Again, in the last week, I have come across a few reports and news items which are worth passing on. This week it seems to be, at least in part, to be follow-ups of last week’s finds.
These include first:
Medicare claim system far from easy
Annabel Stafford, Canberra
July 26, 2007
AN EFTPOS-STYLE system to allow patients to claim their Medicare rebate in the doctor's surgery — which has been widely spruiked by the Government — is facing a big hurdle just months from the election.
Doctors have threatened not to co-operate with the system unless the Government pays them for every Medicare rebate they process on behalf of patients.
The so-called Medicare Easyclaim system is likely to be popular with voters because it means they will no longer have to make a separate trip to the Medicare office to claim a Medicare rebate.
But the Government is being made to pay for introducing it, with the banks — and doctors — demanding a payment for administering the scheme.
The Age believes that doctors want about $1 per transaction.
In a speech at the National Press Club yesterday, AMA president Rosanna Capolingua said the system as it stood was not efficient enough — transactions had taken practices four minutes per patient — and its introduction should be delayed. And the doctors should be paid for processing claims. "While the objectives of Easyclaim for patients are worthy, the bottom line is that it will save the Government huge dollars in the scaling back of Medicare offices and the processing of claims," she said.
…..( see the URL above for full article)
This is a great example of how not to undertake implementation in the health sector. In this case the Government is trying to save itself huge sums in terms of staff and office space by moving Medicare claims to the individual practices. Only problem is that this inevitably involves extra work for the doctor’s staff at best and the doctors themselves at worst. Someone has to pay for the extra work and you can bet that, unless some sensible arrangement is made, the whole project will come to a sticky end.
The banks have done well and increased their profits markedly having all their customers do all the data entry to manage their finances and we have been happy to do it because it makes banking more convenient. There is nothing in it for doctors and their staff to do this to improve the Government’s bottom line. This is another example of where a payer and the patient gets most of the benefits and it is the doctor and their staff that have more work to do.
I have no idea what the right level of payment is likely to be but I know that banks are getting between $0.20 and $0.50 per transaction processed. Given manual over the counter processing is known to cost some number of dollars for the Government, which will now be avoided, you can bet the AMA will not take this lying down. I await, with interest, the next move. There is no doubt a sensible compromise is possible and this should have been worked out long before this.
Of course there is the view that all this is a medical rip off..see here for the differing view:
http://www.theage.com.au/news/opinion/doctor-heal-thyself/2007/07/28/1185339314714.html
Doctor, heal thyself
Jason Koutsoukis
Apart from more money in doctors' pockets, the AMA doesn't know what it wants. And we pay the price.
..... (see the rest at the URL above)
Second we have:
Chips: High tech aids or tracking tools?
By Todd Lewan, AP National Writer | July 22, 2007
CityWatcher.com, a provider of surveillance equipment, attracted little notice itself -- until a year ago, when two of its employees had glass-encapsulated microchips with miniature antennas embedded in their forearms.
The "chipping" of two workers with RFIDs -- radio frequency identification tags as long as two grains of rice, as thick as a toothpick -- was merely a way of restricting access to vaults that held sensitive data and images for police departments, a layer of security beyond key cards and clearance codes, the company said.
"To protect high-end secure data, you use more sophisticated techniques," Sean Darks, chief executive of the Cincinnati-based company, said. He compared chip implants to retina scans or fingerprinting. "There's a reader outside the door; you walk up to the reader, put your arm under it, and it opens the door."
Innocuous? Maybe.
But the news that Americans had, for the first time, been injected with electronic identifiers to perform their jobs fired up a debate over the proliferation of ever-more-precise tracking technologies and their ability to erode privacy in the digital age.
To some, the microchip was a wondrous invention -- a high-tech helper that could increase security at nuclear plants and military bases, help authorities identify wandering Alzheimer's patients, allow consumers to buy their groceries, literally, with the wave of a chipped hand.
To others, the notion of tagging people was Orwellian, a departure from centuries of history and tradition in which people had the right to go and do as they pleased, without being tracked, unless they were harming someone else.
Chipping, these critics said, might start with Alzheimer's patients or Army Rangers, but would eventually be suggested for convicts, then parolees, then sex offenders, then illegal aliens -- until one day, a majority of Americans, falling into one category or another, would find themselves electronically tagged.
The concept of making all things traceable isn't alien to Americans.
Thirty years ago, the first electronic tags were fixed to the ears of cattle, to permit ranchers to track a herd's reproductive and eating habits. In the 1990s, millions of chips were implanted in livestock, fish, dogs, cats, even racehorses.
Microchips are now fixed to car windshields as toll-paying devices, on "contactless" payment cards (Chase's "Blink," or MasterCard's "PayPass"). They're embedded in Michelin tires, library books, passports, work uniforms, luggage, and, unbeknownst to many consumers, on a host of individual items, from Hewlett Packard printers to Sanyo TVs, at Wal-Mart and Best Buy.
But CityWatcher.com employees weren't appliances or pets: They were people made scannable.
"It was scary that a government contractor that specialized in putting surveillance cameras on city streets was the first to incorporate this technology in the workplace," says Liz McIntyre, co-author of "Spychips: How Major Corporations and Government Plan to Track Your Every Move with RFID."
…..( see the URL above for full article)
This is an interesting long one from the Boston Globe that goes on to explore a range of aspects of implanted RFID in humans and just where all this may be heading. Well worth a browse.
Third we have:
http://www.sacbee.com/101/story/286594.html
Medical records, advice just a few clicks away
By Danielle McNamara - Bee Staff Writer
Published 12:00 am PDT Monday, July 23, 2007
During her cancer treatment, Doris Taylor made sure to record medical appointments on a hanging calendar in her house. The problem: She never read it.
