Why Fee For Service Hurts Us: The Plain Language Version
I’ve had a few conversations recently with elected state officials, and I’m reminded that speaking plain language always helps.  Here goes: We all agree that fire stations are a good thing, right? And we agree that we don’t want them to be busy …  So if the firefighters are always watching Three’s Company reruns, that would be good.  We still pay for the fire station.  We still pay the salaries.  Happily. Therefore – paying firefighters more for fighting more fires would be silly:  their financial success would align with hardship in the community.  Bu...
Source: Docnotes - February 28, 2020 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

Toyota Mirror Replacement
.. and now for something completely different.  For me, writing a blog isn’t about getting clicks, earning ad revenue (no ads here) or getting tweeted.  I write here to share insight that may be helpful to others.  I started writing this in 1999.  Topics vary, but I don’t think I’ve blogged yet about car repair.  My last big home improvement project (replacing the tank water heater with an on-demand tankless one when the former died suddenly) was well covered on Facebook.  I think my rationale there was: “hey friends, look what I did!”  Facebook is good for t...
Source: Docnotes - February 2, 2020 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

When sponsored CDS is a crime …
Today, The Department of Justice issued an announcement that was “the first ever criminal action against an EHR vendor.” Criminal action The core of the criminal action was something inevitable:  the tension between better health and better profit.  Here’s what I saw … all of which caused me to be not-so-surprised today when the news broke. In 2008 I was the CMIO at Allscripts.  Much of my work was focused on how our customers could use our products to improve the health of our patients.  We implemented clinical practice guidelines in the software as a way to help clinical teams...
Source: Docnotes - January 28, 2020 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

A purpose
We went for a walk yesterday. Griffin carried a stick. Humans go for walks to “clear our minds” or “get in touch with nature.”  Dogs already have clear minds. For them, the freedom of a walking trail without security of a leash or the familiarity of a daily walking route can, it seems, be confusing.  “What am I here for?”  “Where are we going?”  “What’s our goal?”  Griffin (see photo above) promptly found himself purpose in the form of a big stick to carry.  “Now I feel so much better,” he seemed to say. Clay Christ...
Source: Docnotes - November 3, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

The Rapid Cycle Mini-RFP
Like many businesses, our organization has problems to solve.  We have good people, products and processes but on occasion we decide that we need more than we have.  Our Chief Strategy Officer sometimes reminds me that my vision for our achievements might not be aligned with our capacity.  Perhaps this is the role of the CEO – to think a bit bigger than we are.  But that’s another blog post.  The point here is that we may need help sometimes. When businesses develop strategies to solve problems, they generally adopt one of a handful of approaches: Hire a person or people Buy somet...
Source: Docnotes - October 6, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

#TweetRegret?
I have been an occasional Twitter user for a long time.  Indeed, I’ve used Twitter since long before you even knew Twitter existed.  I say this with some confidence, as Jack Dorsey posted the first tweet in March, 2006.  My first tweet was four months later in July 2006. I am Twitter user #1922.  Today there are over 130 million twitter users. Twitter is an effective medium to communicate short messages to many people. It’s also an easy way to say something  – or imply something – that you didn’t quite mean, or didn’t get to explain deeply enough. Blogs are bette...
Source: Docnotes - September 27, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Health Policy VBP Source Type: blogs

It ’ s not a beer
When we announced a few weeks ago that our IPA had executed our first contract, I found myself explaining what an IPA is and what it does.  An IPA is a business entity that assists multiple independent organizations to contract with managed care organizations (health plans).  But it’s uncommon (unheard of?) for an IPA to work with organizations that are not physicians.  We even had to update the Wikipedia entry on IPA to clarify that physicians aren’t the only ones who can create or join an IPA. Where we are now We have over thirty organizations participating in the IPA.We have two executed agree...
Source: Docnotes - August 27, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

Conferences / Unconferences
Our (amazing) team at Alliance for Better Health is planning an event in June.  The purpose is to bring together people in our community who are using the Healthy Together platform, celebrate the community’s accomplishments, and strengthen the connections so that we can find greater success in the future. I offered a thought this morning that perhaps this isn’t a conference, but an unconference.  I wikipedia-ed (it’s a verb, yes?) the term, hyperlinked it in my email and (after sending) went back to read the wikipedia entry.  It’s accurate and (I now know) expresses a long history of ...
Source: Docnotes - April 19, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

