The US ‘Fiscal Cliff’ Might Make A Mess Of E-Health In The US. Could Be Ugly.

This appeared a few days ago.

The Fiscal Cliff and Meaningful Use: Be Very Afraid

By Joseph Goedert

NOV 16, 2012 8:11pm ET

During the congressional tax/budget debate coming very soon, someone in the Republican Party is going to demand another $20 billion or so cut from an entitlement program or another government program that is near and dear to the Democratic Party. Someone in the Republican Party will mention that boondoggle health information technology initiative in the hated stimulus bill, and someone in the Democratic Party will decide that’s where another $20 billion in savings can come from. Whatever federal funds are left to support electronic health records meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.
Don’t believe all the talk of how health I.T. has bi-partisan support. Nothing but the most sacred cows will be considered sacred in the upcoming budget battle. Since health I.T. doesn’t pass the sacred test, the spigot is in danger of running dry unless the nation’s physicians and hospitals rise up en masse and scare the hell out of their congressional representatives and senators.
Yes, AMA, you have to stop whining about ICD-10 and focus elsewhere on the real here and now. Yes, AHA, all of your hospitals are spending millions of dollars on EHRs and soon won’t be getting those rebate checks, unless you also turn them loose to fight for what they were promised. Yes, insurers and employers, if you want to have any government funding for information systems that will support bending the cost curve and moving to payment models better than fee-for-service, you also have a lot of work to do. And you all need to do it now.

More here:

http://www.healthdatamanagement.com/blogs/fiscal-cliff-electronic-health-records-meaningful-use-45265-1.html

The US ‘fiscal cliff’ is a series of taxation measures and spending cuts which have already been legislated and which begin to bite come January 1, 2013. The net effect on US GDP will be a contraction of the order of 4% of GDP next year - and given the fact US growth is only about 2% presently, this - if unchanged - may turf the US back into recession according to the non-partisan Congressional Budget Office.

There is going to have to be some serious ‘horse trading’ to avoid this cliff given the political divide we have in the US. At present the President rather has the upper hand in getting some concessions as he has a veto over any legislation that might prevent tax rises.

As the article points out there is a very large Health IT incentive program and you can bet those who want some spending cuts will want to wind that back big time.

We live in pretty interesting  times as, if the US does not sort this out - as most expect - we will also be hit down under.

I am reminded of Winston Churchill’s comment on the Americans - ‘They will always do the right thing - after having exhausted all other possibilities’ We can but just wait and watch.

David.

The Commonwealth Funds Provides A Primary Care And Health IT Report. Useful Stuff.

This report has had a lot of coverage in the last week. For example:

UK GPs top for use of EMRs

15 November 2012   Rebecca Todd

More than two thirds of UK GPs use electronic medical records and can also order tests or prescriptions online, manage patients lists or generate patient information electronically, a new survey reveals.

The 2012 Commonwealth Fund International Health Policy Survey of 8,500 primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, the United Kingdom and the United States, places the UK at the top of the table in their use of electronic records.

The report, published today, shows that more than two thirds (68%) of GPs in the UK said they have ‘multi-functional HIT capacity.’

Lots more here:

http://www.ehi.co.uk/news/primary-care/8202/uk-gps-top-for-use-of-emrs

and here:

Aussie GPs lag behind on e-record use

21st Nov 2012

Danielle Cesta

AUSTRALIA’S high rate of GPs keeping electronic patient records has declined since 2009 and Australia lags behind other countries in terms of electronic exchange of patient summaries with doctors in other practices, new research shows.

A survey by the Commonwealth Fund of 10 countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US – found progress in the use of health information technology in healthcare practices, particularly in the US.

Yet a high percentage of primary care physicians in all 10 countries reported they did not routinely receive timely information from specialists or hospitals.

Of the 500 Australian GPs surveyed, the use of electronic medical records was high but fell from 95% to 92% from 2009 to 2012 while the other nations mainly recorded increases.

Australia also had one of the lowest rates of GPs reporting they could electronically exchange patient summaries and test results with doctors outside their practice, at 27% – third last when compared to the other nine countries, with only Canada and Germany trailing.

