When Doctors are Owners, Surgery Goes Up

More and more physicians are owners in surgi-centers, imaging facilities and GI labs.  Some have labeled these ownerships as the "triple dip" because the doctor collects a professional fee as well as the facility profits and the investment value.  A study by John Hollingsworth, MD, a Robert Wood Johnson Clinical Scholar,  shows this creates a potential conflict of interest.  The study showed

CEO Summit at the Governor's HIT Conference

On most Thursdays, I write about something personal. However, this week is filled with special HIT events convened by Massachusetts Governor Deval Patrick.

Today, the Governor's Healthcare IT Conference began with a panel of CEOs from Humedica, Patientkeeper, Vecna, eCW, Microsoft, Intersystems, Concordant, Biscom, Bessemer Ventures, Life Image, EMC, NaviNet, Navigator Ventures, Meditech, and T2Bio.

Here's a summary of their comments

*The uncertainty in meaningful use and standards caused a delay in sales for 6 months, followed by record sales once hospitals and eligible professionals felt confident about their purchases

*Qualified staff is getting harder to find. Over the next few years, there is likely to be a competition for trained healthcare IT professional, similar to the Dot Com era. The states can really help by adding additional resources to community colleges for staff development as we prepare for 50,000 new HIT jobs.

*Medicaid programs and private insurers can accelerate adoption of HIT by aligning incentives. For example, if states and private insurers adopted meaningful use criteria, we could reduce healthcare costs by eliminating redundant testing.

*Massachusetts CEOs emphasized the need for affordable housing and transportation investments so that staff living in lower cost areas can commute to corporate locations.

*Standards, especially a consistent way to transmit clinical data from place to place are enablers.

*Loan programs for clinicians will aid investment today to achieve meaningful use stimulus payments in the future

*Health Information Exchange is a Greatest Good for the Greatest Number activity. State Governments need to provide leadership to ensure the stakeholders in each region are aligned with a single project plan, a single set of transaction priorities, and all the enablers such as regional infrastructure to accelerate adoption of data exchange.

*Regulatory barriers such as variation in privacy laws need state and federal government action to enable data liquidity. For example, revisions in the clinical laboratory improvement act (CLIA) and e-prescribing for controlled substances are already in process.

The afternoon of the conference included a great keynote by David Blumenthal outlining everything ONC has done thus far.

All that remains in the current grant program is the announcement of Beacon Communities, which he said will occur very soon.

My Thanks to HITSP

Today I wrote this email to all HITSP members thanking them for all their service from October 2005 to the present.

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Folks:

Today is a milestone day. The HITSP Contract extension expires but our work will live on as a foundation to meaningful use, standards and certification.

It is my hope that all of us will continue to be part of the ONC processes, providing input to the Federal Advisory Committees, staffing workgroups, and implementing interoperability solutions in our communities.

The HITSP website, containing all the HITSP documents, will continue to be available. ANSI has graciously offered to maintain the website for the next few months until contracts are awarded and other arrangements are made.

The new RFPs have not yet been awarded and we'll continue to watch for those announcements.

What's new in the heatlhcare standards world this month?

The April HIT Standards Committee focused on vocabulary standards, consumer engagement and healthcare reform transactions.

NHIN Direct continued its work to define simple transport implementation guides and addressing specifications.

We'll see the revised Interim Final Rule on Standards and the Notice of Proposed Rulemaking on Meaningful Use before Summer.

A busy time for all as we implement all the standards and interoperability we've all worked so hard to define.

Thank you for all you do and I look forward to seeing you in Washington as we continue our work in a new ONC framework that leverages everything HITSP has accomplished.

John

Gene that Regulates Pain

I've often wondered about people's pain threshold and why some people seem to experience more pain than others.  New research reported in the Proc Natl Acad Sci USA, shows that a rare mutation in a gene (SNC9A) that encodes a protein in a type of sodium channel is associated with disorders of either excessive pain or insensitivity to pain.  Those with a rare allele that is found in about 10% of

The April HIT Standards Committee Meeting

The April HIT Standards Committee today had a rich agenda and very active discussion.

We began with an update from the Implementation Workgroup and their desire to make toolkits, accelerators, and best practices available via the web. They'll align their efforts with the Tools and Standards Repository RFP described in my earlier blog.

We next discussed healthcare reform and its requirements for comprehensive insurance plan enrollment standards support as written in SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

"Not later than 180 days after the date of enactment of this title, the Secretary, in consultation with the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs, as determined by the Secretary."

