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Developing World’s health lessons for U.S.


Community health center in Kerala, India.

John Glaser, Ph.D., senior vice president of population health with Cerner in Kansas City, Mo., writes in H&HN Daily:

“{Healthcare}innovation in the United States … is often blinded by proximity and the belief that innovation requires wealth. We confine our search for innovative ideas to our shores and, occasionally, to other developed countries. We assume that innovation requires a critical mass of talent and substantial investment.

“We rarely believe that emerging countries have much to teach us about innovation. This is a mistake.”

“If emerging countries are to adequately address their complex range of health care challenges — a range more onerous than the significant challenges we face in the United States — they will need to innovate. And they must innovate in ways that are often different — different because these countries often have less-developed capital markets, smaller talent pools, and laws and regulations that hinder entrepreneurs. …Moreover, these countries might very well choose to follow an innovation path that’s different from the one we have chosen.”

He then gives some examples of successful healthcare innovation around the world. Among his observations:

In the developing world, innovation doesn’t necessarily mean creating something sleeker and with more bells and whistles (read, more expensive). Rather, emerging markets allow innovations to be good enough.”

“In India, for example, a watchful eye is kept on whether costs justify benefits in introducing everything: new business models, surgical techniques, IT solutions and medical devices. For instance, a small hospital in Bangalore may opt to implement a ‘lightweight’ electronic health record, a system that is less full-featured than others but one that certainly delivers the right core set of capabilities.”

While dispersing a band of medical foot soldiers to care for patients in remote areas may work well in some instances, many emerging markets are also capitalizing on the ubiquity of mobile devices and health applications to make health care more accessible to the masses.”

“For example, in India, diabetic patients affiliated with Apollo Hospitals Group can text their blood sugar count to clinicians and receive readings and advice, bringing basic care and education within the reach of millions of rural poor. In other parts of the world, patients share body weight and other physical factors with caregivers via text to help predict and prevent widespread malnutrition. Additionally, mobile health … has proven to be quite beneficial for activities such as public health surveillance and disease tracking in remote locations.”

“In fact, a 2014 PwC study found that 59 percent of all emerging market patients use at least one mobile health application or service, compared with 35 percent in the Developed World.”

To read his essay, please hit this link.




CMS care-delivery project shows mixed early results

States participating in Round 1 of the Centers for Medicare & Medicaid Services State Innovation Models Initiative relied heavily on data-sharing and health information technology to enhance care delivery. Problems arose, says a CMS report on the  program’s second year.

The report summarizes the policies and strategies used by the six states in the program–Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont.

Maine’s goals, for example,  included connecting behavioral-health providers to the state’s health information exchange and piloting patient access to medical records via the Blue Button project. Financial support went to behavioral-health organizations to improve their electronic health record technology.

In Minnesota the aim was to increase EHR and HIE use among providers in ACOs and the broader community and create an eHealth Roadmap to expand use of such tools by behavioral-health providers.

In Arkansas it was to use the state’s HIE to send emergency and admit-discharge-transfer information to Medicaid patient-centered medical home providers.

In Massachusetts it was to create a portal, Community Connect, for caregivers and beneficiaries to access home care records.

In Oregon it was to implementing an HIE system, CareAccord, for secure messaging.

And in Vermont, it was to look into telehealth solutions.

The report notes several challenges faced by each of the states. Massachusetts, Maine and Oregon, for instance, had trouble incorporating innovations into provider workflow.

“Oregon’s direct messaging technology has seen little uptake by providers, many of whom already have a preferred internal secure messaging system,” CMS wrote.

The accuracy and completeness of data has been an issue for states; in Arkansas, for example, a “lack of patient-specific behavioral health data” hindered provider efforts to treat patients.

CMS Principal Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., wrote that it’s “too early to attribute specific quantitative results” to the initiative. However, he believes the findings  show that progress is being made by states, as shown in  declines in ER visits and inpatient readmissions.

 To read the CMS report, please hit this link.

To read a FierceHealthcare  news article on this, please hit this link.

Partners in frustration



Anger and frustration are rife in the still rocky introduction at Partners HealthCare’s hospitals, in Greater Boston, of Epic’s electronic health record system. Some say the technology is hurting patient care and reducing efficiency. This Boston Globe story tells the tale well.



