Sunday, August 30, 2009

Choosing health care in MN based on best quality and cost

Want to compare health care providers in Minnesota for the quality of care they provide and total health care cost? Use Minnesota HealthScores, a non-profit Web site that helps consumers choose the best MN health care providers for them and their family based on cost and quality of health care they provide. compares cost and quality of care provided by medical groups and clincs for the following conditions:
* Asthma
* Breast cancer screening
* Cancer screening
* Cervical Cancer Screening
* Chlamydia screening
* Colorectal cancer screening
* Depression
* Diabetes
* High blood pressure
* Vascular disease also provides cost reports that display payment amount for physician services, including amount a health plan pays for a procedure such as colonoscopy or office visit plus the amount a health plan tells the physician to collect as a copayment from the patient. uses data provided by MN health plans and data submitted by more than 300 medical clinics statewide.

Here are some ways consumers can use
* determine how well care is being delivered by your clinic
* learn about what type of care or "standard of care" consumers should expect from the health care system, so that they can discuss it with their health care team
* search for a new medical group or clinic
* If you have a specific condition, such as diabetes, review the scores for the diabetes measure to determine which medical groups in your area had the highest scores. Groups with the highest scores performed better in giving patients the right care for this health condition.
* determine payment amount for physician services


Being a Minnesota resident, I decided to learn about the state's HIE efforts. MN HIE is operational and has ~3 million residents (or 58% of MN population) in its patient directory. It provides medication history for past 12 months via provider's EMR or via a secure web application, and will provide following additional services starting this fall:

* patient eligibility
* lab results
* immunization history
* exchange of medical record information

Since medication history is based on pharmacy claims data, clinical data exchange will be possible starting this fall when medical record information exchange is offered as a service by MN HIE.

Do you know the "state" of your state's HIE?

Monday, August 24, 2009

Disease registry: "Chronic disease tracking system" for those who cannot afford an EMR

For practices that do not plan to purchase an EMR and want to proactively manage the health of population, a registry can be used instead. This registry can be used to track a practice's diabetes patients, including their required labs and preventive services. This information can then be used to manage population health proactively.

A simple MS-Excel based Disease registry can be found here at This file tracks interventions and clinical parameters that are important in diabetes management. In case problems are encountered, an alert is displayed. For instance, if the date of a patient's last A1C was more than 90 days ago, that date cell turns yellow as a warning; and turns red if more than 180 days ago.

Identifying all patients in the practice with a chronic disease such as Diabetes type 2 and initial data entry of this registry excel sheet are identified as major challenges to achieving a complete and functional disease registry. However, once the registry is complete, it provides many advantages:

  • Proactive management of chronic diseases
  • Use for preventive services and screenings such as Pap smears, mammograms, colon cancer screening etc. for general patient population
  • Increased compliance with recommended services
  • Improved patient care
  • Document performance as part of p4p activities

Dr. David Ortiz who created this registry worksheet recommends:
  • Start small, pick a chronic condition that you want to improve
  • Involve your practice staff. Get their buy-in and agreement before operationalizing the plan

Friday, August 21, 2009

IT critical to improving care of patients with chronic diseases

There are those who suspect the power of health IT to significantly improve cost and quality of care. Quite likely they may also consider funneling multi-billion stimulus funding to HIT a colossal waste. Here is evidence that proves otherwise and might even force such detractors to rethink their opinion.

Results of a 5-year Medicare Physician Group Practice Demonstration study involving 10 large MD practices were published that attributed improved quality of care for patients with chronic diseases to use of HIT. This Medicare Physician Group Practice Demonstration study is also mentioned as the "first" P4P project to work directly with physician practices. Here are some impressive figures from this study.

* Geisenger improved care on all 32 categories that include continuing programs for diabetes and coronary artery disease, adult preventative care, and hypertension

* University of Michigan (UM) Family practice group improved care on 29 categories. Care improvements were made in areas that included diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.

* UM Family Practice group claims $2.9M in Medicare savings surpassing the CMS target

How did they get this done?

* Provided clinical decision support through alerts/reminders within the EHR

* Start small and then expand the program - First year focus on Diabetes. Congestive heart failure and coronary artery disease were included in second year. Hypertension in year three.

* Commitment of physicians and administrators within the practices

Reducing costs while improving care -- who says it can't be done!! Studies such as the one cited above have far-reaching consequences considering chronic diseases account for ~60% of the deaths worldwide and half of them can be prevented!

Tuesday, August 18, 2009

EHR video tutorial

Here is an EHR tutorial from The Video Network.

Monday, August 17, 2009

EMR | EHR | PHR | HIE | RHIO defined

NAHIT (National Association for Health Information Technology) is shutting down Sep 30th. It published HIT terminology definitions, including those for EMR EHR HIE and RHIO. Complete report can be found here.

Sunday, August 16, 2009

HIEs and their status

Here is a directory of HIEs compiled by eHealth initiative. HIEs in Stage 5, 6, and 7 are operational HIEs. This is one of the most comprehensive and updated HIE directory I have come across.

If you find your HIE is not included, please use the link on the directory page to submit your HIE informaiton.