#HampForward
A few days ago, I wrote about the convergence that seemed to be happening at Hampshire College. Yesterday, the President and another Board member resigned.  There was cheering and excitement at Hampshire, facebook, and Slack. Why was there cheering?  Because the President charted a course for Hampshire that many in the community felt was (so far) an unnecessary last resort.  Is it possible that Hampshire would some day need to partner with another institution?  Yes.  It’s possible – after other options are deemed infeasible.  The problem here is that the community doesn’t und...
Source: Docnotes - April 6, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

Hampshire College: Convergence?
Yahoo! It’s Spring! Wow.  It’s been too long since I’ve posted here.  I’ve been busy with my day job .. and writing elsewhere (some recent stuff referenced here).  Now .. the topic of today: Hampshire College. It’s not in a good spot.  Lots of history here .. and here .. and here.  Yesterday’s Boston Globe article is a short summary of the most recent events. Why do I care?  Because – well – Hampshire is an amazing place, doing amazing things, and the world needs it to be there forever.  I spent three years there as a student, an...
Source: Docnotes - April 3, 2019 Category: Primary Care Authors: Jacob Tags: Uncategorized Source Type: blogs

Why we ’ re launching a Consumer Directed Exchange (CDEx) project
If your first question is “what’s Consumer Directed Exchange?” please feel free to google it and come back. Last week, Alliance for Better Health?launched the first regional effort in the United States toward facilitating CDEx for Medicaid Members. Here’s my short (?) version of what/why/how We consumers (people?) are becoming increasingly aware of the information that others have acquired about us.? We implicitly trust Facebook, Google, Apple, etc. to keep our information safe, and share it with others only when we choose.? As health care has evolved from paper, there is now an extraordinary quanti...
Source: Docnotes - July 30, 2018 Category: Primary Care Authors: Jacobr Tags: Consumer Source Type: blogs

Why we ’ re launching a Consumer Directed Exchange (CDEx) project
If your first question is “what’s Consumer Directed Exchange?” please feel free to google it and come back. Last week, Alliance for Better Health launched the first regional effort in the United States toward facilitating CDEx for Medicaid Members. Here’s my short (?) version of what/why/how We consumers (people?) are becoming increasingly aware of the information that others have acquired about us.  We implicitly trust Facebook, Google, Apple, etc. to keep our information safe, and share it with others only when we choose.  As health care has evolved from paper, there is now an extra...
Source: Docnotes - July 30, 2018 Category: Primary Care Authors: Jacobr Tags: Consumer Source Type: blogs

Apple, Cerner, Microsoft, and Salesforce
… all rumored to be in the mix to acquire athenahealth. Nope. Why not? a) Apple doesn’t do “verticals.”? It’s that easy.? Apple sells products that anyone could buy.? A teacher, a doctor, my mom.? Sure – they have sold high-end workstations that video editors can use, but so could a hobbyist filmmaker. Likelihood of Apple buying athenahealth?? ~ .01% b) Cerner?? Nah. While (yes) they have an aging client-server ambulatory EHR that needs to be replaced by a multi-tenant SaaS product (like the one athenahealth has built), they have too much on their plate right now with DoD and VA and the...
Source: Docnotes - June 8, 2018 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Apple, Cerner, Microsoft, and Salesforce
… all rumored to be in the mix to acquire athenahealth. Nope. Why not? a) Apple doesn’t do “verticals.”  It’s that easy.  Apple sells products that anyone could buy.  A teacher, a doctor, my mom.  Sure – they have sold high-end workstations that video editors can use, but so could a hobbyist filmmaker. Likelihood of Apple buying athenahealth?  ~ .01% b) Cerner?  Nah. While (yes) they have an aging client-server ambulatory EHR that needs to be replaced by a multi-tenant SaaS product (like the one athenahealth cas built), they have too much on their plate rig...
Source: Docnotes - June 8, 2018 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Funding Disruptive Innovation
“Innovation” is a provocative word. For some, it invokes an eye-roll of disdain: “why can’t we just get our work done?” They rhetorically ask.? Sometimes, the way we are doing things is just fine.? Why distract ourselves with new variants of people, processes, or products just for the sake of doing something new? These folks have a point.? Sometimes we just need to do what needs doing. And sometimes the way we’ve been doing it (or even what we’ve been doing) isn’t optimal.? “There must be a better way” says … someone. That someone is the innovator.? The eye...
Source: Docnotes - May 7, 2018 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Funding Disruptive Innovation
“Innovation” is a provocative word. For some, it invokes an eye-roll of disdain: “why can’t we just get our work done?” They rhetorically ask.  Sometimes, the way we are doing things is just fine.  Why distract ourselves with new variants of people, processes, or products just for the sake of doing something new? These folks have a point.  Sometimes we just need to do what needs doing. And sometimes the way we’ve been doing it (or even what we’ve been doing) isn’t optimal.  “There must be a better way” says … someone. That someone is the...
Source: Docnotes - May 7, 2018 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Parsing Volume to Value, Proxy Measures, and the Streetlight Effect
Despite some concern that the migration from fee-for-service to value based payment (VBP) is being reversed, there remains strong momentum for VBP – both nationally – in the form of the bipartisan 21st Century Cures Act that was passed and signed into law last December, and many state and commercial initiatives, including the one I’m personally involved with, New York Delivery System Reform Incentive Payment Program (DSRIP). ?Defining value, of course, is not easy. ?I’ve often returned to Michael Porter’s short essay on this topic when I feel my definition meandering. Go read it now. ?Please. ...
Source: Docnotes - August 19, 2017 Category: Primary Care Authors: Jacobr Tags: Technology Value Source Type: blogs

