EHR & our healthcare system, match made somewhere?

EHR & our healthcare system, match made somewhere?

Electronic Health Records are a good thing, except when they are not. Being disabled, medical professionals are a major part of my life. Interactions with them, for the most part, can’t be avoided. I consider myself a geek and reasonably wise to electronic communication means. I even have a working knowledge of HIPAA and all that entails. Coming to grips with the utter lack of EHR implementation at the consumer level is difficult to deal with. One of the providers has a reasonably popular medical specific web portal. It’s not very functional, but it exists. Another group is part of the region’s largest system. My mind struggles with the concept of a total lack of confidence in modern medical communications and associated technology. Having a secure HIPAA compliant communication portal, app, or even Whatsapp, which is 100% encrypted, suitable for transferring files that can be imported into the record keeping that all facilities are mandated by law to control. As the nation nudges toward a single payer system, despite current politics, inefficiencies become sore wounds and costly. The lack of portable EHR with a common format for the secure interchange of data will come back and bite the clients who are in no position to weather the outcomes. Nobody, not even TPTB, wins in that environment.

Recently, I had a doctors appointment with my family physician. What is interesting about this event? He carried a tablet with a keyboard dock with him as he discusses with the patient. All of our conversations are transcribed and available for reference. The rest of the office only has the standard technologies; desktop computers, printers, faxes, that sort of thing. I printed out the most recent list of medications, and the staff either scanned or typed the information in their systems; couldn’t tell which, and it didn’t occur to me to ask.

As I was researching this post, there are few events in life that haven’t happened to someone else, this being no exception. As early as five years ago, this entered my view:

Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully (Tong, 2012)

If any of my interactions are any guide, these lessons were not learned nor executed. And that is a shame really. Anything close to a potential utopian solution must have the free and fair interchange of Electronic Health Records while automating as much of the nonclinical minutiae of the American Health Care system; even if it remains a continuation of the Affordable Care Act.

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What Rep. John Conyers’s sweeping single-payer health care bill would actually do

 

North America and UK current systems. Canada is a national network of province systems. 

You can’t fault the Democrats and Liberals for trying. After all, the base (which includes me) is finished with half-measures. I am among them, though I’m not quite ready to go all-in for the total government system. My preference is that everyone who is not covered by an employer or Veterans Affairs coverage is eligible for Medicare with everyone 200% or less of poverty level eligible for Medicaid. Medicare isn’t perfect, and I have some issues with it myself, but it is certainly better than the alternative. If I say, Carolinas Healthcare, it’s in my operating interest to take care of patients that are done now in the Emergency Rooms, without having to worry about them getting paid or trying to collect on folks that will probably never pay it back, due to chance or choice.

H/T Vox.com

While Republicans were trying and failing to repeal Obamacare, Democrats in Congress were quietly lining up behind a single-payer health plan that, as written, would fundamentally reshape American health care for every single person in the country.

That plan has now gained the backing of 60 percent of House Democrats, the most support a single-payer plan has ever enjoyed in Congress, and Sen. Bernie Sanders (I-VT) is planning a national campaign for a similar proposal in early September.

But by its author’s own admission, the House single-payer plan — Rep. John Conyers’s (D-MI) HR 676 — may not be ready for legislative prime-time. For instance, it contains only a skeletal outline of how to raise the trillions of dollars needed to achieve the universal, free coverage it wants to give every American.

But the bill is the sudden rage among the Democratic base and its congressional officials, aligning the party with a piece of legislation whose scope and speed would likely be unrivaled by any recent law in the Western world, according to four health care experts.

Source: What Rep. John Conyers’s sweeping single-payer health care bill would actually do

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare

I wondered out-loud in a draft version of this blog post the following:

I cannot tell if this is the career politician FDA speaking or what, and frankly, this shouldn’t be an issue with any administration, but it sure is with this one.