As David Blumenthal described it, the intent of this provision is to make signing up for insurance as easy as using an ATM card. All the supportive transactions including identity documentation, eligibility checking, and matching identity among diverse databases needs to be specified over the next 6 months. To do this, it is clear that the Policy and Standards Committees will need to work together. Doug Fridsma and ONC was charged with recommending a process, a structure, and a framework for us to do this work.

Dixie Baker and Steve Findlay updated us on consent standards and the suite of consumer focused domain standards. The industry is asking for more specificity in the patient engagement portions of meaningful use - when producing an electronic copy of a health record, what should be included? What fields are required for an outpatient summary? The HIT Standards Committee working with ONC has more work to do in this area.

Janet Corrigan and Floyd Eisenberg described the ongoing efforts by the Quality workgroup to retool existing metrics to be EHR friendly and their project to catalog existing electronic quality measures already in use.

After lunch, Jamie Ferguson outlined two recommendations of the Vocabulary Task Force. The need for a single government office or agency to coordinate vocabulary subsets/codesets and the need to make them available via "one stop shopping" in a single repository. The committee endorsed these recommendations and they were forwarded to ONC.

Arien Malec and Doug Fridsma presented an update on the NHIN Direct effort and its short timeline to produce reference implementation. NEHEN will work to connect Massachusetts with other states as a demonstration of the NHIN Direct protocols. The HIT Standards Committee agreed that we need to coordinate all the privacy/security efforts of the HIT Policy Committee, HIT Standards Committee, NHIN Connect, and NHIN Direct efforts to ensure consistency.

Finally, Jodi Daniel from ONC and Michelle Ferritto from the Drug Enforcement Administration/Office of Diversion Control presented all the requirements for e-Prescribing controlled substances. Identity proofing is key to reducing fraud, so two factor authentication is required. Audit trails are required. Certification of software is required. e-Prescribing of controlled substances is not required as part of meaningful use at this point, but it is likely clinicians will want to do it so that they have the same workflows for prescribing Lipitor (a non-controlled substance) as Valium (a controlled substance).

The work ahead for the next few months will include

Content standards - administrative transactions such as enrollment and claims attachments in support of healthcare reform

Vocabulary standards - all the subsets/codesets required for meaningful use

Transmission standards - supporting the NHIN Direct effort

Privacy/Security - continuing our work on consent standards and the specificity needed for patient engagement

All of this will be done in the context of evolving harmonization frameworks which are supported by new RFPs.

I look forward to the work ahead!

Healthy Senior Inspiration

Thanks to KM for turning me on to this inspirational 73 year old grandmother who runs marathons, trains with weights and has a passion for helping other women reach their peak conditioning also. She started at age 56 when she realized she didn't like the way she was looking in a bathing suit. She adamantly denies using performance enhancing drugs or special supplements. She does take Vitamin D

The Genomes, Environments and Traits Conference

This morning, I'll be on stage with all the humans who have had their genomes sequenced - James Watson (pictured above), Henry Louis Gates, Misha Angrist, John West, Jay Flatley, Greg Lucier, Seong-Jim Kim, Rosalynn Gill, George Church, and James Lupski.

The GET Conference 2010 marks the last chance in history to collect everyone with a personal genome sequence on the same stage to share their experiences and discuss the important ways in which personal genomes will affect all of our lives in the coming years.

From 9a-12p, we'll discuss our personal experiences with sequencing and its impact on our lives, families, medical care, and policy thinking.

At noon we'll gather for a photograph of all the sequenced humans. By 2011 the number of individuals with personal genome sequences will rise dramatically, from a dozen today to hundreds, and possibly thousands. This makes tomorrow's photograph the last opportunity to have us all together.

I'll publish the photo on my blog as soon as it is available.

A few interesting items from the conference

In April 1953, Watson and Crick published their article characterizing DNA

In April 2003 the first Human Genome sequence was completed

In April 2008 the genetic non-discrimination act (GINA) was published

The cost of a complete human sequence in 2000 was $3 billion

The cost of a sequence 2004-2007 was $70 million

The cost of sequence in 2008 was $50,000

The cost of a sequence in 2010 is $1500

This is Moore's law on steroids. No one in the industry can believe the amazing drop in sequencing costs over the past decade.

My sequence is in the public domain and my stem cells are available online for $85.00.

I'm Coriell subject 21070.

The next addition to my online public data is a functional MRI map of my brain. I completed the scans over the weekend and I'll post an overview soon.