RHIOs are syuch a great idea. We all share data which allows us to spend less per capita and have better outcomes...do you hear the koombya lyrics in the background? However, landing on Mars seems to be an easier feat than setting up a RHIO in every neighborhood.
Enter the IPA. They have strong incentives to serve as RHIOs. And, they are now rolling out EMRs which is one of the foundations of a RHIO.
I am thinking that inta-IPA RHIO's are a good way to go.
Thoughts?
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
I agree completely. Once the technology matures a little more to accomodate the next wave of adoption (the users who want Google like simplicity), you will see IPAs as the natural conduit to promote EHR among their users. I do believe this will require the cost effectiveness and improved usability of next generation web based apps and I believe the PHR (with user permission) will become central to dissemination of information between providers using the CCR at first and then moving to the more structured HL7 version of CCR (CCD). I do not believe EMR to EMR transmission of data will ever gain traction. There will be an intermediary and it will be the PHR.
We agree on something!
Disclaimer: I am the founder of e-MDs. Highest rated by doctors. All posts are opinion only
DrWinn: I agree completely. Once the technology matures a little more to accomodate the next wave of adoption (the users who want Google like simplicity), you will see IPAs as the natural conduit to promote EHR among their users. I do believe this will require the cost effectiveness and improved usability of next generation web based apps and I believe the PHR (with user permission) will become central to dissemination of information between providers using the CCR at first and then moving to the more structured HL7 version of CCR (CCD). I do not believe EMR to EMR transmission of data will ever gain traction. There will be an intermediary and it will be the PHR. We agree on something!
To quote Lowell, do I hear the kumbya lyrics in the background? Can a hearty manhug be far behind?
BTW, I also agree. Now if we can get Al to agree, we can go ahead and hoist the Mission Accomplished banner - oops sorry, bad reference. I meant Well Done!
The PHR as the intermediary...it would be an easier pill to swallow for EMR co's to write for a PHR than another EMR.
Does this mean that Google Health will become a partner of sorts for EMR co's? Will Google Health and MS Vault develop Disease Management strategies that will include their EMR partners?
Will the DM programs (and the billions of dollars associated with them) become something that IPA's take on with their Google Health partner? Or, will health plans keep the DM dollars themselves and partner with PHR companies?
Seems like we can look forward to lots of good things coming out of these partnerships. We are entering an era of chronic care management and I think we will see health plans and IPAs coming up with interesting strategies around DM.
Sharing data (RHIO) is central to DM and it would seem that an IPA who has its members on the same EMR would be in a better position to do DM than a large multistate insurer. I suspect insurers will conclude that DM is more of a local strategy and so the IPA level is the way to go.
I love speculating despite mt track record for being erroneous!
Clinical Integration is the 800lb gorilla here. A combination of EHRs, PHRs, and registries utilized by the the lionshare of an IPAs' membership is key. This will enable meaningful care collaboration within the IPA which is a key to IPAs becoming clinically integrated. This will further enable collective contracting or at least collective contracting approved by the FTC!
HTAdvocate: Clinical Integration is the 800,000,000 lb gorilla here. A combination of EHRs, PHRs, and registries utilized by the the lionshare of an IPAs' membership is key.
Clinical Integration is the 800,000,000 lb gorilla here. A combination of EHRs, PHRs, and registries utilized by the the lionshare of an IPAs' membership is key.
I hope everyone realizes there is no guarantee this will happen. My feeling is it will *NEVER* happen. Digital Medicine's roadmap is not written. A good rule of thumb will be this: if the roadmap to digital healthcare is drafted on paper, it's going to fail.
Why do you feel this way? It actually seems pretty easy to have IPA members share information if they are on the same system.
Also, the medical home concepts around care coordination would be easier to achieve if I could email a specialist within my IPA and/or see their notes.
It is a slow road. My current IPA is doing this and it has been over a year and the offices are barely up and running. Also, there are significant cost issues (T1 lines) and EMR subscription costs. Maybe IPA will see enough benefit to further offset these costs especially if they get into DM.
Lowell
DrK: The PHR as the intermediary...it would be an easier pill to swallow for EMR co's to write for a PHR than another EMR. Does this mean that Google Health will become a partner of sorts for EMR co's? Will Google Health and MS Vault develop Disease Management strategies that will include their EMR partners?
The two big PHR players will be Google and Microsoft. Microsoft seems to be focuising more on tight security while Google's approach is more shared and easy 'open' access. I suspect Microsoft will have to loosen up and Google will have too tighten it down a notch. I strongly believe that effective disease management will be a shared responsibility of the physicians's EHR and the patient's PHR. Semi-automated DM rules can be fired off to the patient, but it sometimes takes a doctor's 'reminder' to nudge the patient into compliance.
DrMurdoch: HTAdvocate: Clinical Integration is the 800,000,000 lb gorilla here. A combination of EHRs, PHRs, and registries utilized by the the lionshare of an IPAs' membership is key. I hope everyone realizes there is no guarantee this will happen. My feeling is it will *NEVER* happen. Digital Medicine's roadmap is not written. A good rule of thumb will be this: if the roadmap to digital healthcare is drafted on paper, it's going to fail.
Does this count? Already live in a number of locations.
