By John Ballard
Reader advisory: This post is too dry for the average reader. If you find wonky details boring you might want to move to whatever is next on your reading list.
There are two parts. Part One is a progress report on how Massachusetts is coming along with what is being called "meaningful use" of EHR (electronic health records). And Part Two looks at rational thinking from a scientific point of view, as seen through the lens of researchers who study and evaluate the subject rather than rattling off editorial opinions.
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Readers of Newshoggers tend to be more interested in politics and policy than science, so here are a couple of hooks to get your attention. Without going to the trouble of finding links, I'm sure the following memes about health care reform will need no elaboration.
- We don't need government getting into our private business
- Information about my health is between me and my doctor
- Rationing is no way to handle medical care
- Competition leads to lower costs. That's the advantage of free enterprise..
- Centralizing information is another step toward socialized medicine.
I could go on, but you get the idea. One of the first indications that fear-mongering was to be a weapon of choice for opponents of reform followed a widely-distributed hit-piece (mainly via viral emails) from the Wall Street Journal in February.
Republican Senators are questioning whether President Barack Obama�s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.
Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.
Senators should read these provisions and vote against them because they are dangerous to your health.....
The bill�s health rules will affect �every individual in the United States�.... Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.
But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and �guide� your doctor�s decisions....
And so on...
(Here are links to my old blog with further information for anyone interested.)
By now we have all had multiple doses of this kind of crap thanks to the signs and screams from teabaggers and town hall temper tantrums. No need to elaborate.
Okay, then, here is actually what's under way in Massachusetts, thanks in part to the stimulus bill. I like to imagine that similar programs are under way in other parts of the country, but because I am one of Dr. Halamka's readers this is the one I can report about. I'm stealing his post in toto, hoping he won't mind.
I've previously described the Beth Israel Deaconess Physician Organization's (BIDPO) decision to create a community registry for quality data warehousing in support of meaningful use.
As the project has progressed, we've made several decisions that I'd like to share.
What quality indicators will we store?
We've inventoried all the pay for performance reporting requirements of our local payers and crosswalked it with the 17 quality metrics required for meaningful use, as documented on the new HHS Blog.
In summary, the measures will include treatment process and outcomes data for:
- Acute Bronchitis
- Adverse drug events
- Asthma
- Cancer Screening
- Cardiovascular Conditions
- Depression
- Diabetes
- HIV
- Hypertension
- Immunizations
- Lead Screening
- Medical Home
- Pediatrics
- Pharyngitis
- Reproductive Health
- Substance Abuse
- Surgery Patients
- Tobacco
- URI
- Vital Signs
You'll find the details in this presentation.
Other decisions we've made include:
1. All our data content transfers from eClinicalWorks and our home built EHR will be done using the HITSP C32 implementation guide of CCD.
2. Transport will be done using the HITSP Service Collaboration 112, specifically using TLS with certificate exchange. We will use the NEHEN network (diagramed above) for routing from our EHR hosting site to the quality data center.
3. To protect confidentiality we will pseudonymise the data, separating identifiers from the data itself. BIDPO will be able to re-identify data for queries such as assembling quality measures from different data sources, but a breach of the registry itself will not release any patient identified information.
This project will enable us to implement and refine many of the standards recommended by HITSP and the HIT Standards Committee. I will continue to report experiences from our implementation efforts which I hope will be used to enhance the standards implementation guides.
I skipped a couple of links from the original, but the point of this post is simple: as I have said before and repeat here, health care reform is already under way and the right people are pursuing the right goals with due diligence and workmanlike results. I, for one, am very impressed and receive this progress report as very good news on a Monday morning when much of the world seems to be imploding.
Before I go to Part Two, this snip from the government blog (HHS has a blog. Who knew?) is too good to miss.
What is a standard?A standard (per the definition of the Healthcare Information Technology Standards Panel) specifies a well-defined approach that supports a business process and:
(1) has been agreed upon by a group of experts;
(2) has been publicly vetted;
(3) provides rules, guidelines, or characteristics;
(4) helps to ensure that materials, products, processes, and services are fit for their intended purpose;
(5) is available in an accessible format; and
(6) is subject to an ongoing review and revision process.Mature standards are those with running implementations in diverse environments.
HITSC is charged with recommending standards, certification criteria, and implementation guidance, that will help accelerate interoperability in the context of the policy goals recommended by the HIT Policy Committee for the meaningful use of EHR systems. All stakeholders are represented � consumers, government, industry, payers, providers, and employers. HITSC has 4 working groups � Privacy and Security which focuses on technical security and data integrity; Clinical Quality which focuses on metrics that measure quality; Clinical Operations which focuses on the content and vocabulary standards that enable data exchange between organizations for quality measurement, clinical care, population health, and patient engagement; and Implementation which identifies and mitigates barriers to interoperability.
This does not strike me as a sinister attempt on the part of Big Brother to do anything with health care other than clean up and organize a database of information from which to derive better outcomes, without, of course, superfluous tests and procedures which not only add nothing to better outcomes but may very well cost more and even be harmful.
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(Sorry. Part Two will have to wait. I got called to an overnight assignment and will have to finish later.)
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