Money available for EMR Training– Come Get Yours

With escalating costs and  decreased reimbursements, it will be hard enough to come up with funds for electronic record implementation, let alone training for it.

The government thinks so too. In August, the U.S. Department of Health and Human Services publicized that it was making $1.2 billion available to create regional health information technology centers. These centers are to support physicians and healthcare providers implement new systems.

Unfortunately, there are not enough experts in health IT to man the centers yet. This will change as Medsphere initiated its free Medsphere University this past March once demand for Open Vista became popular.

NITHealth is taking up the challenge as well. They have applied for a $4.5 million grant from the U.S. Department of Labor for training centers where healthcare providers can come to take federally funded courses.

Lior Blik, the CEO of NITHealth and chief information officer of N.J. University Medical Center, stated that “I don’t think that doctors should have to pay [for training]. I think the government should pay for it, since they are making it a requirement.”

I am sure that physicians feel the same way.

EMRs- Increased Risk or decreased Liability?

One of the many aims of EMR implementation is to decrease the liability. However, because usage is still at such a low percentage yet, medical liability insurers have no proof that it in fact cuts down on risk.

Many insurance carriers feel there are not enough practices using EMRs yet to measure how effective the systems are at decreasing liability.

Worry now is that in fact physicians will be open to even more risk because of all that is entered into the record.

No EMR discount has been offered by PRA yet.

The medical liability insurance company, Professional Risk Associates sponsored a survey in 2007 to make a case for decreasing premiums for providers that implement EMRs into their practice. It found that 45% of the 115 practices surveyed believed that EMRs made them less vulnerable and 20% received discounts.

The market manager for Professional Risk Associates, Jennifer Jones, stated, “We feel there are a lot of benefits to EMR adoption but there are many downsides too.” 20% had liability cases where EMRs were used for documentation and 55% of those felt that the EMR was helpful.

While CMIC, an insurance company in Connecticut and Massachusetts is not sure whether risk is decreased; it is decreasing the premium rates for those using EMRs to increase implementation rates for healthcare providers. Susan Sperzel, director of claims operations and loss prevention confirmed that the company provides a 5% discount for each physician in practices that are using EMR certified systems for a year.

The downside is found in the alerts that EMR generates or additional information that a physician may not act upon. Former chair of the medical malpractice section of DRI, an organization for defense attorneys, Bruce Cranner points out that EMR default settings may not allow physicians to add information to medical records that could be essential to defense at a later date.

Other members of the legal team fear that too much information entered into the program may increase risk.

Most agree however that EMRs will ultimately lower malpractice cases. Dr. Troxel of the Doctors Company, a physician-owned liability insurance carrier stresses “Every insurance company bases premiums on their loss experience, so fewer cases filed mean lower premiums for doctors”.

Dangling Carrots are Healthy Too

Bribes have often been used to modify behavior. Pavlov proved that with his scientific experiments. The question now is whether bribes will modify behavior toward maintaining or obtaining wellness and by eliminating bad habits.

We will soon know the answer since the Senate has passed a provision in the new health bill called the Safeway amendment, allowing employers to design health insurance wellness programs. Provisions will offer $200 million in grants and provides for wellness incentives to be added to individual insurance exchanges in 10 states or more by 2014.

By meeting targets set by healthcare providers, employees will be eligible for incentives of 30 to 50 percent rebates in insurance costs as well as free benefits like gym or Weight Watchers memberships. If the target is not met, penalties will come in the form of higher insurance premiums and copays.

Targets will take the form of maintaining regular exercise programs, weight loss, smoking cessation and regular annual physical examinations or preventive care appointments.

The Safeway amendment has been favorable to both Democratic and Republican parties, uniting incongruent groups like the Humana insurance company and Third Way, a progressive think tank. David Kendall, from the Third Way voiced support because it concentrates on transitioning health care toward results and preventive care, empowering employees to take a more active role in self-care.

This addresses todays biggest problems- obesity and getting patients to exercise and maintain a proper diet. Two-thirds of people in the U.S. are overweight. Obesity accounts for 10% of current healthcare costs in the United States with high blood pressure, two and a half times the incidence of heart disease and 20 times the incidence of diabetes, which contributes, to rising costs.