More here:

http://www.medicalobserver.com.au/news/aussie-gps-lag-behind-on-erecord-use

Here is the link to the original report:

http://www.commonwealthfund.org/Publications/In-the-Literature/2012/Nov/Survey-of-Primary-Care-Doctors.aspx

The key part worth quoting is the summary of findings:

Key Findings

• Two-thirds (69%) of U.S. primary care physicians reported using EMRs in 2012, up from less than half (46%) in 2009. Both U.S. and Canadian doctors expanded their use of health information technology (HIT), though the two countries lag the U.K., New Zealand, and Australia in EMRs and use of HIT to perform a range of functions, like generating patient information or ordering diagnostic tests.
• In the U.S.—the only country in the survey without universal health coverage—59 percent of physicians said their patients often have trouble paying for care. Far fewer physicians in Norway (4%), the U.K. (13%), Switzerland (16%), Germany (21%), and Australia (25%) reported affordability was a concern for their patients.
• More than half (52%) of U.S. doctors said they or their staff spend too much time dealing with insurers’ restrictions on covered treatments or medications—by far the highest rate in the survey.
• In each country, only a minority of primary care doctors reported always receiving timely information from specialists to whom they have referred patients, while less than half said they always know about changes to their patients’ medications or care plans.
• U.S. physicians were the most negative about their country’s health system, with only 15 percent saying the system needs only minor change.

The full article and associated downloads are well worth a download and read. The report clearly identifies some gaps that Australian GPdom could do well to work on - as well as some areas that are going pretty well.

A part of the report I found interesting regarding GPs was the apparent drop in use of EMRs by a few per cent since the last survey in 2009 and the ongoing low level of connectivity and patient focussed services offered in Australia for patients electronically. There is a market opportunity for someone there I believe.

It is also of interest how few Australian GPs presently use secure messaging exclusively to transmit prescriptions rather than transmit the prescription and also print out a copy for the patient to present to pharmacist - to scan the barcode to download the prescription. Just a system difference I guess.

David.

It Looks To Me Like Those Operating The NEHRS Are Not Very Good At Their Job. Additionally No One Is Using It.

This very revealing article popped up today in The Australian.

More bumps in e-health road

• by: Fran Foo
• From: The Australian
• November 27, 2012 12:00AM

THE Gillard government's personally controlled e-health record system is facing more bumps in its rollout following frequent disruption to its software vendor testing environment.

In the past seven months, only five vendors have passed the requirements for their software to be connected to the live e-health production platform. There are more than 250 software vendors who need their 300-400 products certified for the PCEHR.

The PCEHR is intended to be a secure electronic summary of people's medical history that is stored and shared in a "network of connected systems".

Software used by hospitals, GPs, allied health professionals, dentists and radiologists is often custom-made and needs to be compliant with the web-based national PCEHR system.

The longer it takes to test the systems, the longer it will take to roll out the software to hospitals, GPs and others who need to use it.

Sources close to the e-health project told The Australian the test environment had been going offline two to three times a week. This included planned and unplanned outages. The Department of Health and Ageing declined to comment on the outage frequency.

However, a spokeswoman said: "Obviously the test environment exists so things can be trialled before going live in the main system. That's the normal way IT systems like this operate the world over."

As recently as last Tuesday, the test system was offline for nine hours, but the spokeswoman said the test environment was stable.

She declined to provide reasons for unplanned outages.

The test environment had been available to software vendors since April this year, she said, adding that unavailability of the test environment had no impact on the live system.

"Software vendors are not permitted to connect to the (live) production system without passing testing in the software vendor test environment," the spokeswoman said.

"The test environment has absolutely no impact on the access to or functionality of the main system -- that is, patient and doctor use of the main system is not affected at all."

She declined to say how many times the test platform had been offline since it became available.

Meanwhile, 19,617 people had registered for an e-health record, the spokeswoman said.

The full article is here:

http://www.theaustralian.com.au/australian-it/government/more-bumps-in-e-health-road/story-fn4htb9o-1226524459540

Looks like the system is unstable and no one much is using it. Worse those who have to use the test environment are being messed about.

As for clinical use this paragraph says it all.

“As of last Thursday there were 16 shared health summaries and one discharge summary uploaded into the PCEHR, the spokeswoman confirmed.”

Amusingly in a separate article we discover the geniuses who are running the program are so worried people might be alarmed about how things are being done that they have blocked the management minutes from FOI. This really shows they have something to hide! See here for article:

http://www.theaustralian.com.au/australian-it/government/department-keeps-details-secret/story-fn4htb9o-1226524460937

All in all this just seems to be going from bad to worse...At this stage it seems to be costing $20,000 per summary. The Return on Investment on all this is a bit dubious to say the least.

David.