Docnotes

EHR Incentive Program Registration Instructions

Registration opens today for the EHR Incentive Program.  The process is not so easy as one would like.  Here's an overview for how to register as an Eligible Provider.

1. Go to the Registration Program's login page.
2. You need a login.  This is your NPPES login.  Oh?  You don't have one?  Neither did I.  
3.  I do have an NPI.  So do most EPs.  If you have an NPI - you can create an NPPES login here.  If you don't have an NPI - you will need to apply for one here.
4. OK .. go back to the login page (link in #1 above) and log in.
5. Click on "registration"  (the tab at the top) and scroll down to the bottom.  Your name is listed and at the bottom-right is hyperlink:  "Register."  Click that.
6. Click through to the page that is going to stop most providers in their tracks.  There are several questions:  First - you need to select whether you are participating in the Medicare or the Medicaid program.  You should know.  Most providers will choose Medicare.  This next part is counter-intuitive:  you need to select the radio button - and then click "apply."  It's terrible design.  What does "APPLY" mean?  Am I applying for the program?  No.  In this case - what I THINK the web designers meant was that you are APPLYing your selection of the radio button.  When you choose "Medicaid" - a drop-down list appears so that you can choose your state.  Only a handful of states have competed their paperwork - so only a handful of state Medicaid programs are open for registration.  If you plan to register for the Medicaid program in one of the states not listed here, you need to wait days, weeks or months until the program is active.  There is a link to this page (ugh! pdf - more bad web design - here's a non pdf version) that lists the state programs and their expected ETA.  Don't know which program you qualify for?  Use this nice wizard to figure it out.
7. Once you select the program - you are asked whether you have a certified EHR - and if so, what the certification number is of that product.  This is an OPTIONAL question.  I assume that's because some products are not fully certified yet - or because in many scenarios - one needn't even have an EHR yet.  This is just registration for the program.  Note that this page requests a certification NUMBER but in fact - what they want is a "YOUR CERTIFICATION ID" - and NOT the "Certification # of the product.  Yes - this is confusing.
8. This page directs you to the CMS website here.  But that's not the right place to go.  What you need is the CHPL - the Certified Health IT Product List.  To create your certification ID (you don't really need this - recall that it's optional)  .. go to the CHPL here .. then browse the list or search for your vendor(s).  The second column is the PRODUCT's certification #.  Not what you want.  If you have one complete EHR - click on "add to cart" and follow step #9 below.  If you have several modules - add all of them to the cart.
9. At the top of the page - you will see a link to your "shopping cart."  Click on that link.  Now you see your list of modules.  You need 100% Certified EHR technology - so if you have modules that don't make you "complete" - you won't be able to create a certification ID.  Have 100%?  Great.  Now click.  There is your certification ID.  That's what goes in the optional field on the EHR Incentives registration page.  Let's hope they fix this soon so that it's more clear.

I didn't get past this page - (yet) as my state isn't one of the active ones - and I will apply for the Medicaid program.  If you got past this screen - please let me know if you encounter anything challenging. 

 

Bronchitis and Product Management

AAFP's Acute Bronchitis Handout

In the December issue of American Family Physician is a nice short article on Acute Bronchitis. With the article is an updated patient handout. The original (now over 10 years old) was something I printed out for probably thousands of my patients over the years - and I successfully used it to help educate patients (also medical students & residents) that one needn't (shouldn't) treat everyone who is coughing with antibiotics.

This is of course a familiar topic to those of you who have been reading my blog for the past 11 years .. so to some degree I know that I am preaching to the choir - but it is clear that physicians still struggle with this problem.  This recent study looked at prescribing practices - and gave physicians tools to employ when they felt pressured to prescribe.  It's challenging situation:  physicians know that the patients would most likely do just as well without the antibiotic - but in many cases, they are pressured by the patient to do so anyway.

