Politicians pump money into health centers

Senators Charles E. Schumer and Kirsten Gillibrand announced earlier today that they are funding healthcare projects throughout the great state of New York as part of the Capital Improvement Program (CIP). The funding will be used to build new facilities, renovate existing structures, purchase cutting-edge equipment and implement electronic health records. "This funding is just what the doctor ordered," said Schumer. The CIP grants will support the construction, repair and renovation of over 1,500 health center sites nationwide. More than 650 centers will use the funds to purchase new equipment or health information technology (HIT) systems, and nearly 400 centers will adopt or expand the use of electronic health records.

Here's a synopsis:
Western New York: $1,095,875 in American Reinvestment and Recovery Act (ARRA) funding
- $535,880 to the Community Health Center of Buffalo
- $559,995 to the Northwest Buffalo Community Health Care Center

Queens: $2,715,600 in American Reinvestment and Recovery Act (ARRA) funding
- $1,491,800 to the Floating Hospital in Long Island City
- $855,115 to the Joseph P. Addabbo Family Heath Center in Arverne
- $368,685 to the Project Samaritan Health Services, Inc. in Jamaica

Finger Lakes Region: $5,172,510 in American Reinvestment and Recovery Act (ARRA) funding
- $827,235 to Oak Orchard Community Health Center, Inc. in Brockport
- $485,690 to Finger Lakes Migrant Health Project in Penn Yan
- $1,027,840 to Westside Health Services, Inc. in Rochester
- $2,500,000 to Rochester Primary Care Network
- $331,655 to Unity Hospital of Rochester

Brooklyn: $5,530,729 in American Reinvestment and Recovery Act (ARRA) funding
- $518,695 to Brooklyn Plaza Medical Center, Inc.
- $805,374 to Brownsville Community Development Center
- $837,895 to Bedford Stuyvesant Family Health Center, Inc. will receive $837,895
- $868,765 to ODA Primary Care Health Center
- $2,500,000 to Sunset Park Health Council, Inc.

St. Lawrence County: $536,895 in American Reinvestment and Recovery Act (ARRA) funding
- $536,895 to the Cerebral Palsy Association of the North Country

Staten Island: $250,000 in American Reinvestment and Recovery Act (ARRA) funding
- $250,000 to the Beacon Christian Community Health Center

**update:
Congressman Brian Higgins (NY-27) announced that Northwest Buffalo Community Health Care Center has been awarded $559,995 in a federal grant. The funds were made available through the American Recovery and Reinvestment Act and authorized for the Department of Health and Human Services (HHS) to address health care facility and equipment needs. "Providing the best and most efficient health care starts with investing in health care facilities and equipment," said Congressman Higgins. 

That's a whole lot of money! (I'm double checking to make sure I got the figures right, but the bottom line is, a lot of money is going into this project!)

Washington Hearing on Health IT: Short Synopsis

I read a recent article in the Washington Internet Daily that provided a synopsis of a House Small Business subcommittee on regulations and health care. Witnesses asserted that the Recovery Act's provisions for adopting health IT isn't necessarily a good fit for small practices and specialists. While we disagree, I understand what the witnesses are trying to say. They are asserting that small practices and specialists need something more, but what? The witnesses (people who I don't know, or else I wouldn't keep referring to them as witnesses) urged a broad definition of meaningful use that would essential cover many providers as possible.

David Blumenthal, national health IT coordinator at the Health and Human Services Department, said his office understands "that small practices carry an extra burden." He also said HHS doesn't intend to compel other types of health care providers to adopt health IT. It isn't compelling doctors and hospitals to use health IT, just offering incentives and penalties through Medicare and Medicaid reimbursements.

But that system worries Chairwoman Kathy Dahlkemper, D- Pa. She said she fears doctors will look at the potential penalties on top of already small Medicare and Medicaid reimbursements and decide to turn away from those patients altogether. The $44.7 billion in incentive payments -- up from an original estimate of $20 billion -- should ease the way for those providers to purchase health IT systems, Blumenthal said. The regional extension centers will provide hands-on technical help in implementing the systems, he said. "It's certainly our hope those penalties will never go into effect."

To help small practices meet the start-up costs of adopting health IT, Dahlkemper introduced legislation Wednesday creating a loan program at the Small Business Administration. The SBA would back private loans of up to $350,000 for a single provider and $2 million for a group. The bill authorizes $10 billion for the program.

