Online Servers: May not Always Be on Line

ASP solutions

In an ASP solution, both the application and the data reside on the supplier’s servers, and the practice or clinic employees use a regular web browser to access the software. In some cases, client software is installed on in-house computers, but the critical data still resides on the vendor’s computers.

The main advantage of ASPs is that IT professionals at the vendor’s office maintain the application and data. Performance, availability, scalability and stability are all critical network issues. Service providers can leverage unique IT networking expertise that can help a clinic or practice build a best-in-class next generation application. Multiple layers of firewalls and security, uninterruptible power supplies, fail-over (instant switching from one computer to another in case of a crash) and reliable backups are all standard operating procedures for these vendors – and they combine to virtually guarantee that data will always be secure and available. This is an important consideration in a HIPAA and its concerns over data security.

The biggest risk of online solutions is that they require an active Internet connection. Since no Internet connection works 100% of the time – the internal network may fail, the hosted ISP may experience an outage, or an Internet malware may cause congestion – it may not always be able to access data or applications.

Choosing who to host your Software

Client-server solutions

Most office software today is locally hosted – the program runs on an in-house computer (desk tops, notebooks or laptops) and stores the data either on a hard drive or on a network server in the premises. This offers the greatest control, since the data and the program reside on in-house servers. Further, there is the bonus that because the data is local, overall application speed tends to be higher, especially when dealing with large amounts of data.

Client-server proponents point out that EMR applications are generally quite stable and require little maintenance. There is a capacity to create scheduled backups that copy data to off-site computers fairly easily.

It does however require the practice or clinic to be responsible for upgrades, database maintenance, security, backups, and generally making sure the system works as it’s supposed to, all the time. If there is no internal IT staff and data centre, it is quite likely that a practice manager or doctor will find themselves rolling up their sleeves pretending top be IT specialists. Alternatively they will be spending quite a bit on consultants and hardware.

If the client-server route is selected, then it is more likely to pay a lump sum to buy the software outright and then a smaller monthly or annual fee for support. If the practice or clinic has multiple users, there will be need for a high-capacity server to run the application, which can mean a hardware bill of several thousand dollars, or more.

Health Insurance Perks Come to an End

“Price-fixing, bid-rigging and market allocation” have all been perks of the Health Insurance companies since 1945 when they became exempt from Anti-trust laws that held stringent guidelines for all other businesses and have been responsible for driving up costs.

Fortunately, this is about to end.  President Obama just endorsed a bill that would rid us of the “privilege” that insurance companies enjoyed for far too long.

Perhaps the money that these companies were spending “under the table” to maintain political favor can now be funneled into strategies that will keep the companies profitable while still making coverage affordable for the masses.

Seems like a “no-brainer”.  I’m glad that we have come to our senses on this one!

Health Insurers Should be Held to the same Rules as Businesses

The McCarran-Ferguson Act of 1945 gave insurance companies a free pass on monopoly restriction, leaving industry regulation up to state governments.

According to Robert Gibbs, the White House Press Secretary, removing the exemption, woulld “allow appropriate enforcement and examination of potential policies that mighyt prove uncompetitive, might stifle competition.  And we think this better promotees affordability and innovation through greater choice and less market concentration”.

Half of the states have only 2 insurers managing 70% or more of the state population so that according to an AMA report,caused  “near total collapse of competitive and dynamic health insurance markets”.  The anticompetitive predicament allows hugh premium increases with no choice but to pay it.

Although the House voted for the repeal, the Senate is reluctant to insert it into their healthcare proposal.

Holding insurance companies to the same standards and restrictions that businesses must abide by, makes sense.  Let’s not wait to see if a large healthcare bill is killed or passed.

This antitrust law can be changed to encompass insurance companies regardless of the bigger picture- and it will then paint a prettier picture as we move forward.

Healthcare Parts may be Stronger than the Whole

Now that President Obama has revealed his latest healthcare proposals for  reform, it is left out in the open for criticism and vulnerability to Republican scrutiny. (and it will get just that, undoubtedly)

Perhaps, as has been stated before, baby steps are needed before trying to accomplish a complete package of mammoth proportions.

Certain aspects of the bill are without reproach.  Everyone feels that individuals with pre-existing conditions should not  be turned away from insurance companies.  Enact that and stipulate that insurance companies may not add exorbitant fees to the premiums in order to make the coverage affordable.  Enact it separately.

Allow individuals to purchase insurance across state lines to foster competition and provide people with the best coverage for the least cost.  Enact it.

Structure a subsidy for low income families to help in purchasing their health coverage.  Enact it.

Check, check and check.  Take a look at the list- no drama, no controversy and you are more than half way home for affordable insurance coverage.