NextGen Community Health Solution (NextGen CHS) is a central data repository that enables a user to exchange patient data securely in a community setting with other health care organizations, even those with non-NextGen electronic medical record systems. Providers and practices that otherwise share no technological connection can use NextGen CHS to import, export, and share data with labs, hospitals, and other providers, building a longitudinal patient record and streamlining workflow processes.
This innovative technology allows you to improve patient safety, quality of care, and communication among providers, while streamlining referrals and monitoring patient follow-through. You reduce risk and liability because automatic data exchange eliminates the errors that can occur when information is transferred manually or re-keyed into different systems. In addition, you reduce administrative costs and maximize reimbursement.
Using the powerful NextGen CHS, you can share data such as:
In addition, entities such as Regional Healthcare Information Organizations (RHIOs), Local Healthcare Information Organizations (LHIOs), Health Information Exchanges (HIEs), and Independent Physician Associations (IPAs) can use NextGen CHS to track referrals, patient safety, and quality initiatives, as well as perform comprehensive studies on community health issues. In addition to advancing individual health care organizations’ progress towards interoperability, this visionary application also supports national efforts to devise information exchange standards and, ultimately, a national health information network.
BTW - case studies
http://www.nextgen.com/images/pdfs/Ann%20Arbor.pdf
http://www.nextgen.com/images/pdfs/Kittitas.pdf
Enjoy!
opus313: Does this count? Already live in a number of locations. http://www.nextgen.com/pro_chs.asp NextGen Community Health Solution (NextGen CHS) is a central data repository that enables a user to exchange patient data securely in a community setting with other health care organizations, even those with non-NextGen electronic medical record systems. Providers and practices that otherwise share no technological connection can use NextGen CHS to import, export, and share data with labs, hospitals, and other providers, building a longitudinal patient record and streamlining workflow processes.
Bob - Yep I would say that counts. Just find a way to lower the cost of your software and the cost related to implementation so that the small practices that make up the majority of IPAs can afford to use it and you have a big winner on your hands. Convert that feature rich software to a true web based SaaS model while you are at it and you could do even better!
Your friend,
Joel
DrK:Why do you feel this way? It actually seems pretty easy to have IPA members share information if they are on the same system.
When everyone is on the same system many interesting things can happen. Local gains by local groups with focussed interests can really bring interesting results.
The number one barrier to digital medicine is who is going to fund initial and ongoing costs ? Electronic documentation and patient care is more time consuming and requires a different model of remuneration. I think payors benefit from electronic documentation and they should pay for the whole shebang - and I mean the whole shebang.
Breaking up remuneration of physicians into (1) management and (2) documentation might be an effective way forward. If a doc normally would receive $60 for a visit - break that up into $40 for the management, and $20 for the documenation. Now, if you document electronically your $20 will go up to $35. or you can stay at $20 on paper.
At what point is the snail's pace of progress considered a failure ? Lowell you are an optimist who liked RHIOs 4 years ago. How are they doing today ? However, they were an EPIC FAIL.
Besides fatals flaws in the roadmap such as funding and standards, I think there are serious questions of whether or not it is worth it at all ! With the inefficiencies that electronic documentation creates are we sure the returns are worth it ? Mounting evidence casts a shadow of doubt.
In the US, where healthcare is fatally flawed by private insurance, hardly should much time and effort go into EMRs. When the core is rotten, are you sure spit shining the surface is worth it ? In short, you can't digitize a healthcare system that doesn't exist.
The most significant problem is the general unaffordability of Healthcare worldwide with the US being the best example. I feel that the underpinnings of the push towards EMRs lies in two major forces (1) the idea that business has gained much from computers and medicine got "left behind" and (2) that digital medicine may be more affordable. I think medicine is more complicated than banking and digital medicine is either more or equally expensive than brick and mortar (and paper!) medicine. When it becomes more clear that digital medicine is not cheaper the massive funding required for EMRs will dry up fast.
I think most clinicians are "opting out" of EMR because there is no compelling reason for it clinically or financially. Are you sure doctors are doing that terrible currently and that the solution to making Americans healthier will come from a computer ?
HTAdvocate: opus313: Does this count? Already live in a number of locations. http://www.nextgen.com/pro_chs.asp NextGen Community Health Solution (NextGen CHS) is a central data repository that enables a user to exchange patient data securely in a community setting with other health care organizations, even those with non-NextGen electronic medical record systems. Providers and practices that otherwise share no technological connection can use NextGen CHS to import, export, and share data with labs, hospitals, and other providers, building a longitudinal patient record and streamlining workflow processes. Bob - Yep I would say that counts. Just find a way to lower the cost of your software and the cost related to implementation so that the small practices that make up the majority of IPAs can afford to use it and you have a big winner on your hands. Convert that feature rich software to a true web based SaaS model while you are at it and you could do even better! Your friend, Joel
Thanks Joel - I like the SaaS model as well and have been trying to convince some of the people around here that it might be a way to go. Of course with the acquisition of your friend and neighbor HSI, we are expanding the ways that we can deliver NG. It will be interesting to see how the market shakes out over the next couple or years.
BTW, did you see that Jonathan Bush execised a bunch of his athernahealth shares only to have to sell them immediately to pay his ex-wife the settlement on their divorce. I don't know whether to feel sorry for him, envy him that he can afford to write a check that big and move on or just be thankful that when I got divorced 26 year ago, I really didn't have anything to divide in the settlement.
http://biz.yahoo.com/bw/080604/20080604006246.html?.v=1
Hope you are well.