At my annual physical exam last week, my primary care doctor employed a widely used web-based calculator to plug in cholesterol levels and other risk factors to estimate my likelihood of having a heart attack during the next ten years. I thought this was a neat idea until it produced an answer of 8%. Wait, you mean I have a one in twelve risk of a heart attack over the next decade? That sounded really high. She calmly and thoughtfully explained that the main value of the algorithm was to help make a judgment about prescribing statins or other interventions that could lower risk. She also noted that anything under 10% at my age was a very good number.
So, I was going to write this post to tell this story and to make the point that these kinds of estimates can be shocking for the uninformed unless we have a Data Breaches In Healthcare within which to interpret them. I was also going to assert that the estimates give an impression of precision that may not be valid. What is the standard deviation around the estimate? How often is the actual estimate found to be true?
And, then, like a deus ex machina, the New York Times published this story about the very heart risk calculator that we had been using. The pertinent excerpt: A new study finds that a widely used version of the ubiquitous heart attack risk calculator is flawed, misclassifying 15 percent of patients who would use it almost six million Americans, of whom almost four million are inappropriately shifted into higher-risk groups that are more likely to be treated with medication. No, you didn’t miss anything, there is no Government EHR. But should there be one? And if so, what should it look like? The argument in favor of a Government EHR goes something like this: If we have 19 Billion dollars to spend on EHR adoption.
Why not spend a small fraction of that money and buy or build an EHR and make it freely available to all physicians and hospitals? Not a bad idea. I would add that, if we must, we could spend the rest of those billions on training and supporting physicians in their efforts to computerize their Data Breaches In Healthcare. So how would a Government go about accomplishing such monumental task?
He first option would be a fixer upper. Buy something like Epic, which has both an inpatient and an outpatient EHR, hire a team of software developers and hordes of usability and medical informatics experts and set them down to work on the existing product. A slightly less expensive option, which is frequently mentioned, is to use VistA instead of Epic. After all the Government already spent boatloads of money on VistA and many of its users seem satisfied with the product even in its current state. Epic has many satisfied customers as well. Either way, it shouldn’t take more than a couple of years to have a fairly usable product, migrated to new technologies, scaled down for small hospitals and practices and scaled down even more for patients.
Doctors who get three-quarters of the way there won’t receive a dime. And a lot of uncertainty remains about dependent processes that CMS and ONC must quickly put in place, like accreditation of testing and certifying bodies, and the testing schemas for certification. All in all, we expect most physicians in small practices to sit on the sidelines until the dust settles
Nevertheless, while it is good to get Meaningful Use behind us, it may be better still seeing beyond it. After all, the incentive payments for becoming a “meaningful user of certified EHR technology are merely a small down payment on the savings that could be realized if health care supply, delivery and payment are affected by the changing policy and market environments over the next 5 years. The EHR incentive programs are meant to prime the pump by putting approximately billion, give or take a few billion, into the hands of physicians and hospitals who adopt EHR technology during the 5 years.
I was debating merits of DIY healthcare with my buddy HIPAA Data Breach analyst and pundit extraordinaire – the other day.I am also a big believer in ACOs, patient-centered medical homes, and informed physicians, and all that stuff, but I think increasingly Data Breaches In Healthcare consumers are going The internet has made Medical Data Breach information more accessible than ever before. People with serious illnesses and/or chronic diseases sometimes end up knowing more about their condition than their physicians. But reading and understanding a medical condition is only scratching the tip of the consumer empowerment iceberg.
What I am really interested in exploring is how technology can be used to further drive a true consumer-directed healthcare revolution. Now I want to make it clear I am not proposing that people do their own surgery. Nor am I proposing self-prescription of expensive and/or potentially toxic therapeutics.