Parsing Volume to Value, Proxy Measures, and the Streetlight Effect
Despite some concern that the migration from fee-for-service to value based payment (VBP) is being reversed, there remains strong momentum for VBP – both nationally – in the form of the bipartisan 21st Century Cures Act that was passed and signed into law last December, and many state and commercial initiatives, including the one I’m personally involved with, New York Delivery System Reform Incentive Payment Program (DSRIP).  Defining value, of course, is not easy.  I’ve often returned to Michael Porter’s short essay on this topic when I feel my definition meandering. Go read it now....
Source: Docnotes - August 19, 2017 Category: Primary Care Authors: Jacobr Tags: Technology Value Source Type: blogs

Parsing eCW ’ s $155M payment to the government
UPDATE: ?Here are the public records for the case. ?More details there about the original complaint. ?Excerpt: @eClinicalWorks to pay $155M fine: https://t.co/RngioK62SX But what’s it mean? Certification The purpose of any certification program is to create a method for the purchasers of a product to have confidence that the product safely and reliably does what it is supposed to do. ?One example from USDA: Turning Point for Meat Inspection ??In 1905, author Upton Sinclair published the novel titled The Jungle, taking aim at the poor working conditions in a Chicago meatpacking house. However, it was the fi...
Source: Docnotes - June 1, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Parsing eCW ’ s $155M payment to the government
UPDATE:  Here are the public records for the case.  More details there about the original complaint.  Excerpt: @eClinicalWorks to pay $155M fine: https://t.co/RngioK62SX But what’s it mean? Certification The purpose of any certification program is to create a method for the purchasers of a product to have confidence that the product safely and reliably does what it is supposed to do.  One example from USDA: Turning Point for Meat Inspection   In 1905, author Upton Sinclair published the novel titled The Jungle, taking aim at the poor working conditions in a Chicago meatpacking...
Source: Docnotes - June 1, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

National Coordinator 6.0: A Blueprint for Success
  1.0 Brailer 2.0 Kolodner 3.0 Blumenthal 4.0 Mostashari 4.1?me 5.0 DeSalvo 5.1 Washington 5.2 White 6.0 Rucker Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. ?Don Rucker is a good pick for the nation, and will be a great National Coordinator. ?I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. ?Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. ?I have known Don for 20 years. ?He’s got a long track record of integrity, he’s a...
Source: Docnotes - March 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