The new MU


Is Meaningful Use — the Feds’ electronic health record incentive program — really going away? Well no, but it will change a lot, as this Medscape article explains.

Do medical scribes slow EHR improvement?


Some physicians at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS) expressed concerns about the growing use of medical scribes  to make entries into electronic health record systems.

George Gellert, M.D., of the CHRISTUS  Health hospital system in Texas, said:

“The use of scribes is undermining the usual market forces that would drive the advancement of EHRs,” arguing that physicians may be “satisfied with a suboptimal product because ‘my scribes deal with it,'” thus slowing improvement of EHRs, which still leave much to be desired. Other physicians at the meeting discussed the danger of “mission creep,”  in which over-busy physicians would let scribes, who are not clinicians, make EHR entries that should only be made by physicians.


A Chicago-area clinics chief is upbeat



MU hardship exemption soothes providers and CMS



Herewith a look at how letting eligible hospitals and  other providers participating in CMS’s Meaningful Use  electronic health record apply for a blanket hardship exemption to avoid reimbursement penalties will  help CMS as well as the providers.

Congress  recently passed bill S. 2425, which lets any eligible hospital or  clinician to apply for an exemption for 2017 from MU penalties. Previously, hospitals and professionals had to meet certain criteria  to apply for the exemption.

As Becker’s Hospital Review noted, the hardship exemption “offers an obvious respite {to providers} in their journey to Meaningful Use attestation. Not only does it stave off penalties, but it softens the burden of meeting the newly released stage 3 requirements….”

The news service added: “What’s more, CMS eases the burden on itself with this blanket exception. Since the agency no longer has to review hardship exemptions on a case-by-case basis, that eliminates thousands of applications it needed to individually review….”


Johns Hopkins system’s ACO problems


This article in Academic Medicine discusses the difficulties of an Accountable Care Organization formed by Johns Hopkins Medicine, some Washington, D.C.-Baltimore area hospitals and three medical practices.

One big problem was electronic health record systems that didn’t communicate with each other.

Other problems included trying to getting and analyzing claims data, governance issues and getting the full cooperation of providers.

The authors’ conclusions included this observation:

“Network strategies among AMCS {academic medical centers}, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.”









Peril to patients seen in EHR firms’ ‘gag clauses’



Politico reports that that some of the biggest electronic health record companies have inserted “gag clauses” in their taxpayer-subsidized contracts. These clauses effectively bar healthcare providers from “talking about glitches that slow their work and potentially jeopardize patients.”

The news service reports that “Vendors say such restrictions target only breaches of intellectual property and are invoked rarely. But doctors, researchers and members of Congress contend they stifle important discussions, including disclosures that problems exist. In some cases, they say, the software’s faults can have lethal results, misleading doctors and nurses who rely upon it for critical information in life-or-death situations.”

The article says that the  Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services, which are responsible for the EHR subsidy program, have ”done little about the clauses, though providers and researchers have been grumbling about them since the 2011 Institute of Medicine report warning that ‘[t]hese types of contractual restrictions limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks.”’


From the EHR to the EHP

John Glaser writes in Hospitals & Health Networks about how that the electronic health record is evolving to become the electronic health plan. Among this comments:

“Provider organizations will not thrive in an era of health reform simply because they have a superb and interoperable electronic health record. They will thrive because the care they deliver consistently follows a plan designed to ensure desired outcomes. The EHR must evolve so that it focuses on an individual patient’s care plans — the steps required to maintain or create health.”


“Every patient’s EHR should clearly display the master care plan — a long-term care plan to maintain health integrated with short-term plans for transient conditions. The EHR should be organized according to this master plan: It should highlight the steps needed to recover or maintain health, list the expectations of every caregiver with whom the patient interacts, and include tools such as decision support and a library of standard care plans. Interoperability is a necessity, as various providers must be able to use the plan-based EHR. ”


“The shift is underway. The electronic health record does not disappear as a result of this shift, but the strategic emphasis will move to technologies and applications that assist the care team (including the patient) in developing and managing the longitudinal, cross-venue health plan and assessing the outcomes of that plan.”

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