In their third open letter to the National Coordinator for Health IT, now identified as Dr. David Blumenthal, David Kibbe and Brian Klepper make clear something that is becoming increasingly obvious.

Health IT certificiation is the tip of the reform spear.

Their letter calls the issue “the elephant in the room,” but the issue represents in microcosm the larger problems bedeviling health reform, problems that could easily derail it.

The current system is filled with incumbents, whose interests are their own and not that of the system. This is also true in health IT where CCHIT, a group created by incumbent suppliers, is due tol certify computer gear eligible for aid under the HITECH portion of the Obama stimulus. Read More...

http://healthcare.zdnet.com/?p=2191

David Kibbe and Brian Klepper are developing a fascinating series at The Health Care Blog concerning the HITECH bill and how deep standards should be for systems which get aid.

HITECH, you will recall, is the health IT portion of the Obama stimulus, with as much as $19 billion in subsidies for those who buy certified Electronic Health Record (EHR) systems over the next five years.

In Part I they note there is, as yet, no standard definition of what an EHR must contain. It’s subject to change and thus, they suggest, only the power to create such a record should be specified.

In Part II they go deeper, describing the various layers of technology — physical, device, application, connection — and what should be done by regulators in terms of history. Read More...

http://www.nextgov.com/nextgov/ng_20090417_3515.php

Debate is growing over public access to anticipated data comparing the results of health care treatments subsidized by Medicare and Medicaid.

The records of physician claims paid by Medicare are not available currently to the public, despite court battles by consumer advocates to make the Health and Human Services Department release certain claims that are stripped of patient names. "No other vendors, besides those doing work for classified operations, have that kind of privacy," said Brian Klepper, managing principal of Florida-based market research firm Healthcare Performance.

"The health care industry has fought tooth and nail to block transparency and the public's understanding of what works, and what doesn't, and who's doing a good job, and who isn't," he said. Klepper added that the data HHS decides to publish should be understandable to the public. "People don't like to sift through endless tables," he said. "What they want to do is punch in: 'Who are the best performing doctors in my community for this procedure?' and have a list of six names come up. It needs to not be just lists."

Read More...

The Jacksonville Business Journal



by KIMBERLY MORRISON

JACKSONVILLE — Business owners say they are being crushed by the escalating price tag of their employee health plans, and are looking for relief.

Many employers have already made cuts, and aren’t putting away the scissors. About one-third of Florida employers said they plan to increase deductibles, co-payments and out-of-pocket expenses this year in an effort to mitigate rising costs, according to a recent Mercer LLC survey of 105 Florida-based employers.

But more companies are shifting strategy from the bottom line to the waistline, and finding real savings in healthy employees. Read More...

Published in the Florida Times-Union 1/19/09


by Jeremy Cox

Consumers shouldn’t expect higher reimbursement rates from health insurers for “out-of-network” care, despite an overhaul of the payment system announced last week by the New York attorney general’s office and two of the nation’s biggest insurers.

UnitedHealth Group subsidiary Ingenix settled an investigation of its reimbursement rates by agreeing to pay $50 million toward the creation of an independent nonprofit that will take over the company’s rate-setting duties. In a separate agreement with the New York attorney general, Aetna offered to seed the new organization with an additional $20 million.
Read More...

From the Providence Journal

In recent years, reformers have looked to electronic medical records as a way to streamline health care and to reduce errors. The prize was to be that most elusive of goals: lower costs. But lately, the promise has dimmed. Offices converting to such systems have found them expensive and an interruption of work flow. And technology specialists admit that the available systems may not be ready for prime time. Read More...

Dana Blankenhorn in ZDNet

Here is something you should ask your doctor next time you see them. Especially if they are about to cut you open.

Do you use a checklist? Read More...

After re-reading the post Brian Klepper and David Kibbe offered The Healthcare Blog Monday, and spending some time with my own doctor and her latest intern, the profession’s objection to their approach crystallized in my mind.

Doctors don’t want to become bus drivers.

Kibbe and Klepper want to focus on decision support, give patients control of their data, link the Web more tightly to the profession, make doctors accountable through data, simplify claims, and generally make things more collaborative. Read More...

From the Boston Globe

Specialists tell Obama current systems flawed

By Lisa Wangsness

WASHINGTON - As Barack Obama prepares to spend billions on health information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems.

In a recent open letter to the president-elect, a top technology adviser to the American Academy of Family Physicians said that current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.

Read More...