This is not unlike many relationships between a business and a customer.  Successful architects, designers, software companies, computer companies, car companies and electronics companies deeply understand the core principles of giving their customers with what they NEED rather than what they ask for. This is the task of a product manger.  In many ways - physicians are product managers for the core product that we provide to our customers:  optimal health.  Take a look at this free book (pdf) on product management if it's new to you.  You'll need to translate from CorporateSpeak to terms that make sense in healthcare.

So - do patients NEED antibiotics for bronchitis?  In general - No.  So why do over 1/2 of patients who seek care for a cough get antibiotics?  I'd argue that it's because physicians are rotten product managers. Indeed - if we just change the words we use to describe the diagnosis - demand for the antibiotic decreases significantly.  Is this Marketing?  Product Management? Of course it is.  We alter demand for a product - based on how we describe it.  How is that different from marketing cars?  vitamins? 

Yes - of course - the best interest of the patient is what is at stake here.  We're not talking about their listening pleasure - or how warm their bottom is while driving that BMW with a heated seat - this is their HEALTH! .. 

But who are we fooling?  Yes - their health/happiness/satisfaction .. that's all the same - no?

Yes - I am trying to provoke discussion.  :-)  It's nearly 2011.  Let's start the blog off to a new year!

 

Health IT Strategic Plan: Consumer Empowerment

I am in Washington DC today attending meetings hosted by ONC - The Office of the National Coordinator of Health Information Technology.

We'll try a little "liveblogging" as there is free wireless.

Josh Siedman opened

Christine Bechtel is speaking now on consumer engagement.  She is very smart - but more importantly seems to focus on common sense approaches to things.

What she says:

• RECs can help providers choose
• Providers can/should engage consumers and consumer organizations as priorities are identified.
• Consumers can be leveraged to move agendas forward:  It's not about "if you build it will the come?" .. rather "if you build it WITH them .. they will already be there."

Next:  Silus Buchanan - Cave Institute.   Siuls attended Health2.0 in San Francisco .. what he saw/heard:

• Very few minority attendees at the conference
• He spoke with Health2.0 vendors about minorities / disparities.  Were they focused on disparities or people of color?  No.
• HIT vendors seem to be focused on "people with money"
• There is an opportunity to innovate FOR and WITH minorities.  This is a market opportunity.  Social factors are ignored in general - and have not attracted sufficient attention in the mainstream.

The Cave Institute is soon to open "ehealthandme.com" (not up yet - no hyperlink) to provide basic overviews of health IT.  Inviting vendors to participate.

Next up:

Tom Sellers:  National Coalition for cancer Survivorship.  

Tom has been a 11 year cancer survivor and his mom died of cancer at age 51.  

• How can we get specialty providers to adopt and engage with HIT?  Only about 5% of oncology has an EHR.
• Cancer patients endure lots of redundant events:  exams, tests, etc .. since the docs don't communicate.
• "handoff" from oncology to primary care seem horribly inefficient.  Missed opportunity for patient benefit.
• No current models for how patient INPUT and feedback exists
  • Pain
  • side effects
  • complications
  • symptoms
• Patients are/may be/will be much more interested in data sharing / research opportunities than patient privacy groups would represent.
• "I talk about PATIENTS and not CONSUMERS"
• Patients WANT their information shared with other providers.  
• Survey:  over 90% of patients are comfortable with performing health related activities online

Last panelist:  Ginger Viera - Life coach/health coach, type 1 diabetic, celiac disease 

• Ginger recounted a handful of events that have occurred that are byproducts of a disconnected system of providers who know what they know .. and don't necessarily know what they don't know.  She has had to advocate for herself (too much) in the face of providers who are overwhelmed by a dysfunctional system - and who doubted her.  She hopes that Health IT will provide better access to the information that was missing from the providers' brains. 

 

 

Gordon's Notes: The phone call is dead - sort of

Phil Bradley comments on a Tech Crunch essay on the death of the phone call.

via notes.kateva.org

John (agreeing with Phil) comments that the unscheduled phone call is dead.