Upon further review, this is the type of announcement was expected and favored; and consistent with the history of the FDA Commissioner, a political appointee of POTUS45. I fully understand the temptation to speed the process up of software when it comes to medical capabilities. This process has been thought carefully, but two things stand out for me.

  1. HIPAA is the law of the land when it comes to digital medical records. This is a complicated system; that is where we are. How does this idea of a pre certification tie into these requirements? Blog posts on this subject here, here, here, and here.
  2. All of this is moot if the majority of citizens can’t access it due to not being covered under Medicare and Medicaid; the very constituency that can be best served by digital medical options in software including telehealth initiatives.

As for point #2, the rules for current Medicare reimbursement are found here (PDF) and are in my opinion, lacking. A change of mindset when it comes to payment overshadows any other aspect of our current system. In my ideal health care system, there would be Medicare for all with the private insurance market to fill gaps similar to Medicare Supplement policies of today and to “jump the line” in services for a fee. Digital medical options, such as Telehealth and Software based Medical Case Management would be included in the base Medicare and Medicaid plans.

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare [Official]

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California Single Payer Is a No-Brainer – Jacobin

California Single Payer Is a No-Brainer – Jacobin

I have written and tweeted to stories about this very subject. A non-governmental observation with distinct clarity has proven to me that the most logical solutions are not the one’s that are implemented. Oligarchic influences and “special” interests outside the moneyed class have much to lose if this proposal follows through. Never mind that some of these same entities will benefit with a guaranteed income stream of new business. There are two existing successful models for what California is trying to do. Medicare and the VA. Virtually every other industrialized country has a version of universal healthcare as a right for its citizens. Medicare has issues regarding what they will and won’t pay for, and this is not always communicated properly to medical professionals and especially patients. As a personal example, my physician writes a prescription for Ondansetron, nausea and vomiting inhibitor that actually works, and is recommended for cancer patients all the way down the sickness chain. When it was first prescribed for me, Aetna, the Medicare Rx provider in my area, would pay for it. For what has been cited as cost reasons, they decided not to pay for it without notice to me (not that they are required to tell me…). It is their system, they write and can change the rules of the game without my consent; I get that. Despite this, it’s still better than not having the option at all or having to pay full retail for this, last time I checked, around $5 a pill. Any system has flaws, but they can be fixed if the parties are so inclined. Our job is to force their inclination.

via California Single Payer Is a No-Brainer

Why data analytics, remote care and interconnectivity are prepared to transform medical care

P/C Fierce Healthcare

One of the points of emphasis on this blog and my other one is the intersection of technology, healthcare, and basic income. Both of the dominant healthcare systems in my region have telehealth facilities and programs. With them not being currently covered by Medicare, there is no opportunity to fully test them as neither system would provide me a free session, and that is their right. Therein lies the rub and large animal in the room that has not been addressed. Without Universal Healthcare and/or Single-Payer, the benefits that are touted below are useless and serves little purpose; this will backfire on the proponents of this tech and everyone will suffer, even the “haves”.

Experts say telehealth and mobile devices will push medical care from the doctor’s office to the home.

As the healthcare industry turns to video conferencing, patient-generated data and modern communication tools, medical visits of the future will look vastly different than the current approach to care.

Technology will take on a distinct role in changing the way patients receive care and how healthcare providers operate within a transformed industry. Using smartphone applications and telehealth technology, medical care in the future “will increasingly take place everywhere but the office,” two healthcare futurists — Eric Topol, director of the Scripps Translational Science Institute, and Ray Dorsey, director of the Center for Health and Technology at the University of Rochester — wrote in Fortune.

RELATED: Eric Topol: Technologies, genomics are pushing adoption of personalized medicine

The op-ed coincided with new research by Dorsey and his colleagues at the University of Rochester Medical Center that showed virtual visits were widely embraced by patients with Parkinson’s disease.

Internet-enabled connectivity will bring together a broad array of specialists and clinical consultants to offer continuous, targeted expertise for patients. Access to real-time data from wearables and mobile devices will drive clinical decisions. Instead of making an appointment, patients will text their doctor for immediate medical advice.

