February represents the 6th month of our venture into the realm of social media. As I mentioned in the original post on this blog, our intent has been to foster an objective view of the intersection of the practice of nephrology and health IT. In that spirit, today’s post will examine a few topics to keep your eye on as 2011 unfolds. In no particular order:
1. Mobile Computing
Smart phones, defined as phones with PC-like capabilities, are predicted to become more common than the classic cell phone before the end of 2011. Of additional interest to the casual observer; the most recent Nielsen ratings suggest the Android operating system is running away from both Apple and RIM (iPhone and Blackberry) and appears to be on its way to becoming a dominant player in this market. While the medical profession may not mirror the experience within the broader consumer market, I do think we will see a consolidation in the platforms supported as 2011 evolves.
2. Resurrection of the Tablet
I used a tablet PC while making rounds in the dialysis unit 5 or 6 years ago. Heavy, expensive and requiring a stylus to enter text—one had to be a true advocate to make it work. Enter the iPad. A true revolution in the realm of hardware, Apple sold about 14 million units in 2010 (including the one I bought) and remarkably expects to sell another 36 million this year. The form factor of this device makes it ideal for use in the office and the dialysis facility. Check out this review regarding its use in a hospital setting. Competition is on the horizon, however, as Google finalizes Honeycomb 3.0, the Android OS for Tablets.
3. Meaningful Use
The buzz created over the last two years will start to play out over the next few months. How successful will the program be? Who will take David Blumenthal’s place at the helm of ONC? What will be the impact on future stages of meaningful use? The answers to these questions will become apparent as 2011 unfolds.
4. Health Information Exchange (HIE)
Over the past few years a multitude of HIEs have sprung up across the country. Often started with grant money, many of these ventures have failed in the absence of a sustainable financial model. ONC is throwing their muscle behind the drive towards HIE with the Nationwide Health Information Network (NHIN). In 2011 we should witness substantial progress in this realm.
5. Accountable Care Organization (ACO)
The ACO model is variously described as a performance risk and shared cost savings construct that unites multiple providers responsible for a patient’s care delivery. The anticipated release of the final rule has been pushed back to this spring. How will this impact the nephrologist? That remains to be seen, but you can bet Health IT will be involved as a critical backbone supporting this process.
6. The Impact of the Bundle
Appropriately christened “the single largest change to dialysis provider reimbursement,” the bundle has important implications for the nephrologist’s intersection with Health IT. The bundle will increasingly align the interests of the nephrologist and the dialysis organization. Health IT has a very prominent seat at this table as these providers (nephrologists and dialysis organizations) become more closely integrated.
7. The ePrescribing Penalty
CMS has created a number of “carrot and stick” financial constructs designed to motivate providers to adopt technology. Daniel Pink describes the fallacy of this approach in his best selling book Drive. The first penalty to raise its ugly head will be the one for not being deemed a successful e-prescriber. We may need to wait until next year to see if Pink is correct, but keep your eyes on this in 2011.
8. Value Based Purchasing (VBP)
CMS is on record as stating they are moving away from their historic role as a passive payer toward an active purchaser of quality healthcare. Within this construct, the days of fee for service (FFS) where the purchaser of health care is billed for quantity instead of quality may be numbered. VBP involves a conceptual fraction (quality/price). Health IT will be at the center of this transition, facilitating the measurement of quality and assisting with the transparency of price.
9. The Evolution of Clinical Decision Support (CDS)
Historically EHRs have evolved as replicas of paper charts. In this environment many EHRs have simply served as data repositories. One of the promises of Health IT is to aggregate and transform this collection of data within an intelligent construct, serving up to the end user the right information for the right patient at the right time. Pay attention to this evolution as it begins to take the shape of robust clinical decision support.
10. ICD-10/5010 Transaction Standards
Not a popular topic and one which we will likely revisit on this blog in the near future. Everyone utilizing Health IT will be impacted by these two related topics at some point in 2011. The 5010 deadline is Jan 1, 2012, although most should be compliant prior to this date. The ICD-10 deadline is October 1, 2013, but again many of us will begin to feel the pain this year.
11. Voice Recognition (VR)
VR has come a long way over the past several years. Today the medical version of one of the leading products begins its install with a few basic questions: What is your accent? What is your specialty? As an indication of the evolution of VR, the accent options are diverse and “nephrology” is a specialty option. Why have I included VR on my list? The simple answer is that as nephrologists we have a story to tell. Whether it is within your impression and plan or as part of a letter to your referring physician, you must communicate a story. Every attempt to “template” the story that I have come across over the past decade fails to effectively tell the story. Creating the story requires free text which today is impossible to template. If you do not type 60 words per minute, the answer you seek may lie within the realm of Voice Recognition.
So there you have it. Eleven things to keep an eye on as 2011 unfolds. I would very much like to hear your thoughts on the above as well as on items I have missed. Let’s keep the conversation going.
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