iPractice recommends Quarterly IT Checkups

iPractice recommends Quarterly IT Checkups.

This is some great advice, coming from an apparently independent source (a pharma company).

While, we at Critical Systems (www.critsys.com) recommend a Managed Service contract that gives you not only routine quarterly checkups, but a partner that is always assisting with your Practice or Hospitals Technology needs, a 24x7 helpdesk response by email or phone, and strategic planning for your future technology needs.

Government Health Care data

Saw that http://www.hospitalcompare.hhs.gov is available and you can download Hospital Quality data as an Access database.

The ability to look up Physician Fee Schedules and to download the data... http://www.cms.hhs.gov/PFSLookup/

I am looking at the Medicare data and considering what are other ways this information might be helpful on the Internet, maybe by integrating geocoding and mapping, or maybe rating and comment system. Ideas and discussion are welcome.

Given all of the data available from the Government. It should be fairly straight forward to setup something like http://www.healthgrades.com

EHRs and Freedom and Motivation to Develop Good Software

David Kibbe (creator of the CCR standard) wrote a very interesting post about the recent guidelines from the government on achieving meaningful use. He discusses how the guidelines can open up the creativity of software development to hopefully when the "dust setttles" achieve better quality in our health care system.

http://www.thehealthcareblog.com/the_health_care_blog/2010/02/ehr-redux.html#more

Health Care Rising Costs, Nothing New!

Here's a pop quiz, this quote is from the first paragraph of a Technical Memorandum written by U.S. Congress in what year?

"The increase in the cost of hospital care has been a persistent and growing problem for both the Medicare program and the general public for more than 15 years. A substantial portion of the increase in hospital costs has been attributed to an increase in the use of new and existing medical technologies. * Medicare expenditures for inpatient hospital services have increased more than tenfold since its inception...the average cost of a day of hospital care increased at an annual rate of almost 18 percent, and Medicare expenditures for hospital services increased at a rate of over 19 percent. In ????, hospital costs increased by 15.5 percent, three times the rate of inflation in the economy as a whole."

Any guesses for this year or last year? That's what my guess would probably have been!

The facts about the rising cost of Health Care and specifically hospital visits could have been taken directly from a congresspersons rhetoric yesterday. The only thing that is missing is speaking about how instead of hospital services increasing at 15 or 19 percent a year, it is health insurance premiums that are increasing by that amount.

Give up? Know the answer? That is the first paragraph, of the congress technical memorandem on Diagnosis Related Groups (DRGs) back in 1983 as the Congress found that Hospitals were holding too much leverage over the increasing Health Care costs, and instituted a standards for "prospective payment system" (if you go to the hospital for x the hospital always gets paid y) so the government could better control costs. Here is the memorandum and the full paragraph...

http://govinfo.library.unt.edu/ota/Ota_4/DATA/1983/8306.PDF

"The increase in the cost of hospital care has been

a persistent and growing problem for both the

Medicare program and the general public for more

than 15 years. A substantial portion of the increase

in hospital costs has been attributed to an

increase in the use of new and existing medical

technologies. * Medicare expenditures for inpatient

hospital services have increased more than tenfold

since its inception—from about $3 billion in

1967 to more than $33 billion in 1982. From 1979

to 1982, the average cost of a day of hospital care

increased at an annual rate of almost 18 percent,

and Medicare expenditures for hospital services

increased at a rate of over 19 percent. In 1982,

hospital costs increased by 15.5 percent, three

times the rate of inflation in the economy as a

whole."

http://en.wikipedia.org/wiki/Diagnosis-related_group

http://www.cms.hhs.gov/AcuteinpatientPPS/

http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/

What turned me on to DRGs, which I had never considered (although I often consider ICD and CPT), was the credit at the bottom of the Patient Safety section of http://www.ucomparehealthcare.com/hospital to 3M for their All Patient DRG codes.

