Interview: Blumenthal talks meaningful use

July 13, 2010,  By Matthew Holt

Absolutely hot off the recorder, here’s my interview with David Blumenthal, the Obama administration’s National Coordinator for Health IT.

Listen to recording HERE

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HEALTHBEAT: From Texting To Two-way Feedback, Testing Cell Phones As Tool To Fight Disease

(AP)  WASHINGTON (AP) – “What if my blood sugar’s too high today? Is it time for my blood pressure pill? With nagging text messages or more customized two-way interactions, researchers are trying to harness the power of cell phones to help fight chronic diseases. "I call it medical minutes," says Dr. Richard Katz of George Washington University Hospital in the nation’s capital. He’s testing whether inner-city diabetics, an especially hard-to-treat population, might better control their blood sugar – and thus save Medicaid dollars – by tracking their disease using Internet-connected cell phones, provided with reduced monthly rates as long as they regularly comply.

Consider Tyrone Harvey, 43, who learned he had diabetes seven years ago only after getting so sick he was hospitalized for a week, and who has struggled to lower his blood sugar ever since. In May, through a study Katz began with nearby Howard University Hospital’s diabetes clinic, Harvey received a Web-based personal health record that he clicks onto using his cell phone, to record his daily blood sugar measurements. If Harvey enters a reading higher or lower than preset danger thresholds, a text message automatically pings a warning, telling him what to do. And at checkups, doctors will use the personal health record, created by Indiana-based NoMoreClipboard.com, to track all his fluctuations and decide what next steps to advise….

….The trend is called mobile health or, to use tech-speak, mHealth. If you’re a savvy smartphone user, you’ve probably seen lots of apps that claim to help your health or fitness goals – using your phone like a pedometer or an alarm clock to signal when it’s time to take your medicine.

Katz and other researchers are going a step further, scientifically testing whether more personalized cell phone-based programs can link patients’ own care with their doctors’ disease-management efforts in ways that might provide lasting health improvement.”

Read full article HERE

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“Patients with diabetes or hypertension or both who communicated with their doctors via e-mail got better care and better health outcomes, new California research contends.The improvements as a result of the e-mail exchanges included such measures as blood sugar and blood pressure control, according to a report appearing in Health Affairs.

The American Recovery and Reinvestment Act of 2009 has called for implementing “secure patient-physician messaging” as part of electronic health records by 2013.

Kaiser Permanente health system started phasing in secure e-mail communication nationwide in 2004. In southern California, some three million patients as well as all primary and specialty care Kaiser doctors signed up for it and, by the end of 2008, 35,423 adult patients (7.8% of members in that geographical area) and 3,092 primary care physicians had actually used it. The study authors, from Kaiser Permanente, analyzed 630,807 e-mail messages between patients and doctors from March 2006 to December 2008, then compared them to baseline data from the previous year. The vast majority of the e-mails (85%) were initiated by the patients.

Those who emailed their doctors saw improvements of 2.4% to 6.5% in blood sugar control and screening, cholesterol screening and control as well as screening for retinopathy and nephropathy (kidney disease). Also, more patients with diabetes or hypertension alone achieved blood pressure levels under 140/90. And the more frequently emails were exchanged, the greater the improvements.

According to prior studies, patients most often e-mailed to report some kind of change in their condition, to talk about lab results and to discuss medication issues.

Patients also tended to respect the doctor’s time, with three-quarters sending messages on actual medical issues as opposed to “their mother’s favorite meatloaf recipe,” said Terhilda Garrido, vice president for health information technology transformation and analytics at Kaiser Permanente and senior author of the study. “It sounds a little cliche. .. but the hypothesis (about why this works) is that putting the information in the patient’s hands makes them feel empowered and, therefore, in control of their condition,” Garrido added.”

Read article HERE

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The U.S. Centers for Medicare and Medicaid Services will officially post several proposed new additions to Medicare’s coverage of telehealth services in the Federal Register on July 13.  These additions were proposed by ATA and a number of other entities last December. While not all of ATA’s requests were approved in their entirety the proposed changes represent a significant victory for telemedicine and for patients. This is another clear sign that the use of remote health services has entered the mainstream.  

The changes address remote clinical services and patient education and intervention. They do not cover remote monitoring, except for prescribed cardiac monitoring.  Several of the proposed changes require that patients must first be diagnosed and treated in-person before subsequently being seen by a physician via telehealth. 
 The following new coverage areas for telehealth services are proposed to take effect on January 1, 2011:
 

• Subsequent nursing facility care services using CPT codes 99307-99310:  CMS is proposing coverage for these codes, with the limitation on the patient’s admitting practitioner of one telehealth visit every 30 days. However, these are in addition to the minimum number of physician visits for skilled nursing home patients that are mandated by federal rules. Although not all of the additions requested by ATA were adopted, this is an important new coverage that can greatly benefit high acuity, complex patients requiring multiple on-going physician consultations.

