Sunday, November 26, 2006

Version Upgrade of The Inland Empire RHIO Blog

For those few of you "addicted" to my meanderings here, I want to let you all know that the IERHIO Blog is being superceded by "Health Train Express". The link to it is . The new blog will include subject matter including RHIO Information, but will be much more diversified.

In the future specific Inland Empire RHIO information will be emailed directly to participants.
This old blog will remain published and available as an archive at this url.

Future posts will be made and "Health Train Express". Health Train Express will have a site feed by atom and rss.

This post is the last one at this url..... for further information go to

Wednesday, November 22, 2006

The Daily Scan

Each morning my RSS feeds and email newsletters bring in a wealth of information on health care, medical economics, and social public policy issues. There is a great deal of "information", some of it drivel and some of it visionary. From experience we all know that well intentioned statisticians and policy makers design and implement programs that once in place have unintended secondary effects. My opinion is the "pay for performance" lies in the later category. Recently California Healthline carried the following article,

Physician Concerns Might Delay Pay-for-Performance Measures
September 25, 2006
The health care quality reporting requirements currently under consideration by Congress are "encountering resistance from physician groups, leaving open the possibility that the issue could linger on after the election" or until 2007, NPR's "Morning Edition" reports (Rovner, "Morning Edition," NPR, 9/25).House Ways and Means Subcommittee on Health Chair Nancy Johnson (R-Conn.) on Wednesday met with physician groups to discuss a proposal that would include a 1% increase in Medicare reimbursements for all physicians in 2007, with an additional 1.5% increase later in the year for physicians who agree to report health care quality information to the federal government.Senate Finance Committee Chair Chuck Grassley (R-Iowa) on Thursday said that he and ranking member Max Baucus (D-Mont.) have neared an agreement on a proposal that would reverse a 5.1% reduction in Medicare physician reimbursements scheduled to take effect on Jan. 1, 2007 (California Healthline, 9/22). According to NPR, some physicians are concerned that:
Most proposals linking quality to compensation are based on Medicare claims data;
Physicians treating Medicare beneficiaries tend to have a sicker patient population than hospitals, nursing homes or physicians who do not see as many Medicare beneficiaries; and
Medicare payments have not kept pace with medical inflation, causing medical students to not pursue specialties with longer training periods.The NPR segment includes comments from:
Paul Ginsberg, president of the Center for Studying Health System Change;
Frederick Grover, president of the Society of Thoracic Surgeons; and
Steven Nissen, president of the American College of Cardiology ("Morning Edition," NPR, 9/25).

So as one can extrapolate a 1.5% increase is meaningless, not withstanding the increased overhead it would require to implement it in the first place.

Payors are misleading businesses and employers as to what this means.

Monday, November 20, 2006

Federal Regulations may Change re EHR

(from California Healthline)

Federal Regulations Could Increase EHR UseNovember 20, 2006
Regulations established last month to allow hospitals to donate electronic health record systems to physician practices could spark an increase in use of the technology, the AP/New York Times reports.Donated computer systems must be interoperable with other systems, and physicians are required to cover at least 15% of the system's cost. The new regulations allow for the donation of software, maintenance costs or Internet fees, but donations of hardware, other types of software or personnel to manage the systems still are prohibited, the Times reports."It's been a month since the (new regulations) were announced, and the increase in engagement has been immediate," said Sunny Sanyal, group president for clinical solutions at McKesson Provider Technologies. "Physicians weren't ready to provide a big investment. The fact a hospital can now provide it for them completely changes the picture."GE Healthcare has "already seen an uptick in unit sales this quarter," and the company attributes the increase directly to the new regulations, according to Michael Raymer, vice president and general manager for global product strategy at GE Healthcare. James Kumpel -- a health care analyst with Friedman, Billings, Ramsey & Co. -- said that it could take several quarters to work out the legal issues of hospital-physician partnerships but that the market eventually will experience a significant increase in sales.Jewson Enterprises, a research firm in Austin, has estimated that EHR sales will more than triple to $4.9 billion by 2010, the AP/Times reports (AP/New York Times, 11/19).


While this eases the pain for some physicians, it leaves out those who do not affiliate with a hospital. Remember that most health care is given in the ambulatory or outpatient setting.
First, hospital based EMRs are not designed or well suited for office based practice.
Second, it resists the issue of direct tax credits for physicians and/or providers who invest in EMR to decrease costs and improve efficiencies, to say nothing of what we are being sold in regard to pay for performance and quality measures) (Perhaps I should say "forced down our throats" I don't think anyone would actually buy that), except those in large groups who cater to the whims of managed care and "social public policy" makers.
Perhaps another small "building block" should not be discounted, and taken for what it is...some help.