Cleveland Clinic has already put an incentive program into practice as has General Electric and FedEx with North Carolina designing a program for public employees.

Already Cleveland Clinic has appreciated measurable benefit to its program as witnessed by 112,000 pounds lost in the first nine months by 40,000 employees enrolled in the Healthy Choice Rebate Program. Incentives include rebates of $217 a year with a promise to keep the premiums the same each year.

So before you take a bite of that jelly donut, think twice. Staying on track really will be putting your money where your mouth is.

EMR Curriculum now Available to help purchase Decisions

With over 200 approved electronic medical record vendors vying for your business and more appearing every day, the process of selecting the most appropriate one for your practice as well as implementing it, can be a very daunting process. After all, healthcare providers are educated in medicine, not information technology.

Fortunately, there are now many avenues you can take to help with the difficult decision in choosing the right one for you.

Now, there are various organizations that have formulated EMR programs to educate healthcare providers, providing the information needed to purchase and install the systems. Programs are available from both vendors and independent companies.

OpenVista, which is the free, open-source system based on the EMR instituted by the U.S. Dept. of Veterans Affairs, has a commercial provider, Medsphere.

Medsphere offers EMR education courses. The chief medical officer and executive vice president of products for Medsphere, admits, “ when you have 15% of practices and under 5% of hospitals that are fully adopted, you don’t have a lot of people who know how to do this”. “ You have to have people on site and in the field that know how to use and deploy and make EMRs work”. So clearly there is an educational need.

Another group to recognize the need is Network Infrastructure Technologies Health. Based in New York, the company has been providing free, practice-specific classroom didactic work to train providers who not only get the training but also CME credits.

CEO of NITHealth, Lior Blik feels that the program has a dual purpose: provide healthcare providers and medical institutions with the information they need to make wise decisions and also to train those who may go on to meet the recruitment demands for health IT jobs. They are currently developing an online program as well.

Starting 2010, many community colleges will also be adding health IT programs to their curriculum.

The Borough of Manhattan Community College will be offering classes designed by NITHealth,beginning  January 2010. The program involves 4 lab sessions, 16 classes and costs approximately $3,000.

For those who cannot take the time away from their practice, there are online courses as well.

Train for Compliance, located in Bellevue, Washington sells several curriculums and certification programs which include basic health IT and HIPAA compliance. Depending on the program that is tailored for you, the cost ranges from $95 for an individual course to $1500 for a 10-course package.

There are few things worse than spending a tremendous amount of money for electronic programs, only to let them sit fallow for lack of understanding how to use them.

Taking the mystery out of the available programs will hopefully make implementing the programs less painful and remove the decision stress.

All Those Willing to Accept Society’s Burdens with Headache and Little Compensation– Please Step Forward

While debate swirls around the Senate regarding insurance for the American population, few are looking at who the providers for the insurance coverage will be.

According to the Association of American Medical Colleges in their October 2008 article “The Complexities of Physician Supply and Demand: Projections through 2025”, there will be a physician shortage of approximately 124,000 physicians by 2025 in the United States.

The American Academy of Medical Colleges projects a shortfall of 71,000 physicians by 2025 by efforts to boost medical school enrollment.

In addition to these sad figures, a glaring fact (published in JAMA 2008; 300(10): 1154-1164) is that only 2% of medical school enrollees plan to enter general internal medicine, which comprises the main care-giving specialty. This will create even greater demand and shortfalls in finding the physician to treat you.

So, who will be providing your healthcare?

According to the American Academy of Family Physicians, the number of physician assistant graduates will drop 25% by 2020 and the nurse practitioner graduate number will decline 4.5% each year.

The situation begs the question, why?

Certainly the reason is not due to a failing economy. Poor employment crises in the past led to increased enrollment in medical school. After all, becoming a physician was thought to ensure continued employment and financial security.

Could it be the scenario that is currently being played out?

One where every day, a new burden and obstacle is placed before the physician who is then asked to foot the bill himself?

