Welcome the second full day of HIMSS09. After yesterday’s marathon sessions and opening reception, I was a little slower in getting out of bed this morning, but still made it in time to hear George Halvorson’s keynote address. Of course, it was a two coffee morning.

The keynote started with a video of people on the streets of Chicago discussing their feelings on medical records and the access that is available for their own records. The responses ranged from hilarious to disturbing; here are two of my favorite lines:

• I’m a physician in my 50s and my goal is to make it out of practice before being required to implement an EMR. EMRs cause 4-5 months of financial turmoil and they have not shown any ROI.
• I live in a small town and they know everything about me. My medical records are available behind the desk in my doctor’s office. If I needed my records, I could just go there and grab them.

I guess we still have a long way to go.

Liz Johnson, HIMSS Vice Chair started things off with a couple of administrative tasks and a quick overview of yesterday. She then discussed the financial report for HIMSS that basically closed before the economy went south. Operating revenue increased by 7% over the past fiscal year and HIMSS is financially sound and poised to lead HIT now and in the future. That was good to hear and judging by the attendance this year, next year’s report will likely be similar.

George Halvorson, Chairman and Chief Executive Officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, did a great job in setting the stage by outlining some of the most interesting issues facing HIT today. A couple of interesting quotes/facts from his talk:

• The business model of care is based on maximizing the number of things that have fees. We have 18,000 billing codes for procedures and not one billing code for a cure. No billing codes for improved health.
• A Rand study found caregivers got care right only 50% of the time for adults and less than 50% for kids.
• How often doe diabetics get the right care? According to Rand, 8%. If we could move that to 80%, it would cut the number of kidney failures in this country in half.
• He sits on the board of the IOM and their goal is to see 90% of care based on scientific evidence by 2020. In what other industry would we set the bar so low?
• You’ve seen the commercials for new Alzheimer’s drugs and the warning to inform your physician if you are taking various medications before starting on their drug. How pathetically sad it is when we ask Alzheimer’s patients to inform their doctors of the drugs they are taking?

Kaiser seems to be ahead of the curve in their HIT implementation and I would have liked to have another 30 minutes of his talk. I am planning to pick-up his new book, Health Care Will Not Reform Itself. The proceeds from his book are going to a medical charity in Oakland.

Session: The Intersection of Healthcare Reform and Health IT

This session featured Georgia Congressman and physician Phil Gingrey and former Wyoming Governor Jim Geringer. Both men have a history and strong interest in healthcare and after some opening statements, got down to some serious Q&A.

The session opened with discussion of healthcare reform and HIT reform and how the two are required to make any serious change. “If we automate a bad system, all we will have is a really fast, bad system.” Both men seemed to be advocates for wellness and looking beyond episodic care to public health. “Prevention is the key to moving forward; prevention of illness and prevention of bad health.”

One of the most compelling questions came from an individual who outlined how federal regulations (Red Flag Rules, Stark, HIPAA, FDA Regulations, etc.) are putting a squeeze on smaller hospitals and making it harder to keep the doors open. Governor Geringer had the most interesting response, he said, “Your first obligation is to tell somone. The world is run by those who show-up.” While at first I was put off by the answer, the more I thought about it, the more I like it. He encouraged using the Obama Administration’s emphasis on transparency and accountability as a reason to expose just exactly what the federal government is doing to squeeze healthcare providers. Governor Geringer’s quote, “The government’s roll is to recognize when to get out of the way.”

In the end, both men were clearly on the side of fully integrated EMRs which brought another interesting question. Apparently, many supporters of a Michigan RIO have pulled out of the effort to develop their own EMRs and earn their slice of the stimulus package HIT pie. What can be done to address those who were working together and now are off on their own? Neither had a great answer to the question and sited the need for cooperation and interoperability, but missed the general point. Is the ARRA actually being somewhat counter-productive in regard to HIT? We will see.

As for not answering questions, Congressman Gingry had some great comments:

• If I were doing this and it was within my power, I think the adoption of a fully integrated ERM would be goal number 1.
• Patients don ‘t wan t the government standing in the exam room between them and their provider.
• I’m not sure if that answered your question, but I’ve learn politically if you don’t like the question, answer another one.

And that brought me to a big two hour, visit your favorite vendor break. I recognize why HIMSS wants this break, but I don’t particularity like it. The good news is, I had time to write the first half of this post and catch-up on some communication. Suggestion for next year’s HIMSS, more Recharging Stations!

Session: Using an EMR to Find a Needle in the Haystack: The Next Generation of Clinical Decision Support

The session was conducted by Dr. Robin Helm and  their EMR ManagerSandra Olsen who work for St. Joseph Family Medicine Residency in Northeast Wisconsin. They went live with their EMR in 2001 and completed,  feature build-out in 2004, and now are looking into ways to leverage the data that is now available in the system. “The EMR was not important unless we cold improve patient care.”

