What's Holding Up Those Darned EMRs?

Posted by ED

<ed.note><This is an "ed-itorial" so don't yell at the MBP folks.</ed.note>

<ed.note><Update>: Alton Brantley, MD, PhD, at CCIGroup.org, sent me this very helpful clarification: Ed, The "Health Information Technician" job that you are picking up on is the job description for a person working in Health Information Management which is, today, responsible for handling and codifying paper information. See this. These persons are not informaticists. Informaticists are generally physicians, nurses, and other medical professionals who specialize in understanding medical care processes. They are generally funded at their primary capability level (doctor, nurse, etc).

In a follow up email he adds:

The field of medicine, just like any other discipline, has its own terms. The "Health Information Management" activity used to be known simply as "Medical Records" which was not easily confused with Information Technology or Systems.

There are, in fact, numerous programs to develop health informaticists, funded through the National Library of Medicine. That would be where you should start looking. Generally, one can also get masters degrees in (e.g.) nursing with a focus in information technology and management. The important point is that medical IT is not something one comes at functionally from the technology side. Systems analysts who work in health care settings, over time, learn the applied skills.

Health Care IT is by and large driven by the vendors in the field, as hospitals do not consider developing IT to be part of their core mission. (I've always thought this strange, because many companies such as FedEx are not not IT companies either, but they develop IT systems to drive their business).</Update></ed.note>

Where are the health informaticists necessary to build out the distributed, digital healthcare enterprise? The following is just another factor under the rubric of you get what you incent:

The National Science Foundation’s Federal Cyber Service
The National Science Foundation’s (NSF) Federal Cyber Service Scholarship For Service (SFS) is a unique program designed to increase and strengthen the cadre of federal information assurance professionals that protect the government's critical information infrastructure (NSF, DHS, OPMn NSA, Office of Management and Budget (OMB), Department of Treasury). This program provides scholarships that fully fund the typical costs that students pay for books, tuition, and room and board while attending an approved institution of higher learning. Additionally, participants receive stipends of up to $8,000 for undergraduate and $12,000 for graduate students. The scholarships are funded through grants awarded by the National Science Foundation NSF.

The National Institutes of Health Loan Repayment Programs
NIH Loan Repayment Programs are a vital component of our nation's efforts to attract health professionals to careers in clinical, pediatric, health disparities, or contraception and infertility research. In exchange for a two or three-year (for Intramural General Research) commitment to your research career, NIH will repay up to $35,000 per year of your qualified educational debt. In addition, the NIH will make corresponding Federal tax payments for credit to your Internal Revenue Service tax account at the rate of 39% of each loan repayment to cover your increased Federal taxes. The NIH may also reimburse any increased state or local taxes and/or additional increased Federal taxes (where the Federal tax payments were not sufficient to fully cover your increased Federal taxes) that you incur as a result of your LRP benefits.

Nationwide Health Information Network
So far as I know, Squat.

There is no fedgov educational funding or loan repayment or deferment to "convert" the general post dot com bust out of work IT worker into a health informaticist; and even if there were, they couldn't afford to work in the profession. Please see the following:

From http://www.tnhealthcareers.com/html/him.htm
Health Information Technician – $23,530*
*average median annual earnings

From http://www.usnews.com/usnews/biztech/best_careers_2007/careertable.htm
Clergy - $78,690
Higher Ed. Administr. - $109,557
Management Cnsltnt. - $96,245
Systems Analyst - $70,438

Add to this the pressures to outsource, offshore and down-salary. If you've heard differently, please let me know and I'll post the info here.

Project melds health-care, banking info - Backers say idea could slash costs of medical care

Posted by ED - I would note, ironically, that Patient Privacy Rights - http://www.patientprivacyrights.org, is hosted on Convio, which has several other medically-related associations as customers. Why, Convio could be aggregating that data as we speak. PPR testifies to the necessity of Medical Banking's proposed "unified view" by their own portal practice. See, that high school debate pays off...

Casillas' reaction to the comments made by a privacy advocate in the Tennessean article cited below

Comment: Public Trust is the centerpiece of MBProject's effort to reduce healthcare costs in America utilizing well financed and refined banking systems. No entity has so emphasized this critical issue in cross-industry public forums as MBProject. This very issue has defined us, and we have been instrumental in defining policy in this key area and continue to do so. Our work was recognized by not a few privacy groups (see EPIC testimony to NCVHS). We stand on our record to emphasize the criticality of HIPAA and banking by organizing 12 HIPAA Policy Roundtables over 24 months, reaching over 230 bankers, healthcare and financial agencies and a good many others. Our first two full day Institutes completely focused on this key issue. Today, our Member banks embrace HIPAA inasmuch as the convergence of banking and healthcare is a "fait accompli", whether via better payment processes, consumer-driven healthcare, more liquidity for healthcare, etc. Banks fall under the HIPAA blanket of protection in their relationships with HIPAA covered entities, and so cannot use patient data without authorization. Some may be surprised to learn that many large banks are HIPAA-covered entities who have a direct federal obligation. Moreover, external to this discussion, Public Trust has and ever will be central to banking operations. Without it, banks cease to exist. Privacy advocates should know that MBProject continues to lead efforts to instill Public Trust in medical banking models as we implement a digital framework that will improve healthcare in America and around the world.

Wednesday, 05/09/07, By GETAHN WARD, Staff Writer, the Tennessean

Imagine going to your bank's Web site and being able to pick a doctor, schedule an office visit, check lab results or pay a bill from your last appointment.

That's one of the initiatives of the Medical Banking Project, a Franklin-based think tank that advocates using back-office systems perfected by banks to slash health-care costs.

Later this year, the project plans to launch a computer-based platform called BoardTrust that would let banks share information, including medical records, and provide standards to govern that process.

Executive Director John Casillas thinks banks could cut health-care costs and that they could certainly help trim the $35 billion a year spent to process medical bill payments.

"We're linking the banking system into health care so the health-care world doesn't have to invest in technology and processes that banks already have spent on heavily," Casillas said.

Banks know security

Backers of the project point to investments that banks already have made to secure data — and their Web sites — and the trust many people have in banks among reasons why the idea should work.

"If you trust your bank with your money, why wouldn't you trust it with your health records?" asked David Harris, a partner in New York with accounting and consulting firm PricewaterhouseCoopers, a corporate member of the Medical Banking Project.

Some privacy advocates, however, are concerned that banks could share that information with affiliates and other third parties, creating a nightmare scenario.

"For them to have your medical records too is actually a terrible idea," said Dr. Deborah Peel, a psychiatrist in Austin, Texas, and chairwoman of Patient Privacy Rights, which represents patients and consumers.

Peel's group supports bills soon to be introduced in Congress that would create health data banks in which people could store copies of their medical records. Consumers would control who sees the records, which couldn't be sold without their approval, she said.

Casillas agrees privacy concerns are a barrier. But he said that even without passage of the bills likely to be sponsored by Republican Sen. Sam Brownbackand Democrat Rep. Dennis Moore, both of Kansas, banks could proceed.

In the medical banking model, consumers would have control over their records, Casillas said.

For Casillas, there's also challenges in getting banks and health plans to work together because both ultimately want to own the consumer.