The committee highlighted many important points, for example, pediatrician's low adoption of EMR, 50+ definitions of "meaningful use" (state-specific), and interoperability. The article does a good job at summarizing the hearing.

Source: Leslie Cantu, Health IT Provisions Don't Address All Situations, Hearing Told, Washington Internet Daily Vol. 10 No. 121 (June 24, 2009)

Facebook's Lobbyist Once Pushed For Stricter EMR

Facebook's new lobbyist used to be one of the company's most formidable adversaries. Timothy Sparapani was the former senior legislative counsel for the American Civil Liberties Union. He used to argue that Internet companies had too much control over consumers' data! However, the self-described "privacy zealot" joined Facebook seven months ago.

Now Sparapani is responsible for shaping Washington's view of Facebook, the world's third-most-viewed website and the privacy policies that will define its business.

Sparapani has earned a reputation as a tenacious champion of consumers' privacy rights. At the ACLU, he fought against racial profiling in airport security lines and pushed for stricter rules for how patient information should be used in electronic medical records.

Let's see how this shapes social media networks!

Rising Medical Costs Are Driving Patients Overseas

*Update: I changed the title because I decided it's not really a "failure" of the medical industry, more an implication of rising costs.

I just read a great article in the Pittsburgh Post-Gazette written by Dr. Josef E. Fischer, entitled "Outsourcing Patients: the Failures of Our Health System Are Driving More and More Americans To Look For Treatment Overseas". Dr. Josef E. Fischer is the William V. McDermott Professor of Surgery at Harvard Medical School and a past chairman of the Board of Regents of the American College of Surgeons. (He knows what he's talking about)

The article emphasizes that there is one particular threat to our medical sector that demands particular attention: Medical tourism.

Mainly, [medical tourism] means surgical tourism -- patients going abroad for surgical care. Our initial response to this phenomenon, which began in earnest in 1998, was reminiscent of our response to competition in our manufacturing industries: We denigrated the upstarts. Their products were poor, outcomes unsatisfactory; there were many complications, surgeons were poorly trained, facilities were inadequate -- with dated imaging equipment and the like.

Dr. Fischer has visited overseas facilities and asserts that the clinics are first-class, and various levels of accommodation are available, from moderate to luxurious. Staffs are caring, schedules are tight, and a variety of tests can be accomplished within 24 hours, not spread over weeks as they are in the U.S. Bottom line: most foreign medical centers rival those in the United States.

What's driving thousands and thousands of people overseas?

Dr. Fischer asserts that this phenomenon may be attributable to the "inexorable increases" in U.S. health-care costs at a rate far exceeding inflation, with health insurance companies paying a smaller percentage of the medical bills and patients paying more.

Why would someone travel 10,000 miles to get medical treatment from a doctor they don't know at a hospital whose name they can't pronounce?

Dr. Fischer asserts that its all about "One-stop shopping. Fully integrated hospital medical staff. Immediate access. No technology or quality gap. Competitive prices. A focus on service."

This article is excellent. It notes the scary price gaps that exist between countries. I really never understood the gravity of the price disparity until my family-member had a dental bridge done in India. The price in India: $2,000. What was the price stateside? $15,000 - $20,000! Dr. Fischer notes the price discrepancy:

...the cost of a heart-valve replacement in the United States: $230,000. In India, the same procedure, all costs included, runs $9,500; in Thailand, $10,500; in Singapore, $13,000.

A knee replacement in the United States costs up to $58,000. In India, it's about $8,500; in Thailand, $10,000; in Singapore, $13,000.

Dr. Fischer noted that we can reduce costs of U.S health care. Of the few ways, one was tort reform. If malpractice costs were lesser, the savings would trickle down to the patient. Oh yea, and Electronic medical records! According to Dr. Fischer, EMR may help, but there has to be an emphasis on interoperability. Find the article, read the article!

Source: Dr. Josef E. Fischer, Pittsburgh Post-Gazette (Pennsylvania), Outsourcing Patients: The Failures of Our Health System Are Driving More and More Americans To Look For Treatment Overseas, Pg. B-4 (June 21, 2009 Sunday) (Available in the Two Star Edition, Editorial Section):

ONCHIT Requests Comments on "Meaningful Use"

The Office of the National Coordinator for Health Information Technology (ONC) is asking for comments on the preliminary definition of “Meaningful Use,” as presented to the HIT Policy Committee on June 16, 2009. Comments on the draft description of Meaningful Use are due by 5 pm est June 26, 2009, and should be no more than 2,000 words in length.