So, to improve patient care, they started by developing  a quality improvement model

• establish benchmarks
• select champions (utilizing both nursing and physicians is a key)
• set goals based on benchmarks
• write reports
• provide education to provider or patient
• create interactive programs
• apply to other disease populations

They have used this model to improve immunization rates, improve the quality of diabetes care, extend screening for led-related health issues, and many other issues. A side benefit to their system is the availability of quality metrics that can be leveraged on multiple improvement efforts and are used to benchmark physicians against their peers; blinded of course.

My sense of their system is, it is relatively basic, but quite effective. You don’t have to have the most impressive system to improve clinical quality; you just need the data in a structured and meaningful way.

Session: From Kiosks to Web: Self-service Opportunities in Healthcare

The presentation was conducted by Jeff Nieman and Ron Kelley Conifer Revenue Cycle Solutions (an off-shoot of Tenet Healthcare).

This session was one of those moments when your realize that there are people who “get it” out there. Conifer has produced kiosks for online bill payment and patient sign-in that are incredibly successful and producing real cost-savings while improving accuracy. The basic premise is, we want to have self-service and if it’s done right, it will make a big difference.

“Self service is doing exactly what you done before in a self service way.” You don’t need to create a new process for self-service, just do what you do.

In 2008, the first year of the system, they had the following results

• 19,821 patients used the self-service kiosks
• 97.3% of patients successfully signed-in
• 84% of patients did not want a printed paper copy of their forms
• on average, patients took 2.6 minutes to check-in
• 98% of patients were satisfied with the tool
• 48% of users were 55 or older
• 33% corrected their records, improving accuracy of their data

Those are solid numbers and really point to what is going on in the world today. We want automation and self-service. Go to a supermarket, the airport, a Home Depot, they all have kiosks and everyone from kids to seniors are using them. They save time, save paper, and improve accuracy.

Great quote, “If you are not online and paperless, you are missing a huge opportunity for cost savings.” Their ROI model is based on a cost of $.25 per printed page and with the reduction in paper of 80%, they are saving over $5 million annually. That’s a lot of green.

Next up, the HIMSS09 Tweetup. Looking forward to meeting all the tweeps running around here.

HIMSS09 Tweetup

The first annual (I hope) HIMSS Tweetup was a smashing success. I enjoyed meeting as many of the HIT tweeple as I could and hope to stay in touch when we get back to the real world. Kudos to Cesar (@himss) for pulling this together!

This is a very long post and if you didn’t make it to the end, I completely understand. If you did, please share your thoughts on the HIMSS09 conference.

Claiming back some of the rewards given to doctors for improving productivity could save the government Medicare program up to $201 billion over the next 10 years, a congressional analysis showed on Thursday.

The move, which could pressure healthcare providers to find new ways to improve productivity, would produce greater savings than adopting medical information technology, as advocated by President-elect Barack Obama, or capping medical lawsuit awards, as favored by some Republicans, the study showed.

The productivity option was one of 115 examined by the nonpartisan Congressional Budget Office in its 235-page “Budget Options, Volume 1: Health Care,” released on Thursday. The CBO does not offer recommendations.

Better record keeping and a move to pay-for-performance could result in increased savings. Improved productivity seems like the obvious choice, but at least we are talking about it. Could this finally be the beginning of a true Health IT push? What is interesting here from a social media perspective is what you can find on the CBO Director’s Blog:

Serious concerns exist about the efficiency of the health care system, but no simple solutions are available to reduce the level or control the growth of health care costs. Steps to restructure the insurance market and to encourage people to purchase less extensive coverage could reduce the use of treatments that provide minimal benefits, but enrollees would face higher cost sharing or tighter management of their care.

Other approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary window.

That sounds like good news for HIT and for patient safety. The “serious concerns” statement should make us all sit-up and take notice. I beileve it is time for our indusitry to recognize the need for change on a broad scale and start to work on solutions from within the industry. While I’m optimistic about Federal reform, I’m just not 100% confident that more governement intervention is really in the best intrest of our industry in the long run.

• Dr. Peter Budetti, MD, JD Chair, Department of Health Administration and Policy, University of Oklahoma Health Sciences Center
• Dr. Paul Grundy, MD, Director of Healthcare Transformation, IBM Healthcare and Life Sciences
• Mr. Len Nichols, Director, Health Policy Program, The New America Foundation

Dr. Budetti began the presentation pointing out the differences in the 1993 healthcare efforts and the present situation. For example, in 2009 the White House will have staff with more experience working with congress and there is a stronger commitment on both sides to work together. This time the major medical groups are supporting universal coverage where it was fought in 1993. Another key difference is the engagement of the end users of health reform, creating the site change.gov to solicit input on change.