In a capitalistic society where people are paid for their efforts and more innovation and effort is put forth for compensation, physicians are being asked to reduce fees, accept less reimbursement for more work and more headache. It is presumed that because there is a healthcare crisis and healthcare is a right of a people, those healthcare providers should naturally, being nurturers, want to step forward and take up the burden.

The greatest minds our youth provide are being diverted into business, not medicine for some very obvious if not lucrative reasons.

If this problem is not addressed, healthcare insurance or lack of it will be the least of our healthcare problems!

Holiday wishes for happiness and health

The following holiday wishes are brought to you care of Claudia Tessier, an active participant  in mhealth initiatives.

Twas the year before mHealth, when all through healthcare’s house,Little patient information was stirring, not even with a Mouse.

The hopes for EMRs were hung by the ONC office with care,In hopes that Congressional mandates soon would be there.

The IT folks were nestled all snug at their desks,While visions of interoperability danced in their heads.

And CEOs in their offices and docs in their pads Had just settled their brains for long Congressional naps.

When out in the ether there arose such a clatter, IT folks sprang to the desks to see what was the matter.

Their Windows they flew open with a flash, And tore open their email and eNewsletters with a dash.

The growing lists of EMR blows Gave luster to each new mHealth glow.

When, what to their wondering eyes should appear, But an mDevice carrier and eight thousand apps so clear.

With this little wireless carrier, so lively and quick, They knew in a moment it must be mHealth’s pick.

More rapid than EMR connections, wirelessly they came.

The mDevices and mApps whistled and shouted, and they called out each name.

Now, iPhone! Now myPhone! Now AT&T and GPS! On Wi-fi. On 3G! On T-Mobile and SMS!

To the top of eCommerce! To the top of eHealth!

Now dash away, dash away, dash away all!

As EMRs’ hopes of interoperability fly by, When users meet with these obstacles, they turn to mHealth in the sky.

So up to the eHealth-top the mConnections they flew, With the wireless sleigh full of mDevices and mApps too!

And then in a twinkling, they heard on the blog The prancing and dancing of each new mSound.

As IT folks drew in their breath and were all agog Down the eHighway mHealth came with a bound

He was dressed all with ease, from portrait to landscape, His reputation untarnished from slander and lies all moot.

A bundle of apps he had flung in his sack,And he looked like a peddler, just opening his pack.

His screen how it twinkled! His networks so merry!

His apps were like roses, each key like a berry.

His droll little package was drawn up with a bow, And the case he was in was as white as the snow.

The stem of a stylus he held tight in his teeth, And its strokes encircled his head like a wreath.

He had broad wireless coverage and a little round belly, Filled with apps that shook when he laughed, like a bowlful of jelly.

He was chubby and plump, a right jolly old self, And they laughed when they saw him in spite of themselves!

A wink of his iDisk and a twist of his settings, it’s said,  Soon gave all to know they had nothing to dread.

He spoke not a word but went straight to his work And connected all parties, then turned with a jerk.

And laying his thumb aside of his nose,And giving a nod, up the wireless highway he rose.

He sprang to his carrier, to his team gave a whistle,And away they all flew like the down of a thistle.

But I heard him exclaim, ‘ere he drove out of sight, Happy mHealth to all and to all a good wireless byte.”

Who can eat?

My friends cajoled me into seeing the midnight buffet.

After getting up early , exercising and running around all day, the only thing that I wanted to see was the back of my eyelids.

I must admit, I had a morbid curiosity to see the buffet-not for the food layout which was sumptuous, but for the throngs of grazers  that would be making their way to  the mounds of delectibles.

The question I asked at this hour was “Who can eat?”  Apparently, there are “loads”.

If patience is a virtue, this is the most virtuous woman on earth

There are many cliches that can be applied to this woman.

  • Everything comes to those that wait
  • Will wins out
  • Follow your passion and your riches will follow

The amazing thing is not that it took more than half of her life to be recognized.  Rather, that she is being recognized at all which is something that was unexpected for her.

Carmen Herrera is a minimalist abstract painter- before most people knew what minimalism in art was.

She painted for sixty years.  No one bought a single painting.  Although she had one or two shows in her early life, it and she went unnoticed.  She did not receive recognition as a painter, nor did she pursue it or crave it.  If you asked her what her career or passion was she would reply that she was an artist, a painter- even if that was for herself.  Just as a writer is one that writes, because one has to, because it is part of that individual’s make-up.