So, now my question is when will HealthVault and Google Health have things relevant to Hospitals and DRGs? A search related to that returns very little. I did find reference to RHQDAPU, required Hospital reporting metrics, which lead me to Quality Net and to CMS where they are supposed to have hospital compare data available. I hope it comes back soon, I could have a lot of fun with that if there is good information in there, and making it available on the web.

http://www.cms.hhs.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp

www.hospitalcompare.hhs.gov (didn't work 11/25/2009)

Update: It is now working and looks informative.

One thing I will leave you with, the Internet Transparency and Technology has only begun to radically change the way we think about Health Care!

A fun blog post...

Q. Who would trust Wikipedia for Medical Information?

A. Doctors

The Health Internet

This coming Health Internet is a firestorm. It is beginning to move with such intensity to choose an EMR/EHR, to define meaningful use/certification/interconnectedness, that momentum is inevitable and is already there.

The problem is that the momentum, like all memes are not fully understood when first introduced and in this world of specialization require many many intelligent influences to navigate. Here are some key technologies and standards that are fundamental to the Health Internet:

Google Health
Microsoft HealthVault
CCR/CCD
EHR/EMR
CPT
ICD-9/10
HL7 (billing transactions)
DICOM (imaging/radiology standard)
NCPDP SCRIPT (ePrescribing)
CONNECT (NHIN)
NPI (National Provider Identifier)
CCHIT (and EHR certification options)
HIPAA

In my experience, I have found the above list to be the health care technology industry terms, standards, and technologies that are fundamental to The Health Internet. As a base to these technologies are obviously the fundamental technologies of the Internet. I think if you focus on a software and technology career on the below technologies, the demand will outstrip the supply for the foreseeable future. Because we are just beginning to see the power of the Internet realized, and we have so much ahead of me.

Web Services/SOAP/WSDL/REST/XML/JSON
HTML/CSS
Javascript/AJAX
Flash/SilverLight/RIA
PDF
HTTP/TCP-IP/SSL
FTP-SSL
and yes even SMTP (even with it's security and HIPAA concerns).
Java, .NET, OpenSource Frameworks/Ruby/PHP/Python/etc.

(note: my focus on network and user interface technologies above. I find the middleware technologies that solutions are built with, such as Java, .NET, PHP, even old school Common Gateway Interface scripts, to be of less risk than the two, what I would consider, biggest and most difficult issues in software development, the user experience and the interfaces/interconnectedness between systems)

Killing Innovation and Reforming Health Care

I just read this morning, that the Health Care proposal coming out of the finance committee; contains a $40 billion dollar tax on the Medical Device industry. So, I dug in deeper. Turns out it is $4 billion dollars a year for the next 10 years, it is on all medical device manufacturers with revenues over $5 million dollars and it is to be based on "relative market share".

Some background, the medical device industry in the U.S. is just less than $100 billion; that means this is a greater than 4% tax on some of the most innovative companies in the United States. Will already having a high barrier to entry through the FDA 510k process and the device registration fees required by the FDA; is this really the smartest tax to apply to our economy--or, as David Auth, a Medical Device inventor and pioneer, states, "Our government rewards dummies and punishes geniuses".

Some references for more context and reference:
New health propsoal is industry's favorite so far. -- AP, Yahoo News
Finance Committee Proposal -- Max Baucus, Senate Finance Committee
Medical Device Pioneer David Auth Seethes Over $40 Billion Industry Tax Idea, FDA Delays

Market Size References [1] and [2] and FDA Annual Device Registration Fee Reference [3] and to even create a device for the market FDA 510k Fee [4] and don't forget the 10's and 100's and of thousands and even millions of dollars to create FDA approved products [5]

Medical Device Manufacturers Association

FMRI (Functional MRI) and Reading the Thoughts

A friend just sent me a 60 minutes video about FMRI and work at Carnegie Mellon and in Germany to use FMRI to read specific thoughts and to attempt to draw out intention. It also brings up the question of using NeuroMarketing. Notice in the interview the discussion about using a light beam to be able to read the brain activity from a distance, this is the area of BioPhotonics that I find so amazing, and what I blogged about earlier in terms of a portable MRI. I think the professor at Carnegie Mellon is correct, give it 5 years and we ("mankind") will be able to determine some complex thoughts using FMRI.