• Subsequent hospital care services provided after initial treatment and admission, using CPT codes 99231 and 99232:  CMS is proposing coverage for these codes and code 99233, with a limit for the patient’s admitting practitioner of one telehealth visit every 3 days. This will benefit patients that require ongoing care by the admitting physician within an institutional setting such as patients with a psychiatric diagnosis or those treated in a psychiatric hospital or licensed psychiatric bed.

• Codes for health and behavior assessment and intervention using CPT code 96153 – Group and 96154 – Family-with-Patient:

• Group medical nutrition services using CPT code 97804:

• Individual and group services related to kidney disease education using HCPCS codes G0420 and G0421:

• Individual and group diabetes self management training, not including at least 1 hour of in-person injection training, using HCPCS codes G0108 and G0109:

In another important area, CMS proposes to make changes to cardiac remote monitoring codes that require technical and professional components of the fee to align with an overall cap. In addition, changes were discussed in the proposed rules at length relating to the provision of continuous, 24/7, cardiac monitoring but there is little change in current policy.  
 
An excerpt of the telehealth section and the cover page for the proposed federal rulemaking is available on the ATA website at www.americantelemed.org

The full CMS proposal (in the current 1250 page format) is available HERE

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Marable Personal Healthcare

empowered by Hello Health 

“I’ve seen this coming for several years – physician extenders will likely replace physicians as the front line to health care access.  See this front page story in today’s Tennessean.  

I’m not knocking nurse practitioners – I live with one.  Just saying family doctors are devalued in our managed healthcare systems and so there are fewer and fewer around to meet the needs.  Those who are left must see more patients per day, making it impossible to do comprehensive care with good delivery of services. 

Since private and government insurance systems are not going to reasonably compensate the family doctors (they currently intend to decrease payments by 20%), there are 3 options: 

1) Try to see even more patients faster (the current face to face time with a patient averages 8 minutes) 

2) Give up the career (that cost well over $100,000 and 12 years to learn) 

3) Find a way to practice outside of the current systems, that allows time to care for people and is financially adequate.  We know creative doctors doing this and tools like Hello Health are helping make that possible. 

I spoke with a primary care doctor yesterday who is hanging on by a thread, seeing all the patients he can in his practice but still having to moonlight because his “day job” cannot support itself.  

I am still moonlighting to support my new practice (as I had to do with my traditional practice) but the difference is I am no longer hanging by a thread.  I now have time to care well for each patient and care well for my family and myself.  And there is significantly more potential as a physician to do more – unlike the traditional systems where doctors are now “obsolete”. 

Making a change, 

Charles”

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—From Medscape Business of Medicine, Maija Rothenberg,  Posted: 06/08/2010,  Read full article HERE

New and upcoming wireless medical devices may redefine the way primary care physicians practice medicine. In addition to the more than 1700 smartphone applications (apps) designed for use by medical professionals, other wireless devices are being developed at breakneck speed.
Wireless health technologies are involved in innovative products that enable physicians to diagnose illness, monitor patients, and transmit medical data from the point of care. Key health data are conveyed more rapidly and accurately, enabling speedier treatment decisions and faster adjustments in care.
Within years, not decades, here’s how life may change for you in your day-to-day practice: 

1.   You’ll throw out your stethoscope.

2.   You’ll help the specialists better help your patients.

3.   You’ll use smart pills to monitor treatment adherence.

4.   You’ll hold off on the sleep lab referrals — at least initially.

5.   You’ll monitor vital signs remotely.

6.   Patient data will no longer fall into the reporting gap.

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Meaningful Meaningful Use

By ROB LAMBERTS, MD    June 10, 2010 

….”What should be done?  The real question should be: what can an EMR do to impact patient care that would be truly meaningful?  If an EMR improves the ability of the doctor to take care of the patient, that is meaningful.  But if the EMR makes the doctor pay more attention to qualifying for the cash payment than to the real care of the patient, it is more meaningless use. 

I use an EMR every day.  I use it because it helps me give better care and makes our office run more efficiently.  If we have a new process that works better by using paper, we use paper.  We are not wed to the idea of using computers, we are committed to good process and excellent care.  The good news for us is that doing so has made us efficient enough to increase our revenue significantly at the same time that we improve our care quality.  That’s what everyone wants. 

