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Transcript of HIT Trends - Circle Squaremichaellake.com/images/HIT_Trends_November_2009_.pdf · 58% say patients...
HIT Trends
November 2009
Circle Square – HIT Trends – Page 2
ContentsNovember 2009
Focus on E-prescribing
– Reports on 200+ plan sponsors that launched voluntary initiatives to increase prescriber adoption of e-prescribing →
– OIG assessment of Medicare Part D plan sponsors’ ability to meet e-prescribing standards shows partial compliance →
– NCPDP, a pharmacy standards group, outlines how pharmacy is supporting industry transformation through HIT →
– Harry Totonis, Surescripts CEO, comments about e- prescribing and Surescripts future industry role →
Focus on EHR
– Study shows EMR clinical decision support applications can lower use of antibiotics →
– Two new studies on EMRs in hospitals point to only marginal gains →
– AAFP 2009 EHR User Satisfaction Survey →
– American Medical Group Association EMR survey →
– Commonwealth Fund reports on how the US healthcare lags other nations including HIT →
– EMR implementation guide released by the Texas Medical Association →
– WSJ Health Blog: Senator Grassley letter to EMR vendors →
Tracking HITECH
– Dr. David Blumenthal outlines how ARRA is designed to attack the barriers to patient-centered care →
– HIT Policy Committee recommends a simple Meaningful Use framework to get started →
– National Quality Forum publishes its Quality Data Set to help rationalize HIT interoperability →
Focus on Health Information Exchange
– Information Week on different models of HIEs →
Focus on Health Information Exchange (continued)
– GE positions new division in the Health Information Exchange platform
market →
Focus on Care Communications
– New body area network is an advance in personal health communications →
– Text messaging reminders improved medication adherence in adolescents →
– AHRQ reports on the impact of Consumer Health Informatics (CHI)
applications on health outcomes →
– AHRQ study confirms a lack of standards for calculating medication adherence
and a variety of data sources used →
– Study suggests that medication adherence may be handled by physicians
without adding time to the visit →
– InformationWeek focuses on Smartphone applications for healthcare →
Focus on Social Media
– Physicians focus on social media →
– Sharecare.com launches a new healthcare search and social media site
backed by big media →
– NPR reports on health social media →
Focus on Comparative Effectiveness Research
– New company launch to bring “big data” technologies to healthcare research →
– IBM announces new Health Analytics Center →
Company Spotlight
– Dell: A comprehensive solution for health systems to help automate affiliated
providers →
Commentary
– End note: HIT to support industry process integration →
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HHS report on Medicare Part D plan sponsor electronic prescribing initiativesFocus on E-prescribing
Reports on 200+ plan sponsors that launched voluntary initiatives to increase
prescriber adoption of e-prescribing
20% of sponsors had a program; 18% more in planning
50% of these had average or high participation
75% didn’t report quantifiable benefits because they didn’t measure
Many because they couldn’t get the data from multiple participating software vendors
25% who measured most commonly reported increases in generics prescribed and formulary compliance
More Info: HHS
Elements of Plan-Sponsored Initiatives
Editorial: While it’s disappointing that more measurement wasn’t done, there is encouraging news about participation. Strategies discussed in the report include: physician mandates, quality bonuses, incentive to pharmacies, and partnering with others.
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OIG assessment of Medicare Part D plan sponsors’ ability to meet e-prescribing standards shows partial complianceFocus on E-prescribing
69% report partial plan-to-prescriber
connectivity and only 8% report complete
Problems implementing the formulary and benefits standard limited connectivity
Plans had problems with a batch process instead of real time for each beneficiary upon request
Only 5% of plan sponsors reported no plan-to-dispenser connectivity
More Info: OIG
Editorial: There are supporting anecdotal reports from health plans indicating that many EMR solutions, in particular, struggle with providing good functional medication management connectivity. This an area where improvements can create significant value.
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NCPDP, a pharmacy standards group, outlines how pharmacy is supporting industry transformation through HITFocus on E-prescribing
More Info: NCPDP
Healthcare Need Pharmacy Experience
Health information network infrastructure to support real-time claims adjudication and coordination of benefits
Telecommunication standards and standardized routing identifiers
Standardized health benefit identification cards
NCPDP healthcare ID cardimplementation guides
Computerized order entry and results reporting
NCPDP SCRIPT standard used for e-prescribing fill status
Integration of medical history from other providers
Use of medication history via the SCRIPT standard
Real-time clinical evaluation of medical history
Use of drug utilization review elements in NCPDP telecommunication standard
Coverage validation before treatmentUse of NCPDP formulary and benefits standard and telecommunication standard
Editorial: Here’s a reminder that pharmacy has the most advanced national network and a discussion of its elements
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Harry Totonis, Surescripts CEO, comments about e-prescribing and Surescripts future industry roleFocus on E-prescribing
Progress in adoption140,000 prescribers or 23% of the market
Good progress but we need to do more in smaller practices
BarriersDEA regulations where there’s been progress
Physician resources where the regional extension centers are helpful
Consumer pressureOn physicians, yes. Less so on pharmacies who have adopted faster.