Electronic responses to the draft description of Meaningful Use are preferred and should be addressed to:
MeaningfulUse@hhs.gov
With the subject line “Meaningful Use”

Written comments may also be submitted to:
Office of the National Coordinator for Health Information Technology
200 Independence Ave, SW
Suite 729D
Washington, DC 20201
Attention: HIT Policy Committee Meaningful Use Comments

Public comment on the definition of "Meaningful Use"

The Office of the National Coordinator is accepting public comments until June 26 on the initial definition of "meaningful use" proposed by the HIT Policy Committee's meaningful-use work group. Remember, the definition will determine whether doctors and hospitals will be reimbursed for their use of electronic health records with regard to the stimulus package.

The goal for 2011 is to electronically capture information in coded format, report health information and use that information to track key clinical conditions. Some of the objectives are implementing drug-drug and drug-allergy checks, recording vital signs, providing patients with an electronic copy of the record, providing electronic submissions of reportable lab results to public health agencies, and complying with fair data practices, HIPAA and state laws.

Source: Agencies, Washington Internet Daily, Vol. 10 No. 116, (June 18, 2009)

Blackberry Tour 9630, It's (more) official!

I apologize for the non-healthcare IT tangent, but this is great news for Blackberry users! I follow crackberry.com, so just thought I would share the news. Also, because I'm trying to find a replacement for my Motorola Razr (which replaced my LG EnV)

Research in Motion has officially announced the BlackBerry Tour 9630. This is RIM's latest next-generation phone. The Tour is a non-touchscreen, full physical qwerty smartphone for CDMA carriers. This phone acts as a replacement for the BlackBerry 8830 World Edition, which users can agree was a hit.

Carriers: Slowly but surely to: Verizon, Sprint, Alltel, Bell, Telus and probably whoever else had the 8830.

Crackberry did a wonderful two-part review of the Tour
Part 1
Part 2

Obama to Observe Green Bay's Healthcare Model

According to a recent Washington Post article, Green Bay, Wis. is one of the best cities in the country according to numerous measures. The city has "managed to control medical spending while steadily improving health outcomes."

Peter Orszag, the Obama administration's budget chief, said, "If we could make the rest of the nation practice medicine the way that Green Bay does, we would have higher quality and significantly lower costs."

In his drive to rein in skyrocketing health-care costs, Obama is increasingly focused on wasteful medical care that does not extend life and may actually be harmful. Today's town-hall-style meeting, his first as president to promote health reform, is intended to spotlight one city's strategy for squeezing out waste without hurting quality.

What Obama is likely to hear in Green Bay is testimony to the value of digital records, physician collaboration, preventive care and transparency, say those most involved in Wisconsin's innovative approach.

"There's been a fairly steady progression of quality" in areas such as diabetes care and cancer screening, said Chris Queram, executive director of the Wisconsin Collaborative for Healthcare Quality, which publishes statewide performance measures....The federal Agency for Healthcare Research and Quality gives Wisconsin high scores on 100 measures, ranging from the treatment of heart disease to childhood asthma.

However, what's exciting the Obama administration the most? The Dartmouth Institute for Health Policy and Clinical Practice have some very interesting findings.

The New Hampshire researchers have documented and mapped wide variations in the cost and types of care given to American seniors through the Medicare program, concluding that spending more on health care has not resulted in better health.

For example, the researchers found that In the final two years of a patient's life, Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Are these differences attributed by big-city prices? According to the article, maybe. WP interviewed a Elliott Fisher, principal investigator for the Dartmouth Atlas Project, who said "but the differences that are really important are due to the differences in utilization rates." That is key, the "utilization rate". This is why the Obama administration is so interested in the study. If we are utilizing our resources at an optimal level, we are operating at an optimal level.

Click here to read the full article

Maryland Gov. O'Malley (D) Develops Health Goals

Maryland Gov. Martin O'Malley (D) has developed the following goals for his administration, which are being monitored by the newly created Governor's Delivery Unit (modeled on a concept developed by former British prime minister Tony Blair).