It really worries me that the imposition of these criteria on EMR will dilute my focus on patients with a focus on achieving meaningful use.  This is similar to the experience of many good teachers who had to abandon more creative teaching methods to ensure better test performance.  If the criteria are not right, they will do this; there is no question. 

So before imposing a set of criteria to be evaluated on doctors, we need to be sure that the criteria themselves are scrutinized.  For them to truly improve care and not add more burdens to medical offices, they should: 

…….The bottom line:  meaningful use has to be truly meaningful.” 

Read full post at THCB

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Hello Health exhibited at Health 2.0 in Washington today. Dr. Gordon Moore gave a presentation on a panel about physician’s use of technology for online patient communication. Patient advocates stopped by the Hello Health booth to learn how the business model can act as a portal to the quality of care patients deserve.

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This looks like a great book for the “Doctorpreneur”   – doctors who want to conquer the chaos of health care delivery today. Those who want to create the future model now rather than waiting for someone else to do it  -this may be a great book for you!

“It’s time to take control again…it’s time to conquer the chaos once and for all”  – Conquer the Chaos

How to Be an Optimist (Without Being an Idiot)

Jun 06, 2010 –

“If an optimist had his left arm chewed off by an alligator, he might say, in a pleasant and hopeful voice, ‘Well, this isn’t too bad. I don’t have my left arm anymore, but at least nobody will ever ask me whether I am right-handed or left-handed,’ but most of us would say something more along the lines of ‘Aaaaah! My arm! My Arm!’”—Lemony Snicket

It’s easy to mock an optimist, isn’t it? Those who hope for the best are scorned as “Pollyannas.” Bart Simpson mocks Lisa’s idealism. Lou Grant mocked Mary Richards in the newsroom. Voltaire enjoys many a knowing smile at the expense of his Candide.  Yet optimism is one of the key strategies for overcoming fear, anxiety, frustration and skepticism in order to make a small business thrive, argue Clate Mask and Scott Martineau in their new book, Conquer the Chaos: How to Grow a Successful Small Business (Wiley, 2010).    

The key, however, is to practice not unbridled, idealistic, romantic notions of cheerfully annoying optimism, but rather to practice “disciplined optimism.” “Disciplined optimism,” Clate and Scott say, inspires you to maintain confidence and get to work removing whatever obstacle is in your way. It allows you to own the problem, and do something about it, because you have a sense that doing so gets you closer to your ultimate goal.

The authors define disciplined optimism as “faith you will prevail plus discipline to confront the brutal facts.” In other words, disciplined optimists do something about the little black rain cloud over their heads—they erect a very large umbrella, say—while blind optimists simply sit in the muddy puddle and cheerfully wish for the rain to stop (and then get wet and chilled and distraught when it doesn’t).

A good way for small business owners to practice disciplined optimism is to spend some time with unhappy customers. It stings when a customer complains about our product or services, and it’s easy to get incensed, defensive, and, ultimately, be simply unresponsive. A disciplined optimist, however, assures an irate customer that they both want the same thing: A seamless customer experience. So the optimist (1) apologizes for the malfunction or disappointment; and (2) thanks the customer for bringing the issue to his or her attention so that the business can make this right and help future customers avoid the same frustrations.

Read the full post HERE 

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By Kevin Pho, Special to CNN  June 7, 2010 7:48 a.m. EDT

"I read all about my condition on the Internet," a recent patient proudly told me. Like other doctors, I’m seeing more patients research their symptoms thoroughly before setting foot in the exam room.

Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults looked online for health information in 2009, up from 46 percent in 2000. These "e-patients" are an essential part of the health care team, and play an increasingly influential role in the shared decision making process with their physicians. Health technology commentator Esther Dyson observed in the Journal of Participatory Medicine that "the amount of medical knowledge is beyond the reach of any one person," and, "because clinicians are overwhelmed … a huge amount of responsibility is devolving to individuals." But she also noted that e-patients encounter physicians "who are often hostile to their efforts."

Indeed, not every physician is enamored with the e-patient. In a TIME opinion piece, orthopedic surgeon Scott Haig called a patient who Googled her own health information a "brainsucker." And, frustrated with the time needed to engage e-patients, he wondered, "if there [were] patients like this in poor, war-torn countries where the need for doctors is more dire."

Most doctors, however, want their patients to be conscientious about their health and informed about their diseases. In a recent survey, health marketing firm Manhattan Research found that virtually all doctors had patients who searched for health information online, and more than two-thirds of physicians found this to be a positive trend.

Read full article HERE

Editor’s note: Kevin Pho, a primary care physician in Nashua, New Hampshire, blogs at MedPage Today’s KevinMD.com.

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