Economics of Health IT in Small Practices

A Health Affairs research article entitled ‘The Value of Electronic Health Records In Solo or Small Group Practices’ presents some much needed economic data on EHR deployments in small offices. Of interest to Free and Open Source Software users is that according to this study, one-third of the cost was due to proprietary software: ‘…Software, training, and installation costs averaged $22,038 per FTE provider. Where data permitted separate estimates, we calculated that software alone accounted for about one-third of overall costs. Software costs depended on such factors as interfaces, other EHR-related software, and the negotiating savvy of the EHR champion; one practice acquired sharply discounted software from another practice. Installation and training costs ranged from virtually none (where there were technically savvy EHR champions) to more than $14,000 per FTE provider. Hardware costs per provider averaged almost $13,000 per FTE provider, ranging from under $7,500 for four practices that had new equipment pre-EHR or acquired used equipment to more than $23,000 for two practices that had little usable pre-EHR equipment, including networking. Revenue losses from reduced visits during training and implementation averaged $7,473 per FTE provider, ranging fromnone (in two practices) to $20,000 per FTE provider in one practice. Losses depended in part on the extent to which providers worked longer hours initially instead of reducing patient visits…’

Open Source EHR Katrina Relief Network

After the podcast call to action Jordan Glogau and Fred Trotter have decided to announce the Open Source EHR Katrina Relief Network.

The idea is to use groups of open source volunteers to get clinics and hopsitals in Katrina effected areas up and running using open source medical software.

If you are an open source hacker and were wondering how you could help, then this is it! Please get in touch with us!

Health Affairs Issue on Health IT Policy

The September 2005 issue (subscription required) of Health affairs is devoted to Health IT public policy. An excerpt from one of the abstracts reacting to a RAND report on building a National Health Information Network: ‘…The current fascination with electronic medical records (EMRs) is not new. For decades, vendors have capitalized on this enthusiasm. But hospitals and clinics have ended up with little to show for their large outlays. Indeed, computing at a typical hospital has not gotten much beyond what was available twenty-five years ago. The RAND analysis continues the tradition of hope and hype. Unfortunately, behind their impressive predictions of savings lie a disturbing array of unproven assumptions, wishful thinking, and special effects…’

3 NHIN Conracts Totaling $17.5 Million Awarded

Among others, Healthcare IT News is reporting that 3 contracts have been awarded under the National Health Information Network (NHIN) RFP. $3.3 million to the American National Standards Institute (ANSI) for you guessed it: health IT standards, $2.7 million to The Certification Commission for Health Information Technology for certifying electronic health record software and infrastructure and finally $11.5 million to Health Information Security and Privacy Collaboration to evaluate business policies, state and local laws that could interfere with electronic health records exchange. These were supposed to have been awarded in September and totaling approximately $100 million. Anonymous sources tell me that the other slots for infrastructure and exchange demonstrations were not funded at all possibly due to the hurricane Katrina response effort. However, they might be funded in the future. Linux Medical News previously reported on this massive federal request for proposal here, here and here.

AMA: CMS takes baby step toward national network

AMA News has a story about CMS efforts with VistA Office Electronic Health Record or VOE: ‘The grand plans of the Centers for Medicare & Medicaid Services to create a national health information network will soon be off to a humble start. CMS plans to recruit five to 10 small group practices to test what it hopes will become a widely used electronic medical record. However, if physicians were hoping to get a free system from the CMS, they’re out of luck. Even those participating in the test will have to pay.

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FreeMED in Japanese

FreeMED shortly will be available in Japanese. A group of physicians in Kuyshu, Japan have set about translating FreeMED into Japanese. One of the difficulties they recognized early in the translation process was difficulty assigning words to some English phrases, keeping the intent or the meaning.

To promote translations, the FreeMED Software Foundation has opened a glossary WIKI as part of its i18n translations so that the nuances of the original phraseology can be maintained.

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Free and Open Source Meetings/Presentations at Fall AMIA 2005

The American Medical Informatics Association (AMIA) Fall conference will be held October 22nd-26th in Washington D.C. Hilton Towers. This is the most complete information that is available so far for the goings-on, exact meeting rooms to be announced: The Open Source Working Group Business meeting will be held in the Hilton Washington – State, Terrace Level 10/24/2005 5:30 PM – 7:00 PM. An informal, un-official meeting of the minds will be held at a local watering hole after the business meeting, location to be announced at or after the meeting. There will be at least 9 presentations that have a keyword ‘open source’. These will include two presentations on VistA: A demonstration by Brian Lord entitled ‘A Practical Demonstration of VistA on the Open Source Software stack’ at the Hilton Washington – Georgetown, Concourse Level 10/24/2005 1:45 PM – 3:15 PM as well as a panel discussion entitled ‘Deployment of the VistA Free and Open Source EHR/EMR Software Stack’ which will feature myself Bhaskar, Brian Lord and Dave Whitten to be held in the Hilton Washington – International Ballroom East, Concourse Level 10/25/2005 10:30 AM – 12:00 PM. This years Linux Medical News Freedom Award will be given in a brief ceremony after the panel discussion. Note that the Linux Medical News Freedom Award is NOT an officially sponsored award of AMIA, but should be.

Physician Self-Referral Exceptions Bad for FOSS?

Exceptions to anti Physician-self-referral laws are being proposed by CMS. The laws ban physicians from referring patients to entities in which they have a financial stake like laboratories. Originally designed to prevent abuses, “They were never intended to stand in the way of bringing effective electronic health care to patients…These new proposals would allow hospitals and certain health care organizations to furnish hardware, software, and related training services to physicians for e-prescribing and electronic health records, particularly when the support involves systems that are ´┐Żinteroperable´┐Ż and thus can exchange information effectively and securely among health care providers…” Could this be good or bad for Free and Open Source Electronic Medical Records? Is there potential for abuse by creating monocultures of proprietary hardware and software through hospitals dictating proprietary solutions? Could this make the problem of fragmentation even worse?

Bootable Live CD for Natural Disaster Response

Slashdot had a link to this ArsTechnica article about experiences with live bootable CD distribution’s (both Linux and Windows) custom built for use in disaster response situations like shelters. Highlights are that there are a number of advantages to this approach such as not molesting what is already on donated PC’s that must be returned. The most used applications were: e-mail, web browsing, and accessing FEMA databases which unfortunately still can only be done through Microsoft Internet Explorer and not FireFox. One of the most-needed applications was VOIP. Interesting read.

Quicken Medical Expense Manager

“Create a medical history for each individual, manage medical bills, prescription costs and payments so you don’t overpay, find medical tax deductions and tax tips, and manage disputes all in one place. “Quicken Medical Expense Manager
Following on a feature first found in the Quicken’s 2004 Mac edition, Intuit has come up with a separate application to track medical expenses. For the first release, reviews have been mixed, at best.

They have an active forum and are already discussing adding patient record information.

Perhaps a tipping point will be when the end user (AKA the patient) has an application that allows them to have their own EMR. They’ll want the information electronically too.