National Coordinator 6.0: A Blueprint for Success
1.0 Brailer 2.0 Kolodner 3.0 Blumenthal 4.0 Mostashari 4.1 me 5.0 DeSalvo 5.1 Washington 5.2 White 6.0 Rucker Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC.  Don Rucker is a good pick for the nation, and will be a great National Coordinator.  I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words.  Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS.  I have known Don for 20 years.  He’s got a long track record of integrity, he&r...
Source: Docnotes - March 31, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Career Transitions
I had lunch yesterday with an industry colleague who was recently let go from his job with a big company. ?He is now?doing what everyone told him to do: ?network, network, network – to find the next big thing. ?Our lunch was of course part of that networking. ?Who do I know? ?Which companies might be hiring people with his skills? ?His sense of urgency (despite the?generous severance package) was palpable. Initially, I answered his questions: ?we brainstormed about?this company or that?company, and I offered to introduce him to some CEOs who may have interest in him. But after the server brought our lunch, and the ca...
Source: Docnotes - January 28, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Career Transitions
I had lunch yesterday with an industry colleague who was recently let go from his job with a big company.  He is now doing what everyone told him to do:  network, network, network – to find the next big thing.  Our lunch was of course part of that networking.  Who do I know?  Which companies might be hiring people with his skills?  His sense of urgency (despite the generous severance package) was palpable. Initially, I answered his questions:  we brainstormed about this company or that company, and I offered to introduce him to some CEOs who may have interest in ...
Source: Docnotes - January 28, 2017 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Why do I run marathons?
That’s me over there in the white shirt. ?Six days ago. ?It was a day that I had worked toward since ~ March. ?I’ve done this every year since 2010. ?For about 15 minutes after the marathon, I was sure that it was my last. ?I ran a 1/2 marathon about 3 weeks ago, and it was amazing. ?I loved it. ?I was downright gleeful afterward. ?Not so after 26.2 – especially NYC, which has a very difficult last 5 miles. ?Just walking the ~ 3/4 mile after the finish was painful. ? Why do I do this every year? Resilience Discipline That’s it. ?If you know someone who has run a marathon, you know a person who has...
Source: Docnotes - November 12, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Why do I run marathons?
That’s me over there in the white shirt.  Six days ago.  It was a day that I had worked toward since ~ March.  I’ve done this every year since 2010.  For about 15 minutes after the marathon, I was sure that it was my last.  I ran a 1/2 marathon about 3 weeks ago, and it was amazing.  I loved it.  I was downright gleeful afterward.  Not so after 26.2 – especially NYC, which has a very difficult last 5 miles.  Just walking the ~ 3/4 mile after the finish was painful.   Why do I do this every year? Resilience Discipline That’s it.  If you know so...
Source: Docnotes - November 12, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Service Innovation
?Shift the business models? ?Re-align the incentives? ?Fee-for-value? These phrases are not new. Nor are the concepts they represent. Yet we?re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health. Notice that I said ?improve health.?? I didn?t say ?Improve health care.?? This not just an insignificant semantic nuance.? When we conflate care and health, we accept the fundamentally flawed assumption that in order for people to be healthy, we ...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs

Service Innovation
“Shift the business models” “Re-align the incentives” “Fee-for-value” These phrases are not new. Nor are the concepts they represent. Yet we’re starting to see new experiments from the federal government, from states, and even small communities that demonstrate a new willingness to deeply engage in understanding and overcoming the barriers to true change in how we improve health. Notice that I said “improve health.”  I didn’t say “Improve health care.”  This not just an insignificant semantic nuance.  When we conflate care and health, we...
Source: Docnotes - September 16, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Value Source Type: blogs

Advice to the new National Coordinator
Two and a half years ago, John posted an entry with this title?- and I recall that it was a good summary of the state of the industry. ?While I didn’t agree with all of his suggestions, I enjoyed the review and it offered a good set of guiding principles. ?Since I was Acting National Coordinator for about the same duration as Vindell will serve, (Fall of 2013 – after Farzad Mostashari departed, and before Karen DeSalvo arrived) I’ll offer some thoughts?from?one who has been in his?position. Certification. ?The health IT certification program is the core of ONC’s responsibility to the nation. ?Whil...
Source: Docnotes - August 15, 2016 Category: Primary Care Authors: Jacobr Tags: Electronic Medical Records Medicine and technology Uncategorized Usability Value Source Type: blogs

Advice to the new National Coordinator
Two and a half years ago, John posted an entry with this title – and I recall that it was a good summary of the state of the industry.  While I didn’t agree with all of his suggestions, I enjoyed the review and it offered a good set of guiding principles.  Since I was Acting National Coordinator for about the same duration as Vindell will serve, (Fall of 2013 – after Farzad Mostashari departed, and before Karen DeSalvo arrived) I’ll offer some thoughts from one who has been in his position. Certification.  The health IT certification program is the core of ONC&rs...
Source: Docnotes - August 15, 2016 Category: Primary Care Authors: Jacobr Tags: Electronic Medical Records Medicine and technology Uncategorized Usability Value Source Type: blogs

