HEALTHY ONLINE

Every article, discussion, blog post, comment and casual remark on the subject of Electronic Medical Records (EMR) and their prominent role in health care reform is never complete without stating that EMRs were designed for billing and hence are poorly suited to contribute to patient care. Most health IT apologists are either trying to refute these allegations or are pointing out to new products and paradigms that will be designed from the ground up for something other than billing. Let’s try a different approach. To paraphrase Coach Green, EMRs are what we thought they were, and we shouldn’t let 'em off the hook! EMRs are designed for billing, and they should be designed for billing and as financial administrative tools, they are uniquely positioned to solve our health care problems, if properly utilized, because the health care crisis in this country is a financial crisis. It is a financial crisis at a national level and for too many people it is a financial crisis at a personal

On May 22nd, the Secretary of Health and Human Services (HHS) published a momentous press release announcing that “Doctors and hospitals’ use of health IT more than doubles since 2012” . The release was accompanied by two beautiful graphs, one for physicians and one for hospitals, titled “Adoption of Electronic Health Records by Physicians and Other Providers” and “Adoption of Electronic Health Records by Eligible Hospitals” , respectively. Both graphs, shown below, start at zero (0) adoption in January 2011 and climb rapidly to “[m]ore than 291,000 eligible professionals and over 3,800 eligible hospitals” by April 2013. Of course, the graph titles are incorrect, since there were plenty of electronic medical records in use well before 2011, and the actual text of the press release does make some references to the world prior to 2011 (more on that below). The White House, eager to display such enormous success, posted the announcement on its own blog and fixed the titles to indicate

“Victorious warriors win first and then go to war, while defeated warriors go to war first and then seek to win.” –Sun Tzu According to the National Committee for Quality Assurance (NCQA), there are around 33,000 Patient Centered Medical Home ( PCMH ) recognized entities to date, 5,560 of which are practices. Subtracting this and noting that many recognized entities are Nurse Practitioners (NPs), we can safely estimate that approximately 10% of the 209,000 practicing primary care doctors in the U.S. are working in a recognized PCMH. There are other accreditation bodies, but NCQA is by far the largest and best known, so the numbers above should be pretty indicative, give or take a few percentage points. My estimate is that another 80% or so of primary care physicians practice in unrecognized medical homes. Yes, 80%. Although it is difficult to get exact numbers, perusing the NCQA lists of PCMH shows that a large number of recognized medical homes belong to health systems, academic ce

If you are tired of practicing medicine, or are compelled to be your own boss, or for whatever reason decide to try something new, you should consider becoming a Health Information Technology (HIT) entrepreneur, because health care is a $3 trillion industry undergoing great upheaval and widespread computerization, and as John D Rockefeller used to say, you should try to turn every disaster into an opportunity. As a physician, you have a significant head start when it comes to credibility, and if you are a tiny bit technically inclined, your value will easily quadruple. There are many ways to go about this, and you can follow your heart and try to “fix health care”, or relegate your entrepreneurship to hobbyist levels and work on some app for this or that, or you can judiciously research the market and pragmatically choose an endeavor most likely to yield quick and overreaching results. For the novice and uninitiated, below lays a semi-serious roadmap for hitting the elusive jackpot. St

“…economic forces determined outcomes with relatively little constraint from political considerations; such was the case, for example, in the original innovation of indentured servitude, in the substitution of slaves for servants…“ -- Galenson, 1984 The Sunday New York Times is reporting that technology firms are supporting, lobbying, advertising and heavily influencing the immigration reform bill now before Congress. When you think about the large Silicon Valley corporations and the 0.0001% that run these firms, progressive images usually come to mind, based on public statements, writings and less frequently, charitable acts of these magnates. Think again. Under the guise of promoting a humane and yet pragmatic solution to the general immigration problem in the U.S. which has almost nothing to do with technology companies, the leaders and investors of high tech corporations are attempting to strengthen and expand an institution that benefits their corporations (and personal wealth)