Health
-- End childhood hunger in Maryland by 2015.
-- Establish a first-in-the-nation comprehensive statewide private-public secure health information exchange and electronic health records by 2012.
-- Reduce infant mortality in Maryland by 10 percent by 2012.
-- Expand access to substance abuse treatment in Maryland by 25 percent by 2012

Security
-- Reduce violent crime in Maryland by 10 percent a year.
-- Reduce violent crime against women and children by 25 percent by 2012.
-- Make Maryland the leader in homeland security preparation by 2012.

Skills
-- Create or save 250,000 growth-sector jobs in Maryland by 2012.
-- Improve student achievement and skill levels in Maryland by 25 percent by 2012.
-- Improve marketable skills of Maryland's workforce by 20 percent by 2012.

Sustainability
-- Accelerate Chesapeake Bay restoration efforts, reaching "Healthy Bay Tipping Point" by 2020.
-- Increase transit ridership in Maryland by 10 percent annually.
-- Reduce per capita electricity consumption in Maryland by 15 percent by 2015.
-- Increase Maryland's renewable energy portfolio by 20 percent by 2022.
-- Reduce Maryland's greenhouse gas emissions by 25 percent by 2020.


Having goals is the only way things get done, so we applaud the Governor's ambition to improve his state. We need to find some more of these ambitious plans!

SOURCE: Gov. Martin O'Malley's office

Why should your IT company know about Security?

Why should your IT company know about Security? Because lawmakers (politicians, judges, etc.) are soon going to require some pretty strict rules about EMR and IT in the clinic.

The stimulus bill included $20 billion to promote adoption of EMR. Adopting EMR promises increased efficiency, lower costs and a reduction of preventable errors. This summer, the Secretary of Health and Human Services will define standards for EMR. Among these standards, I'm pretty sure we're going to see some strong authentication and encryption requirements. (We've been doing this for years, so we're prepared!) The question is, will tougher privacy and security records stunt the efficiency and adoption of EMR?

According to new research co-authored by Amalia Miller, University of Virginia economics assistant professor, Yes.

Ratcheting up the privacy and security of medical records means slower adoption of electronic medical records. "Reducing adoption by more than 24 percent - that's a pretty big effect," Miller said. "It's important to know those costs and have that be part of the policy decision-making process. To decide how much privacy is optimal, we need to quantify the costs and benefits, and those haven't been well quantified.

I personally think its wonderful to have more stringent requirements when it comes to privacy. However, Professor Miller is absolutely correct, we must quantify the costs and benefits of any new requirements.

The issue is, what's more important, speeding up EMR adoption or protecting the actual records? Slowing EMR has substantial costs to our healthcare institution. "How long can we wait?" is the question everyone is probably asking. We have just as much of a public policy concern with slow EMR adoption (since our healthcare insurance costs are so high) as we have with protecting those EMR records.

As long as policy makers are being reasonable in their policy making, I don't see why anyone would really complain about stringent requirements! Why? Because if the requirement is practical, competent IT companies will be able to implement the proper solution. In fact, I highly believe IT companies should ALREADY be taking safety precautions when designing an IT infrastructure. I'm waiting for the first string of these requirements to come forth. I'll keep you posted.

(I won't brag about our credentials in this blog post... maybe next time!)

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eClinicalWorks Ranks 39 in the HIC 100!

Over the years I've known Girish Navani, Mahesh Navani, and Dr. Rajesh Dharampuriya, I've learned they're a pretty smart trio. They've done a terrific job at expanding eClinicalWorks, while maintaining an excellent product with quality support. Let me be one of the first to congratulate eClinicalWorks on being ranked #39 on Healthcare Informatics annual HCI 100 list of companies by HIT revenue. eClinicalWorks ranked #39 this year, moving up from #51 in 2008.

Here is the listing:

eClinicalWorks | Westborough, MA | 508-836-2700 | http://www.eclinicalworks.com

HIT Revenue: $ 86,360,323 ('08) $ 63,900,619 ('07) $ 38,214,865 ('06)
Major Revenue: Physician practice systems

Employees: 750 Market: Private Founded: 1999

eClinicalWorks' unified EMR/PM system manages patient flow and streamlines processes regardless of practice size, specialty and number of locations. Its solutions can create community-wide records.

Company Executives: Girish Kumar Navani, CEO and Co-Founder; Mahesh Navani, Chief Operating Officer and Co-Founder