Monday, November 13, 2006


It's been some time coming, however important linkages are occuring between CALRHIO and the administration of California. iHealthbeat reports today on these issues.

CALRHIO also reports it's list of HIE Vendors that have been reviewed, and their assessments. These are the result of a survey that CALRHIO sent out early in 2006.

Below are the links to the articles:

Governor's proposals

CALRHIO report from RFI 2006 re: Vendor Solutions for EHR

Friday, November 10, 2006

Post Election Doldrums

While some political pundits called the “midterm” election results a political landslide for the democrats, the actual outcome was more of a shift. Whlle the leadership changes, the grass roots have changed very little. How this will affect healthcare economics, health information technology remains moot. Some pending legislation sponsored by lame ducks such as Nancy Johnson ® Connecticut will be sidelined. Others such as Pete Stark see this as a new opportunity to construct more private opportunities based on private entrepeneurship to develop the system. Pete Stark, ever the guardian of hospital influence over physicians proposes alternative means of funding provider health IT without direct hospital contributions.

A House bill to extend the use of health IT might be unlikely to pass after its primary sponsor, Rep. Nancy Johnson (R-Conn.), lost her bid for re-election on Tuesday, Health IT Strategist reports. The bill (HR 4157) is a "big ho-hum" that "does nothing," according to ranking subcommittee member Pete Stark (D-Calif.). Stark favors government compensation that will help providers with the initial costs of IT rather than proposals that would have hospitals give money and equipment to physician practices. He also favors building a health IT infrastructure now and then developing its details later, Health IT Strategist reports."I don't think there is any strong incentive now to complete this," said Don Asmonga, director of government relations for the American Health Information Management Association. "The Democrats can now ... push a bill that potentially has more privacy provisions in it," he added (DoBias, Health IT Strategist, 11/8).

CALRHIO, The California Regional Health Information Organization is about at the end of it’s first funding cycle for meetings and assessment of where RHIOs are in California. It provided some very worthwhile structure and format for business development process. Governor Schwarzzenegger has some proposals for funding Health IT. Perhaps in the next year we will see less talk and more action.
A good source for summary information on RHIOs is at the National Health Information Network, to be found at

Friday, November 03, 2006

Halloween and RHIOs

Several nights ago we participated in the annual ritual of door to door "trick or treating".
It seemed to me there are some analogies between Halloween night and RHIOs.

We are all looking for some "treats" without being "tricked". Some of the takers would shove their whole hand enthusiastically into the candy barrel and come out with a fistful of treats, while some would gingerly pick out one. My wife cautioned me to hand them out one at a time or we would soon run out. The same can be said about enthusiasm for RHIOs. Some are enthusiastic takers, and givers, others are reticent about their choice(s). One thing was for sure, I had to go out and replenish the barrel several times.

We had just moved into a new family neighborhood, and discovered there were literally thousands of children coming to our door. Having been on the far side of the half century mark for some time, we had recently been living in the relative quiet and senior demographics of the desert. There were wonderful fairies, pumpkins, spidermen, supermen, fantastic fours, and even a few dated ninja turtles, coming to our door that evening. In the desert we were lucky if we saw one or two. The future of our country abounds in Riverside neighborhoods.

It came to me that we are not building health IT and/or RHIOs for ourselves but for our children. How critical this need is demonstrated by recent articles about outsourcing not only transcription services but actual health care delivery, such as surgery, and diagnostic testing where these services can be obtained for 10% of what it costs in the United States. A bit shameful for us.

Physicians are now faced with the annual adversarial role with CMS, and it appears, as usual that our fees will be slashed 5.7% on the average. If you do the math, this makes RHIOs and EHRs even more unlikely.

Then there is legislation pending that would mandate EMRs with funding from Congress through a variety of sources. Which is the trick, and what is the treat?

As for me, give me those little foil wrapped chocolate balls.

Friday, October 13, 2006

What are backups for?

The IERHIO Coordinator's office completed a move to Riverside from Palm Desert. During this process we experienced not only a melt down of our main computer and it's data, but also we discovered following recovering the programs that our data backup platform's interface also disintegrated. For about a week we had no access to our mailing list or our stored documents.
Fortunately the data on the hard drive was intact, and a new USB/IDE ATA interface corrected the problems. Part of our contact list however seems to be missing and we are asking you to contact me at with your pertinent email address so you can be kept current on our progress.
Our last meeting was postponed, awaiting CALRHIOs summit and also information from the Long Beach Initiative.
The email is no longer functioning.