US Healthcare Reform Reading Group

Towards best practices in purchasing HIT software and products for medical insitutions, with an emphasis on patient safety

Mobile health devices for health research and treatment (subs required.)

"a perspective on the convergence of personal health records and mobile communication devices, and examine the barriers and opportunities to accelerate their use by health care industry stakeholders"

Considers trust between patient and physician and how this might be affected by availability, interoperability and secondary uses of EMRs

Karen Davis Stephen C. Schoenbaum Toward High-Performance Accountable Care: Promise and Pitfalls September 14, 2010 Authors: Karen Davis, Ph.D., Stephen C. Schoenbaum, M.D., M.P.H. Several lessons can be extracted from the managed care era: Public Backlash. Patients rebelled when they were not able to get the services their physicians recommended and they believed they needed.Excessive Provider Financial Risk. A number of providers in capitated (fixed per-patient fee) contracts with insurers were hurt financially as they assumed risk for services beyond those they provided directly.Incoherent Payment Methods Across Payers. As each major insurer developed its own payment methods, negotiations over payment rates, and systems of rewarding quality and efficiency, administrative burdens on providers escalated.Local Barriers. So-called "managed care organizations" in the 1990s were not successful in many parts of the country, particularly in areas that did not have large group practices, including some urban areas such as New York City and rural areas.Implementing Effective Practices Requires Assistance. The redesign of care to improve quality and efficiency is often a difficult and uncertain journey, requiring resources and expertise beyond most physician practices and hospitals.Public Preference for Smaller Physician Practices. Patients generally prefer small physician practices and their more personalized approach to care over larger groups with many part-time physicians and coverage arrangements in which they are less likely to see the same physicians over time.Market Power. During the late 1990s and early 2000s, the insurance industry underwent substantial consolidation, increasing its ability to set the terms of provider payment. Providers began to push back by dropping out of networks or forming their own larger negotiating entities. Insurers responded by increasing provider payment rates and raising premiums. The consolidation of market power, whether by managed

A challenge facing the health care industry today and in the near future is growing workforce shortages. A product of industry growth and demands for reform, it includes growing shortages of both caregivers (see "U.S. Health Care Workforce Shortages: Caregivers") and health care information technology workers.

"Using a recent survey of U.S. hospitals, we found that the share of hospitals that had adopted either basic or comprehensive electronic records has risen modestly, from 8.7 percent in 2008 to 11.9 percent in 2009. Small, public, and rural hospitals were less likely to embrace electronic records than their larger, private, and urban counterparts. Only 2 percent of U.S. hospitals reported having electronic health records that would allow them to meet the federal government's "meaningful use" criteria"

April 24 2010

"The 2009 federal economic stimulus package excludes clinical psychologists, clinical social workers, psychiatric hospitals, mental health treatment facilities and substance abuse treatment facilities from receiving incentive payments for the meaningful use of EHRs." Bill by Rep. Patrick Kennedy and Rep. Tim Murphy seeks to alleviate situation

Podcast features interview with authors of Beyond Implementation: A Prescription for Lasting EMR Adoption

"proposes a novel, uniform process for developing authoritative clinical practice guidelines and explores how EHR technology itself can enable experts to gather evidence of best practices."

An event featuring networking and panel discussion sponsored by Mass High Tech will take place at Harvard Medical School on June 24, 2010

national Community Health Data Initiative

AHRQ survey of EMR vendors

"National Coordinator for Health IT David Blumenthal published an open letter touting the Nationwide Health Information Network as a model to help health care providers meet the "meaningful use" requirements of the 2009 federal economic stimulus package"

Commission on U.S. Federal Leadership in Health and Medicine reports that investment in interoperable health It systems could result in massive savings