Self-Driving Health
Lots of news about this recently.  Five years ago, you would shake your head and say “no way – not in my lifetime.”  Now you know that this is our future.  It will be safer, will save billions of dollars, and will be have positive consequences we can barely imagine.  The kids need to go to soccer practice?  Send them.  Get the dog to the vet for his check-up?  Plop him in the car and off he goes. It’s real. It will happen.  Soon. So why is it so hard for us to imagine self-driving health?  Do we have a crisis of under-supply of primary care?  Ye...
Source: Docnotes - March 17, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Volume to Value: it ’ s about the caboose
In his post last week, John Halamka expressed optimism: I left HIMSS this year with great optimism. Vendors, technologies, and incentives are aligned for positive change. 2016 will be a great year. Perhaps we were seeing different sides of HIMSS. Yes. there is a “buzz” around the migration from volume to value. Walking the floor of the exhibit hall, it was hard to avoid companies – old and new – describing their population health / care coordination / analytics tools. Yet I didn’t see very much that was really new – really focused on value. I saw re-configured versions of old stuff. One ...
Source: Docnotes - March 12, 2016 Category: Primary Care Authors: Jacobr Tags: Value Source Type: blogs

New York ’ s SHIN-NY Regulation
Posted today. PDF:  SHIN-NY rule. I’ll add narrative later today. (Source: Docnotes)
Source: Docnotes - March 9, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Are follow-up visits necessary?
I've spent two afternoons precepting with the residents recently.  It's good to get back into clinical work – and after spending 3 years in Washington – separated by the Beltway from the real world – I've really felt the need to get back to the front lines of health care delivery to make sure I still understand the real world.  I'm also seeing a window into how these physicians have been trained, and that is different from my life as a family physician in a small suburban practice – which was my reality pre – DC. I've witnessed two themes that seem to de...
Source: Docnotes - February 7, 2016 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Are follow-up visits necessary?
I've spend two afternoons precepting  (Source: Family Medicine Notes)
Source: Family Medicine Notes - February 7, 2016 Category: Primary Care Authors: Jacob Source Type: blogs

CMS RFI on MACRA
I’m a few weeks short of the 1 year anniversary of my departure from federal service.  I loved my time in Washington, and loved the people, the passion, the sense of purpose, and of course the focus on doing what’s right for the nation.  What was intended to be a 1-2 year adventure became a 3 years of commuting to DC from my home in Albany, New York. Stepping away from government has given me the opportunity to get back to the front lines of the intersection of information technology and health.  Notice that I didn’t say “health care.”  Sure – “care&rd...
Source: Docnotes - October 24, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Dad ’ s Eulogy
  It’s been a few months that I’ve been writing this. Well, not quite writing it. Crafting would be more like it. In my head.  Over and over.  Today I needed to write it. The waves of sadness we have felt the past few days are calmed by an undercurrent of peace. We know that dad was ready to go. He had talked about it for weeks. He wanted his life to be rich and full and warm and happy right up until the instant he departed. And it was. I’ve wanted to capture the message. The message that dad sent me for fifty two years, and which I hope can be heard by you – those of you here sharin...
Source: Docnotes - August 18, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Dad's Eulogy
(Source: Family Medicine Notes)
Source: Family Medicine Notes - August 18, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

My Dad
Dad's traverse is complete.  He did it his own way.  Of course.  To be published in various newspapers ..  ——- Arthur Elliot (Pete) Reider, MD —— Arthur Elliot (Pete) Reider, MD, died peacefully at home in San Francisco of lymphoma on Thursday August 13th 2015.  Janet Sampson Reider, his wife of 57 years, and all three of his children were by his side.  Dr. Reider and Janet divided their time for the last few years between their family home in Newton Massachusetts, a home in Vermont and San Francisco where they grew up. A graduate of Harvard Medical School, Pete mar...
Source: Docnotes - August 17, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

My Dad
Dad's traverse is complete.  He did it his own way.  Of course.  (Source: Family Medicine Notes)
Source: Family Medicine Notes - August 16, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