Here is another example of the role of social media and online communications. The tools that help get Obama elected are not being turned to resolve issues in healthcare. Once again, healthcare institutions and providers who are not involved in the social media space are completely missing the boat.

The key message I heard from Dr. Budetti was, the government is asking for involvement from a better-educated consumer who is more engaged and prepared for change then in 1993. The result, new business opportunities are on the horizon for those who are paying attention.

Len Nicholas agreed with the general sense of Dr. Budetti’s presentation, but had more reserve in his talk. He stressed the need to focus on infrastructure for health. He also believes President-Elect Obama has recognized the importance of speaking with one voice on healthcare reform and the voice will be Tom Daschle.

Nicholas stated health information technology grants and loans will be part of the new stimulus package and the focus may be on outcomes. He indicated the most exciting news of what is happening on the Hill is a ground swell of effort to talk about medical effectiveness and spread the sharing of best practices in medicine, the expansion of the medical home, and a move away from fee for services and toward a fee for outcomes or pay for performance.

Personally, I think this type of change may be a ways in the future, but it is definitely needed. The first step has to be creating of common containers and protocols that will allow for outcomes study and measure to be established. One cannot argue the need for these types of systems when you consider the number of patients who are injured or die from bad medical information.

What did the presenters think of the prospect for economic recovery and its impact? Our economy is in uncharted water, there is a reasonable expectation of recovery by mid-2009 early-2010, but there are no guarantees. If the downturn continues, all could be out the window.

The economic recovery a component of health reform, but Nichols stated that bipartisan support and involvement might be the key to long-term change. He indicated that a lot of the Obama’s campaign rhetoric was based on cost savings that are not realistic and the realization of that fact will have an impact on the healthcare debate. As of now, he believes the Republican strategy is still unclear and evolving and will key on the activities of individuals like Senators Grassley and Gregg.

The two issues affecting bipartisan support are:

1. Building a public insurance plan to compete against private insurance. The plan could be something like Medicare which would not be supported by Republicans or more like state employee plans which would garner more bipartisan support.
2. The role of the employer in the insurer model will also elicit strong reactions from both sides of the isle.

At the end of the day, unlike 1993, there is a feeling of strong bipartisan support for health reform and the presenters believe the legislative committees will be authoring the bills. That should mean greater support from Congress.

Why will Daschle be more effective this time? He was part of the Clinton healthcare team in the 90s and profoundly impacted by the failure of that effort. Daschle saw that the failure to cooperate was the cause of the downfall and the reform effort was completely lead by one-party.

During the Q&A section of the talk came the million dollar question: Should I wait to implement an EMR until the stimulus package is announced and will there be money for me if I don’t have an EMR? This question is the core of the Obama campaign in my opinion. The question of what can government do for you? Right or wrong, what sensible business owner (a.k.a. practicing physician) would not take federal money to build or grow their practice?

The presenters responded by saying it is hard to see exactly what will happen with the stimulus package, but the package will contain very large funding amounts. Further, they indicated that government programs don’t typically award funds to existing systems preferring to help with more ground-up implementations. However, in the world of increasing competition for dollars, being able to show a successful implementation and making a case for rapid deployment and expansion may be an effective strategy. Bottom line, check-out systems that are certified and offer the best interoperability and data integration to plan for any future transitions to new systems. While you are doing your research, keep an eye on Washington for stimulus language to come out after the first of the year.

From where I sit, we live in some very interesting times in healthcare and today’s conventional wisdom could be tomorrow’s unemployment line. It’s time to start thinking differently in healthcare; start thinking about embracing technology.

Former Senate Majority Leader Tom Daschle has accepted President-elect Barack Obama’s offer to be Secretary of Health and Human Services, Democratic officials said Wednesday.

The appointment has not been announced, but these officials said the job is Daschle’s barring an unforeseen problem as Obama’s team reviews the background of the South Dakota Democrat. One area of review will include the lobbying connections of his wife, Linda Hall Daschle, who has done representation mostly on behalf of airline-related companies over the years. They spoke on condition of anonymity because they weren’t authorize to discuss the matter publicly.

What does the choice of Daschle indicate about the Obama Administration?

As Health and Human Services chief, Daschle will be responsible for helping set health care policy. He supports a government-funded insurance program for the nation’s uninsured.

Daschle has also been the head of the health care working group in the Obama transition team. Democratic officials shied away from a term some are throwing around — “health care czar” — but say Daschle “is likely to play a leading role in the passage of health care reform and the strategy to implement it.”

Other sources lay out substantial work being done by the incoming administration to enable health care reform, all of which indicates Obama does intend to move on this issue in spite of the monumental difficulties, including financial obstacles.

Get ready for some serious change in the health care industry. Goodness knows, we need it.