That’s not so painful, is it?

Healthcare Suggestions Entertained;Let’s Not Stop Here

President Obama revealed his healthcare plan this morning. His current plan maintains a large portion of the health reform architecture passed by Senate Democrats in December. Features remaining include a requirement for people to purchase their health insurance, government subsidies for people who cannot afford coverage and means to raise revenue to pay for the subsidies.

However, recommendations, suggestions and complaints made to the President and the White House regarding changes to the Healthcare proposals, have not gone unnoticed.

The new plan will allow individuals to shop across state lines to acquire the best coverage with the least premium cost in addition to increasing the selection pool with health insurance exchanges.

In addition, with everyone crying foul, the “Cornhusker Kickback” has been eliminated. This was the provision negotiated by the Democratic Congressman from Nebraska, Senator Ben Nelson that required the federal government to pay for Nebraska’s portion of Medicaid expansion costs. The new proposal calls for the government paying for all of their Medicaid increases for every state until 2018 and a portion after that.

Another write-in, which the White House addressed, is the delay of applying an excise tax for all “Cadillac” insurance policies, not just those held by Union members.

A solution attractive to advancement and protection of small businesses (and just makes sense) is that $40 billion in small-business tax credits would be in place to aid employers paying for insurance for their staff.

Clearly, the White House and President are committed to having a new, affordable healthcare plan in place.

Now, let’s see tort reform and we really will be headed in the right direction.

EMR System Purchase Enigma

There appears to be some excitement over an amendment to the Senate bill permitting healthcare providers practicing in hospital-owned outpatient clinics to get purchase subsidies for their electronic health records. According to the original guidelines of 2009 ARRA, some of these clinicians would not be eligible for the incentive payments.

This poses an enigma for me.  If physicians are working for a hospital-owned facility, wouldn’t the  facility be purchasing the electronic system?  If indeed this is the case, why would the physicians need subsidies to buy and adopt the system?

The downside of buying the system is obviously the expense.

The benefits of adopting the system are plentiful, not just for public gain but for the providers themselves.

Time spent researching optimal treatments for particular ailments are virtually eliminated.  When patients call after hours, the provider can access the record from anywhere to answer questions and treat the patients appropriately, documenting the actions as opposed to collecting “slips of papers” with the entries to be documented at a later time.  Escripts take mere moments and alerts with allergies and cross-reactivity with other medications pop up to help the provider instantly.

Accessing visits the patients have had with specialists and diagnostics tests that were already done would be at the provider’s fingertips.

If you have the explanation to the enigma, I would appreciate hearing from you.  Feel free to voice your opinion.

U.S. to Europe- “We are Behind You All the Way”

According to the International Health Policy Survey, polling ten thousand primary care physicians in 11 nations, the United States lags behind other countries in implementation of health information technology and  decreasing the overall access to care.

The decline in IT and primary physicians is directly lowering the quality of healthcare here.

Only 46% of U.S. physicians use electronic medical records in cointrast to 97% of doctors in New Zealand and Norway.  However, these statistics are greatly increased from last year so it is apparent that we are slowly moving in the right direction.  European governments have strong supportive policies for HIT.

Though medical costs are dramatically higher than costs in most other countries, we are the most expensive country which reflects a situation whereupon we are not getting increased value for our money spent.

Most European countries provide a larger percentage of doctors with financial incentives for providing preventive care services or implementing HIT.

While we are first beginning to offer incentives for healthcare providers in establishing an IT system and intercommunication, interfacing of different systems has still been a problem.

However, we are most assuredly heading in the right direction.  What do you think?

Medicare Cutbacks are Going to Cut Back Physicians

As part of ARRA and Healthcare Reform, physicians have been promised an increase of 1-2% increases in Medicare and Medicaid payments to defray the cost of purchasing and implementing electronic medical systems at their office   or health facility until $44,000 has been covered over a five year period.

What most people are totally unaware of is that Physicians Face 21.5% Medicare Payment Cuts starting on  March 1. If Congress does not fix this issue, the decrease which was originally set for January 1 takes effect on March 1.

If you think that you are not affected as a non-participating Medicare physician, think again.  Private insurers often  adjust their  rates to mimic those on the Medicare schedule.

The issue affects the 30,000 ob-gyns who participate in Medicare.

Governmental actions such as these reflect the problems that a government takeover of healthcare represents.  It also highly suggests that despite living in a capitalistic society, the government is trying to do away with private practice which limits the type of healthcare options that the public will face.

If the government is sincere about wanting paperless healthcare, then enticements to doctors must be real support and not a giving with one hand and taking away (massively) with the other.