Avoid ICD-10! Yes you can!
Lots of news/talk about ICD-10 these days.  Most organizations are spending time and money training care providers on it.  Software developers are busy implementing it – often by changing diagnosis selection search menus from ICD-9 to ICD-10. They're missing a fantastic opportunity. ICD-9-CM and ICD-10-CM are administrative coding systems.  They're used to code diagnoses. Clinicians have (unfortunately) been forced to learn many ICD-9 codes and are being told that we need to shift to ICD-10.  Some of our colleagues are hoping that they can just use ICD-9 and "someone else" will c...
Source: Docnotes - July 23, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Avoid ICD-10! Yes you can!
Lots of news/talk about ICD-10 these days.  Most organizations are spending time and money training care providers on it.  Software developers are busy implementing it - often by changing diagnosis selection search menus from ICD-9 to ICD-10. (Source: Family Medicine Notes)
Source: Family Medicine Notes - July 23, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

Is it Disruptive?
It’s hard to hear a pitch, listen to a speech, or read blogs without hearing/seeing a claim that some cool new thing is distruptive. Most innovations are sustaining innovations. Here’s a good checklist for whether something is a disruptive innovation (via this post in HBR): Does the product either target overserved customers (by offering lower performance at a lower price) or create a new market (by targeting customers who couldn’t use or afford the existing product)? Does it create “asymmetric motivation,” meaning that while the disrupter is motivated to enter higher performance segments o...
Source: Docnotes - April 22, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

Is it Disruptive?
It’s hard to hear a pitch, listen to a speech, or read blogs without hearing/seeing a claim that some cool new thing is distruptive. Most innovations are sustaining innovations. Here’s a good checklist for whether something is a disruptive innovation (via this post in HBR):Does the product either target overserved customers (by offering lower performance at a lower price) or create a new market (by targeting customers who couldn’t use or afford the existing product)? Does it create “asymmetric motivation,” meaning that while the disrupter is motivated to enter higher performance segments over ...
Source: Family Medicine Notes - April 22, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

3rd Platform for Health IT
For the low-low price of $4500 (that's $500 per page) you can buy this 9 page report on how the athenahealth-BIDMC alignment is evidence that cloud-based information technology will form the basis of tomorrow's health IT solutions.  Obviously, I've not read the report.  It's not clear if Bernie Monegan has either, but she's written an article about it, which has generated some buzz on the Internet in recent days.  (One wonders about a relationship between HIMSS – which owns Healthcare IT News – and ICD – but I don't recall that there is one) ..  Let me save you ...
Source: Docnotes - April 1, 2015 Category: Primary Care Authors: Jacobr Tags: Uncategorized Source Type: blogs

3rd Platform for Health IT
For the low-low price of $4500 (that's $500 per page) you can buy this 9 page report (Source: Family Medicine Notes)
Source: Family Medicine Notes - April 1, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

The High Cost of Free Checkups | The Health Care Blog
Vik and Al's post (Source: Family Medicine Notes)
Source: Family Medicine Notes - February 15, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

It's time to stop calling them EHRs
It’s time to stop calling them EHRs.  Yes - we also need to stop calling them EMRs.  In 2011, ONC discussed the difference between the two terms, but I think that conversation missed the point:  whethere it’s “medical” or “health” that is the focus, these aren’t (shouldn’t be) RECORD systems at all.  We need to expand our expectations from CRUD to something that we really need: smart tools that help us collaborate toward improving health for individuals.   In November, when I floated this concept, I was teased (corrected?) for ...
Source: Family Medicine Notes - February 9, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

AMA's letter to ONC
The AMA and 33 other organizations sent a letter to National Coordinator Karen DeSalvo last week.  The letter has seven requests of ONC:Decouple EHR certification from the Meaningful Use program;Re-consider alternative software testing methods;Establish greater transparency and uniformity on UCD testing and process results;Incorporate exception handling into EHR certification;Develop C-CDA guidance and tests to support exchange;Seek further stakeholder feedback; andIncrease education on EHR implementation.Let’s take them one-by-one … Decoupling EHR certification from the EHR incentive programs. ...
Source: Family Medicine Notes - January 22, 2015 Category: Primary Care Authors: Jacob Source Type: blogs

Patient Centered IT
(Source: Family Medicine Notes)
Source: Family Medicine Notes - January 22, 2015 Category: Primary Care Authors: Jacob Source Type: blogs