Yet, despite Carmen’s private and insular habits, Ms. Herrera has been “discovered”.  At the age of 94! The Observer of London called Ms. Herrera the discovery of the decade.

Persistence wills out!

The sale of Ms. Herrera’s first painting was at the age of 89 and at 94, she received a lifetime achievement award from the Walker Art Center in Minneapolis. Art collectors are now clamoring for her works and they fetch handsome prices in the 6 and 7 figure range.

Carmen’s paintings now hang in the great art museums of the world like The Tate in London and MOMA (Museum of Modern Art) in New York.

She didn’t get off to a running start, and she may not have known where she was going in life, but clearly, she has arrived!

Happy Holiday

Currently I am on a cruise ship in the Carribean with people from all over the world.  It is very special during holiday season.  With all the diversity of ethnic and religious backgrounds, we all share common bonds.  Everyone is joyous.  The Christmas tree is decorated and the menorah is lit. 

May we all take this courtesy and a joyous feeling with us into the next year.

Happy and Healthy Holidays to all

Is Obamacare un-Constitutional?

This interesting question and the following was written by John Chandler, director at

A reporter recently asked House Speaker Nancy Pelosi (D–CA) where in the Constitution Congress is given the authority to force Americans to buy health insurance, she responded, “Are you serious? Are you serious?” Responding to a follow-up question to this non-answer, Pelosi’s press secretary said, “That is not a serious question.” (she didn’t answer because she and ALL of Congress knows that it is NOT Constitutional)

We think otherwise at The Heritage Foundation. So should all Americans who value the liberties which our Constitution protects.

And once the mandate question is thoroughly examined through the lens of the Constitution’s original meaning, the answer is inescapable: it is not constitutional.

“For those with a traditional understanding of the Constitution as a charter of liberty (as opposed to the ‘living version’), the list of Congress’ powers in Article I, Section 8, grants it no authority to require any such thing, “writes Heritage expert Bob Moffit. To defend their unprecedented expansion of federal power, Obamacare’s proponents rely upon excessively broad interpretations of Congress’ powers — namely the powers to regulate interstate commerce and impose taxes.

Commerce and taxing power don’t support mandate

In a recent legal memorandum, Heritage legal scholar Todd Gaziano, joined by Georgetown law professor Randy Barnett and Nathaniel Stewart, LLP, argues that the individual mandate is both unconstitutional and unprecedented.

Neither the power to regulate commerce nor the power to impose taxes grants Congress the power, they write, to “mandate that an individual enter into a contract with a private party or purchase a good or service and…no decision or present doctrine of the Supreme Court justifies such a claim of power.”
Though many on the Left overlooked it, the nonpartisan Congressional Research Service even recognized the constitutional obstacles to the individual mandate:

Whether such [an individual mandate] requirement would be constitutional under the Commerce Clause is perhaps the most challenging question posed by such a proposal, as it is a novel issue whether Congress may use this clause to require an individual to purchase a good or a service.

The Supreme Court has long held that there are limits to Congress’ power under the Commerce Clause. An individual mandate would require stretching these limits. Although this has been done in the past, “the current Supreme Court is unlikely to stretch the commerce power further than it already has,” explain Gaziano, Barnett and Stewart.
Congress’ power to “lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and general Welfare of the United States….” also does not validate an individual mandate. The Constitution requires that a tax be apportioned on the basis of the census population, and not vary based upon factors such as the financial condition of the state’s residents. “[But] this [constitutional] requirement will be impossible to meet based upon the variety of exceptions provided in the mandate,” write Gaziano, Barnett and Stewart.
Interpreting the Constitution to support an individual mandate would open the door for future abuses, as Heritage’s Conn Carroll explains:
If the individual mandate is Constitutional, then Congress could do anything. They could: require us to buy a new Chevy Impala each year to support the government-supported auto industry; require us to buy war bonds to pay for the Iraq and Afghan wars; require us to grow wheat (10 bushels each), or pay someone else to grow your share; require us to buy whatever they want.