An Open Letter (1) to the New National Coordinator for Health IT - Untying HITECH's Gordian Knot

DAVID C. KIBBE and BRIAN KLEPPER

First Published on THCB.

Congratulations to David Blumenthal on being named National Coordinator for Health Information Technology (ONCHIT). Dr. Blumenthal will be the person most responsible for the rules and distribution of the American Recovery and Reinvestment Act's (ARRA) nearly $20 billion allocation, referred to as HITECH, designated to support physician and hospital adoption of health information technologies that can improve care.

The job is fraught with difficulties, which Dr. Blumenthal has readily acknowledged. His recent New England Journal of Medicine (NEJM) Perspective, "Stimulating the Adoption of Health Information Technology," is a concise, clear and honest appraisal of two of these challenges, namely how to interpret and act upon the key terms used in the legislation, "meaningful use" and "certified EHR technology." Dr. Blumenthal gets to the heart of the matter by identifying the tasks on which the National Coordinator's success will most depend, and which will foster the greatest controversy.

The country needs Dr. Blumenthal to succeed. The issues are complex and, with huge ideological and financial stakes involved, politically charged.

Clinical Groupware: Platforms, Not Software

DAVID C. KIBBE and BRIAN KLEPPER

First Published on THCB

Clinical Groupware is rapidly gaining acceptance as a term describing a new class of affordable, ergonomic, and Web-based care management tools.

Since David first articulated Clinical Groupware's conceptual framework on this blog early last year -- see here and here -- we've been discussing Clinical Groupware with a growing number of people and organizations who want to know what it is, where it's going, and what problems it may solve, particularly for small and medium size medical practices, their patients and their institutional/corporate sponsors and networks.

A Self-Fulfilling Prophesy: The Continuity of Care Record Gains Ground As A Standard

BRIAN KLEPPER

We live in a time of such great progress in so many arenas that, too often and without a second thought, we take significant advances for granted. But, now and then, we should catalog the steps forward, and then look backward to appreciate how these steps were made possible. They sprung from grand conceptions of possibilities and, then, the persistent focused toil that is required to bring ideas to useful fruition.

We could see this in a relatively quiet announcement this week at HIMSS 09. Microsoft unveiled this:

Are We Adequately Securing Health Care Information?

By BRIAN KLEPPER AND DAVID KIBBE

In a discussion about electronic health records (EHRs) a couple weeks ago, one of the Human Resource team members at a prospective client said, "I don't believe it's possible to secure electronic health data. It's always an accident waiting to happen."

There is some truth to that. More and more, our Personal Health Information (PHI) is in electronic formats that allow it to be exchanged with professionals and organizations throughout the health care continuum. It is highly unlikely that each contact point has the protections to wrap that data up tightly, away from those who would exploit it.

Editor's inbox: Reader questions breadth of sources in article on onsite clinics

BRIAN KLEPPER


First published in Employee Benefit News, April 5, 2010

The article "Reconfiguring onsite health clinics" (EBN February) presented a remarkably limited perspective on modern clinics, resulting in statements like this one: "'In a tough economy, an initial clinic approach should probably employ mid-level practitioners, such as a nurse practitioner or a physician assistant, because they are most cost-effective when rendering basic medical services,' explains Mercer's [Bruce] Hochstadt."

Value Trumps Price In Onsite Clinics

BRIAN KLEPPER

First published in American City Business Journals (in Boston, Silicon Valley, Jacksonville, Nashville, San Jose and elsewhere.)

Onsite health clinics are new territory for most employers. It can be difficult to sort through the different approaches used by different vendors. Worse, in difficult economic times it’s tempting to “get in” as cheaply as possible.But like many purchases, you may get what you pay for with clinics, especially if you scrimp. Here are three reasons to favor value over price when considering an onsite clinic vendor:

On Really Managing Care and Cost

BRIAN KLEPPER

One of my favorite health care stories is about Jerry Reeves MD, who in 2004 took the helm of a 300,000 life health plan in Las Vegas, including about 110,000 union members, and drove so much waste out of that system - without reducing benefits and while improving quality - that the union gave members a 60 cent/hour raise. There was no magic here. It was a straightforward and rigorously managed combination of proven approaches.

Dr. Reeves' work betrayed the lie that tremendous health care costs are inevitable. To a large degree, the nation's major health plans abetted this perception when they effectively stopped doing medical management in 1999. (Most have recently begun managing again in earnest.) The result was an explosion in cost - 4 times general inflation and 3.5 times workers earnings between 1999 and 2009 - that has priced a growing percentage of individual and corporate purchasers out of the health coverage market, dangerously destabilizing the health care marketplace and the larger US economy. In 2008, PriceWaterhouse Coopers published a scathing analysis suggesting that $1.2 trillion (55%) of the $2.2 trillion health care spend at that time was waste.