I (almost) disagree. The unscheduled social call is welcome. When my sister called me this morning, it was welcome.

The unscheduled WORK call is rude. I agree. I get one or two unscheduled "work" calls every day. Until now - I couldn't put my finger on it. I think to myself - as I discover during the first few seconds - who it is and why they called me .. "why didn't you just send me an e-mail so we could schedule a call?"

AMIA EHR Survey

Win an iPod .. and help the AMIA Primary Care Informatics Working Group by filling in a little survey by clicking here.  (and please share the link with your friends!  http://bit.ly/dtSl4x)

 

Ten things to do when your kids leave for college.

1) Walk the dog(s). SOMEONE still loves you! (if you don't have a dog, buy or borrow one).
2) Go for a run. You're not old.
3) Walk around the house in your underwear. No - the neighbors can't see.
4) Put the bread in the fridge. This prevents it from getting modly - since it will be consumed in days (not hours).
5) Work more. So you have a purpose (and can pay for that college tuition).
6) Clean the living room. (Remarkably - it will STAY clean!)
7) Be kind to your spouse. He/She feels sad.
8) Go running again.
9) Resist the temptation to adopt or borrow small children to fill the void.
10) send care packages.

Geeks getting too big?

Population health data is everywhere.  You just have to look for it.

Winning/winning

“Winning” is hard for me to write about.  When I applied to medical schools – I didn’t say “I want to win” – I said that I wanted to help keep/make people healthy and successful.  “Medicine isn’t a competition” I would say – and certainly that is true.  But then again – which doctor doesn’t want to be “the best?"

So – yes – I was honored in 2008 when a survey of doctors in my region voted me to be one of the best family physicians.

And I am thrilled to me a member of the “winning” team of Allscripts.

But winning still feels like a silly goal – and yesterday I won twice and now I think I know what’s different.

a) I won a half-marathon yesterday.  No – I didn’t beat everyone.  I was #108 out of about 650.  But I ran my fastest time ever.  I beat the goal that I had set for myself – and ran the same race 32 minutes faster than I had one year before.  When I finished, I felt like a winner.  15+ months of training, with slow, deliberate progress.  My stride was better, my conditioning was better.  As George Leonard writes in Mastery, the key to success is NOT about seeking finish line – it’s about the plateau of slow progress we make on the long path toward our goal.

b) I won a raffle for a brand new pair of Newton running shoes.  Yay.  I won! No training, no long road.  I just won!  It felt empty and cheap.  I win raffles like this a lot.  Really – I do.  How?  I significantly increase my chances of winning with a simple trick.  Do you know my trick?  Post a comment if you do.  :-)

More on soccer headgear and concussions in soccer

I did some follow-up research today on this … 

2008 consensus statement on concussions.  (pdf)

Sport Concussion Assessment Tool – version 2 (SCAT2) (pdf) – very useful

NY Times article (2004)

My post from May, 2009 with other references.

The Presentation that I made today on this topic.

Running in Winter: Saran Wrap?

It's cold out there in Smallbany, NY these days - which is making it extra-hard to put on them the running shoes and get out there.  Combine that with something that I think my mom gave me (thanks, mom) .. and it's awfully uncomfortable to run - especially when it's windy.  Yesterday I wrapped my toes with plastic wrap ..and they were MUCH happier.  A quick Internet search on this - and I didn't find much .. but this guy posted a few weeks ago on how it helped on a rainy day:

Sotally Tober is Runnin' to the Finish Line: Saran Wrap on my feet?.

Maybe I need to try some of those "winter" running shoes.  Hmm.

I signed up for my first 1/2 marathon of 2010 .. March 7th in Florida.  Sam and I will be there for our annual Red Sox Spring Training Pilgrimage.  My goal is to beat my 2009 time by 45 minutes.  I should be able to do this - if I don't get too lazy/cold over the next 10 weeks.