to "see" inpatients on our unit from home during a blizzard. Still, it is a step in the right direction.

For more info on TMH, check out the Maryland Telemental Health website.

This is a Job for Flower!

First post of 2010. Happy New Year, all! Oh, and enjoy reading the 500+ page Meaningful Use proposed rule [pdf] we got for New Years. More on that in a later post; in meantime, check out David Harlow's post on HealthBlawg.

Alan Viars (@aviars) wrote a post yesterday about his father's difficulties in getting access to his medical records when transferring from Hospital A to Hospital B. His father's POA had to essentially throw a fit just to get a copy of the records prior to open heart surgery at the receiving hospital, as they "don't normally do that." Oh, and his father learned that his EKG from a year ago showed evidence of a silent heart attack but no one ever told him.

Alan concludes:

Lessons for the Wise:

• When you have medical tests, YOU THE PATIENT, need to ask for the results. Get a copy. Make sure your physician has actually reviews your tests. Just because you didn’t hear anything, don’t assume everything is okay.
• If it’s possible, when you go to the hospital have someone by your side who cares about you and can advocate for you. If you’re lucky enough to have a nurse, physician, or other medically educated person to be your advocate, even better.
• Sadly, you may have to get angry in order to gain access to your medical records. Don’t let them tell you no. It’s YOUR data – all of it – and it’s your right to have a copy. Keep your own records.

This is a great example of what the Speak Flower movement is all about.

It's about getting access to your health information -- easily, quickly, automatically.

It's about allowing other authorized individuals or entities to access your health information -- easily, quickly, automatically.

It's about taking control of the health information that is yours -- easily, quickly, automatically.

Licensing One's Own Health Care Data

Paul Roemer at HealthcareITstrategies asked about the difference between a patient owning vs accessing their health care data.

To which I replied:

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Paul, I'd like to see a model considered where the patient owns the data, and licenses it out to others, such as doctors, hospitals, and insurance companies. One could then imagine a situation where that data (including their genetic info), owned and licensed by the patient, might have a value. The patient could then do the following:

• be paid licensing fees for access to their data (from Google or other marketing companies; and from insurance companies and Pharma, who would benefit from knowing this info)
• grant access for free to their providers, spouse, etc
• pay others to access their data in order to gain some benefit, such as analytics

This would change the whole discussion about health care, privacy, and costs.

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Think about the incredible shifts and changes in the marketplace if such a revolution developed.

Not only would there be this "power to the people" shift in mindset, it would also create a huge change in the average consumer's approach to their own health. It would encourage them to pay attention to their data, and thus their health, in a manner similar to how people pay attention to their savings and checking accounts. It might even result in a reduction in health care costs. It would certainly create a more fluid marketplace.

How do we get there? (add comments/ideas)

[Edit: Dec 13- I'm linking to some of the great prior posts and items noted by the commenters.]

• HealthBlawg: David Harlow's interview with law professor Marc Rodwin about idea of public ownership of de-identified health data. [Jul 2009]
• Marc Rodwin's JAMA article, "The Case for Public Ownership of Patient Data". [Jul 2009]
• Silona Bonewald's post about mutual data ownership. [Jun 2009]
• Leo Kish asks: What if all applications, caregivers and patients were connected online? [Nov 2009]
• Gregg Masters (@2healthguru) posts "I Will License or Lease My Health Info to Providers". [Mar 2009]
• Steve Holcombe's piece on granular information ownership. [Aug 2008]

Links to HIT and MU Resources

Please add a comment for other links that should be included. Thanks.

Upcoming meetings & public comment . . .

FDA Hearing on Social Media	Nov 12-13	fdasm.com | Federal Register notice (PUBLIC COMMENTS thru Feb 28) | FDA Notice | AGENDA | Speakers | Panelists | transcript of 1996 mtg re internet
HIT Standards Comm	Thu Oct 29	Public testimony to better understand adoption and implementation issues, needs for enhanced implementation guidance, and identification of enablers that would accelerate interoperability such as new tools or filing standards gaps. We'll also conduct an online forum and accept written testimony. [per John Halamka]
HIT Policy Comm	Oct 27-28	MU relevance to Specialty providers (incl Psychiatry & Behavioral Health), small practices, and small hospitals. | Agenda | Webcast | Oct 27 transcript

• ARRA - HITECH Act | W&M summary | statute
• Meaningful Use page (HHS)
• Meaningful Use matrix (pdf)
• Meaningful Use documents (HHS)
• Summary of comments from non-physician providers and specialist physicians from June 2009 meeting (pdf)

• HIT Policy Committee | meetings | past mtgs | recommendations
• HIT Standards Committee | meetings | past mtgs | recommendations
• HITSP
• CCHIT
• Ed Bennett's Hospital Social Media list (list of hospitals and their official blogs, Twitter names, and Facebook pages)

Twitter links . . .

• #fdasm: FDA hearing on social media and web2.0 (Nov 12-13)
• #hcsm: Health Care & Social Media chat, Sunday nights 9-10 ET
• @ahier: Brian often is the first to post transcripts of the public meetings on his blog
• #hitpol: Tweets related to HIT policy issues
• #ehr: EHR-related tweets
• #hchit: Health care HIT chat, Thursdays 1-2pm ET

HITPC Recommends Changes to HIT Certification Process: 10 Bullet Points

The recommendations from the HITPC Certification & Adoption workgroup came out yesterday (see below).

Here are my ten take-home bullet points:

1. Certification should be solely focused on Meaningful Use, Privacy, Security, & Interoperability. Nothing extra.
2. The setting of criteria and testing of criteria satisfaction should be done by separate entities.
3. HHS establishes the certification criteria (not CCHIT).
4. NIST should oversee the testing to determine if products or orgs meet the criteria.
5. NIST can accredit orgs, such as CCHIT, to conduct the certification process.
6. Certification is required every 4 years (this seems too long?).
7. Slide 17 suggests a surveillance function, which might fill the 4-year gap with periodic monitoring, perhaps.
8. Open source is clearly accommodated.
9. CCHIT should keep doing what it is doing until further notice.
10. "Criteria on functions/features should be high level; however, criteria on interoperability should be more explicit." (Slide 15)

If ONC and HHS agree with all of this, after public comment, then CCHIT will likely become more of a testing org, rather than a standards-setting body.

This is a huge step forward in clarifying and advancing our national HIT undertaking. The Workgroup should be congratulated for this set of recommendations.

HITPC Recommends Changes to HIT Certification Process

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