This is not to say that systems need to conform and have certain interoperability formats to provide physicians with a tool where they are not “taken” on their investment, but it’s been spoken many times that the insurers are the ones that benefit more than the doctors. What we seem to be missing here is the payment side of the issue with throwing money in so many different directions.
There are too many choices out there today and we have software overload. Do we certify the software used by the insurance payers to check on their interoperability, no. There lies the problem with a one side focus. As a consultant trying to advise and support physicians on decisions, I find this is a nightmare myself. Each system is different and I had one MD tell me he had to learn 5 different systems to get through his residency! Did we build a very complicated system that instead turns many off, I think so.
In case you missed it, there’s a new addition to HIMMS as of last year and you can read more here. It doesn’t matter how many systems are created and clinicians will have to learn and deal with it, but the focus, “make money”.
“Who Should Join?
Bankers, healthcare organizations, large employers, IT executives, attorneys, accountants, CFOs, compliance officers, federal and state regulators, lobbyists, treasury and cash management executives, private banking executives, patient accounting managers, health data clearinghouses, financial clearinghouses and others. “
We keep giving contracts to those with the analytics software but with little study information that has impact on the clinician side of things. There are a lot of things that just don’t seem to make sense out there and I have to believe it is all money an perhaps not a true picture of what may work the best.
Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts
We had the AMA and their landmark lawsuit against Ingenix for the fraudulent data base settlement where doctors were paid less and consumers paid more for 8 years and yet I read where the AMA is now promoting Ingenix Care Tracker services, and remember Ingenix is a full owned subsidiary of United Healthcare, so I guess there might be some money potential here? I don’t know, but making an observation here.
Money spent with Ingenix helps fill the profit pot of United. HealthNet in their part of the agreement paid claims at 14% higher than the Ingenix data base rates. Stories like the one at the link below worry me as well as there are algorithms that run to prevent fraud and you can read the Ingenix inquisition about several dermatology offices closed by the algorithms that were run to find “potential” fraud and like anything else in data, you could have some false positives in there.
Skins game With Dermatology Offices in California – All Insurance Carriers Quit Paying For Treatment Within a 5 Day Period
Health Fraud Scores Could Be a Contributing Factor to Medical Claims Being Denied
A bit further here is that we have Dell Computers working with the AMA to provide the software/hardware support for the services provided by the AMA as stated above, so more dollars that can go towards Ingenix, the wholly owned subsidiary of United Healthcare. All of this seems very confusing to me, as I stated above we have EHRs on every street corner, in every size and have over inflated the market with products available. Can/will the AMA be able to impartial when an entire marketing plan of such is in place? Again, I am just looking at the big picture and connecting some dots on who some of the players are.
Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!
The company also makes a huge amount of money selling your prescription data which does not come under HIPAA, this has been going on for years and there are others too in the same business such as Milliman, but again it appears to be one data making money machine via analytics. With pharmacy benefit managers using some of these services, we see numbers like Medco showing 14.8 billion profit in just compiling drug data and getting your prescriptions to you.
Actually as somewhat a breath of fresh air it was nice to see Oracle introducing the same type of analytics and business intelligence into the healthcare market so we have some competition here and truly perhaps a company that is there to do just that. Oracle has been around a long time has offered quality products to the enterprise clients for years.
So again, I say Ho Hum and mention the fact that we are barking up the wrong side of the tree with so many efforts on EHR software and little or none on the payer side, as nothing happens really until that problem is solved.
Health insurance as sold on the market to day and being traded on Wall Street is one bug stumbling block to healthcare reform. If some of the dividend money went back into taking care of healthcare claims, well you get the story on that one.
Consumers are no more going to trust or feel confident with the present standard of business and it will get worse and more illusive for consumers to make decisions as they are all based on money and not better care. Sure some improvements come out of it and that is a normal flow that will happen with technology improvements anyway, but to make huge profits while denying care is a crime. Things out there are not always as they seem to be and it’s more important today to perhaps have an interest in knowing where you dollar goes and who profits, as they will ultimately be the ones controlling what kind of care you receive. 
As one more side note, it is probably also very rare to see most these folks perhaps eating their own dog food as well. The business leaders always know what is good for us, but in the long run they don’t participate and it comes back around to the old word “control”. How many talk about using their software for better records themselves?
Last year I did talk with Steve Shihadeh, Vice President of the Health Solutions Group at Microsoft and it was impressive to hear him talk about the value he finds himself with his own HealthVault account, something seldom heard from others and we seem to get a “sales” perspective instead of “value” being shown through participation. Microsoft of course is known for using their own solutions in house and doesn’t “just market”, and I see that as a big advantage in promoting value. BD
Steve Shihadeh, VP Microsoft Health Solutions Group – The Amalga Software Solution for Aggregating Hospital Information (Interview)
A proposed rule establishing a temporary certification program for testing and certifying health IT systems in order for providers to meet deadlines to receive stimulus law funding was announced by David Blumenthal, head of the Office of the National Coordinator for Health Information Technology, during the Healthcare Information and Management Systems Society conference in Atlanta.
Steve Posnack, policy analyst for the ONC who presented details of the bifurcated programs to a packed HIMSS ballroom, said there will be a 30-day public comment period on the temporary certification program, with a final rule expected by late spring. The first vendor EHRs could be certified under the temporary program by summer, Posnack said.
ONC announces proposed IT certification program - Modern Healthcare
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