"I've missed appointments," Taylor said. "I completely forgot about them."
Since then, Taylor discovered the convenience of managing her health care online. With so many doctor, lab and procedure appointments, it was hard for her to keep everything organized.
"Before there'd be a lot of missed phone calls if I forgot something my doctor told me," the 69-year-old said. "Now I just send an e-mail and they get right back to me."
Taylor uses Kaiser Permanente's Health Connect to track appointments and prescriptions.
She said this new access makes her relationships with doctors more comfortable.
Today consumers are doing everything from buying car insurance to sending party invitations with a few clicks on their home computers. National surveys show that patients embrace the idea of e-mailing doctors and electronically scheduling appointments and refilling prescriptions.
Following society's growing need for instant results, more health care providers are starting to offer online access to their patients -- and the number of enrollees continues to climb. Patient and physician access to medical histories via computer provides safer and better quality care than paper files, experts say.
Kaiser Permanente and other regional health networks that have provided online systems are rolling out more user-friendly and secure Web sites.
…..( see the URL above for full article)
Again a great review of where things are heading from the Sacramento Bee. The rate of enrolment is clearly rising and benefits are flowing for all concerned. Clearly the degree of integration of the Kaiser Permanente’s various delivery arms makes this easier than it may be in Australia – but is seems to me it’s the sort of outcome, for patients and their carers, we should aspire to.
Fourth we have:
http://www.philly.com/inquirer/business/20070722_Hospitals_Going_High-tech.html
Hospitals Going High-tech
By Stacey Burling
Inquirer Staff Writer
If you haven't been in a hospital for a few years, you might be surprised at how technology aimed at making your stay safer and more enjoyable is emerging in this notoriously paperbound industry.
Your doctor may wheel a computer into your room during an exam.
Your nurse may scan the bar code on your ID bracelet before giving you a pill. If you face a long wait for a procedure, a hospital employee may give you a pager much like the ones those perpetually busy chain restaurants hand out. Your preemie may send you an e-mail.
At Bryn Mawr Hospital's new outpatient building in Newtown Square, patients can check themselves in using tablet computers. At the hospital's emergency department, RFID chips embedded in plastic tags tell staff where patients are, when they get an EKG, and when the doctor first sees them.
Doylestown Hospital's emergency department can now scan for information stored on RFID microchips embedded beneath the skin of some patients; the numbers coded in the tiny capsules link to medical records on the Internet.
Cameras in Virtua Health System's four emergency departments allow neurologists to examine patients with stroke symptoms remotely.
Patients at St. Mary Medical Center can order food by phone from a menu - for delivery whenever they want.
These changes in approach come in response to pressure to reduce errors, use space and employees more efficiently, and give savvy patients reasons to choose a particular hospital over a competitor.
…..( see the URL above for full article)
This is an amazing collection of the varying aspects of e-Health that are being implemented in different hospitals around Philadelphia and the impact it is having. Well worth a quick scan.
Fifth we have:
http://www.startribune.com/462/story/1311484.html
Park Nicollet gets tough on snooping in patient files
100 employees have been suspended and the clinic warned of "zero tolerance" for even a well-meaning look into electronic records of relatives or friends.
By Maura Lerner, Star Tribune
Last update: July 19, 2007 – 11:45 AM
More than 100 Park Nicollet Clinic employees have been suspended this year for violating federal laws on patient privacy -- mostly by tapping into electronic records of relatives or friends, according to clinic officials.
This week, the clinic notified its 8,300 employees about the suspensions as a reminder of what it calls its "zero tolerance policy" on confidentiality. Already, twice as many employees have been disciplined for privacy violations in 2007 than in all of 2006, officials say. They were suspended without pay for three days.
The problem has surfaced in hospitals and clinics across the nation as they have switched to electronic records. While new technology has made it easier for employees to snoop where they don't belong, experts say, it has also made it easier to catch them.
"Anyone that has anything to do with patient care, from scheduling appointments to actually performing patient care, has access to the medical record," said Susan Zwaschka, Park Nicollet's general counsel, who wrote the e-mail to the clinic staff. "That's why we take it so seriously."
In many cases, employees have been tempted to peek at charts of neighbors or family members -- a case of "old habits die hard," said Jan Rabbers, a Minnesota Nurses Association spokeswoman.
…..( see the URL above for full article)
Another example of how it is important to ensure there are both procedures, monitoring and sanctions in place to ensure electronic records are not abused. To achieve high levels of compliance and to ensure patient trust frequent policy reminders are crucial.
Lastly we have:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=511249
An Analysis of Leading Congressional Health Care Bills, 2005-2007: Part II, Quality and Efficiency
July 26, 2007 | Volume 64
Authors:
Karen Davis, Sara R. Collins, and Jennifer L. Kriss
Contact:
Editor(s):
Martha Hostetter
Overview
The U.S. health care system will become a high performance health system only with strong leadership from the federal government in partnership with the private sector.
A prior report analyzed the likely effect on U.S. health system performance of congressional legislative proposals to extend health insurance coverage. This report addresses the major bills introduced over 2005–2007 designed to advance the quality and efficiency of the health system. The bills relate to: Medicare prescription drug coverage; Medicare payment reform; transparency; health information technology; patient safety; medical liability reform; and elimination of health disparities. Although they fall short of a comprehensive strategy for systemwide improvement, the legislative proposals potentially lay a foundation for more fundamental reforms.
…..( see the URL above for full article and graphic)
I realise this looks pretty amazingly dry. However the full Executive Summary is well worth a read as it frames nicely where the various arms of Health Reform may make a difference. The full 100 + page report can also be downloaded from the site.
All in all not a bad lot to start the week!
More next week.
David.
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