Hospital executives are already preparing for those changes by investing heavily in telehealth solutions and mobile innovation. Systems like Northwell Health and the University of Pittsburgh Medical Center have launched new telehealth service lines, emboldened by research that shows how electronic consults can improve access to care.

RELATED: Most healthcare executives plan to invest in telehealth — here’s why

These changes will be influenced by outside companies that will trigger a new approach to the healthcare ecosystem, Topol and Dorsey write, leading to changing labor demands, evolving clinical practice and even transforming the physical makeup of hospitals.

Plagued by burnout, physicians may be eager to adapt to a technology-inspired healthcare landscape. Sylvia Romm, a pediatrician for Online Care Group and the medical director for American Well wrote on KevinMD that the long, inconsistent hours drove her to explore telemedicine. At the HIMSS conference in February, American Well CEO Roy Schoenberg, M.D., said technology will be “the new opportunity for care delivery.”

Originally published at http://www.fiercehealthcare.com/mobile/why-data-analytics-remote-care-and-interconnectivity-prepared-to-transform-medical-care?mkt_tok=eyJpIjoiTWpFek5XRTRZbUUxTWpNeSIsInQiOiIraDlWWTlodFprNkpXUDRJWWpzeDljWGliMUE2bEpvSnZ0UWY1bG92TmF1ak5COFBDbkhrK1NFdXB5Y0dUM1NiUmtOVkVYRElMXC9OWVA0UTVmeGpXNTdkbmlvRHYzRDNxWUQxQjA5cGxJMEs3M0hiSWZ0SmxacDRlcnM4MDh0QVIifQ%253D%253D&mrkid=748656&utm_medium=nl&utm_source=internal.

Can California Achieve Universal Health Care in the Age of Trump?


Update April 27, 2017: BILL CLEARS FIRST HURDLE WITH SENATE HEALTH COMMITTEE APPROVAL!

Registered nurses and other healthcare advocates are celebrating the California Senate Health Committee’s passage this week of SB 562, the Healthy California Act, would establish an improved Medicare for all type system in California. Full details of the bill may be viewed here http://bit.ly/2ng5hUg

Lots of states have tried this without success, the most recent being Colorado (Mattie Quinn, 2016). Don’t overlook California, they just may have the answer.


The battle over the American Health Care Act has devolved into a question of whether Paul Ryan can save face by passing something out of the House that he knows can’t advance in the Senate.

Source: Can California Achieve Universal Health Care in the Age of Trump? | The Nation


Since this post is covering California’s attempt to get to Universal Health Care, another perspective is necessary to conceive the way forward. If it were easy, it would have been done. Despite universal health care being the standard throughout the world, we (the US) just has to be different, because. Universal Health Insurance /= Universal Health Care. This point cannot be emphasized enough. This article talks about various and sundry politicians with incremental views, such as the current Lt. Governor to cardinal views on Single Payer, essentially Medicare for all or the VA System.

But it could take years and billions of dollars to achieve coverage for everyone — if it happens at all.

Source: While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care | State of Health | KQED News

H/T RoseAnn DeMoro

Mattie Quinn. (2016, November 9). Single-Payer Health Care Takes a Big Hit at the Ballot. Retrieved April 12, 2017, from http://www.governing.com/topics/health-human-services/gov-colorado-single-payer-health-2016-ballot-measure.html

Medicaid expansion cuts uncompensated care costs

One would think that this is a no-brainer for healthcare providers in states such as the bloggist’s residence, but the only conclusion I can make is that the politicians in power have some other non-rational explanation for why Medicare expansion was not implemented. This article eliminates the financial part.

In states that expanded their Medicaid programs under the Affordable Care Act, uncompensated care costs are down and revenues are up compared to those that didn’t.

http://www.fiercehealthcare.com/finance/medicaid-expansion-cuts-charity-care