Physician incentivesPrimarily safety through more legible scripts and access to medication history
Reducing costs for all stakeholders is what will continue its viability
What’s next for SurescriptsNeutral platform has led to industry collaboration
Leverage these into new services for health information exchange
More Info: Healthcare IT News
Editorial: Surescripts has enormous assets which are likely to make it a larger player in the national health information exchange landscape as it unfolds.
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Study shows EMR clinical decision support applications can lower use of antibioticsFocus on EHR
Hospital-acquired Clostridium difficile infections are almost always associated with inappropriate use of anti-microbial agents
Studied impact of EHR and computerized physician order-enter (CPOE) at Pitt County Memorial, NC (739 beds)
Measured 46 commonly prescribed antibiotics as well as the cases of Clostridium difficile infections before and after EHR
There was an 18% decrease in the use of all anti-
microbials and a 26.2% decrease in the rate of infection after the EHR was implemented
More Info: Public Communications, Inc.
Editorial: Additional proof that if physicians are alerted appropriately by EHRs they generally do the right thing.
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Two new studies on EMRs in hospitals point to only marginal gainsFocus on EHR
Hospital Computing and the Costs and Quality of Care: A National Study (American Journal of Medicine, Himmelstein)
4,000 US hospitals
More computerized hospitals had higher total costs
Degree of computerization is not related to costs
Speed of implementation is associated with higher costs
Hospital quality of care and HIT (reported in the NYTimes, Jha and DesRoches)
3,000 US hospitals
Follow up to New England J. Med. study in April 2009
Categorized as advanced, basic or no-EHR
Results: insignificant marginal gains to an EHR
Prior evidence of benefits come from elite environments studied, e.g., Kaiser, Cleveland Clinic and Mayo Clinic
More Info: Am. J. Medicine; NYTimes
Editorial: The learning is that benefits come from EHRs that are well-implemented and well-utilized.
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AAFP 2009 EHR User Satisfaction SurveyFocus on EHR
2000+ family practice providers rate their EMRs on
a variety of measures
Ease of use, cost and value
Documenting care
Finding and reviewing info
Ordering tests
E-prescribing
Health maintenance
Disease management
Messaging and tasking
High quality medicine
Worth the expense
Training and support
Satisfaction
More Info: AAFP
Editorial: This is the appendix to an earlier study that was only available to members. It highlights the value that some low cost EMRs create for their customers.
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American Medical Group Association EMR surveyFocus on EHR
Major Themes from the Survey
Expected benefits: clinical quality, patient service, efficiency, financial performance, market position
Need to budget for and plan training, system planning and customization
Capturing benefits takes a long time and only after workflow redesign and expanding utilization
Experience breeds optimism as expectations of benefits rise over time
Ongoing education and training is critical to realizing benefits
Patience and persistence are among the most critical factors
More Info: AMGA
Editorial: It’s not the systems per se that create value, but their utilization over time. Commitment to see it through is key.
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Commonwealth Fund reports on how the US healthcare lags other nations including HITFocus on EHR
10,000 primary care physicians surveyed in 11 countries
About US physicians
58% say patients often can’t pay for drugs
29% say they can get patients after hours care
46% use EMRs compared with 90% elsewhere
28% report patients have long waits to see specialists (among the best)
59% deploy care teams (among the lowest)
Practice routine use of IT
Practice Routinely Sends Patients Reminders for Preventive or Follow-Up Care
More Info: Commonwealth Fund
Editorial: International comparisons fuel the health reform debate. These reports also remind us that there is a strong market for EHRs outside the US.
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EMR implementation guide released by the Texas Medical AssociationFocus on EHR
More Info: TX Medical Assoc.
Editorial: Comprehensive (100+ pages) and practical guide covering all relevant aspects of EMR implementation
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Table of Contents of the Guide
Introducing HIT ……………………………………….…………….9
Why now? ..............................................................12
ARRA ………………………………………………………..….…….18
Is your practice ready for HIT? ………….…….…….……27
Case Study: Change is Good
Which product is right for your practice? …..…....…37
Open source solutions …………………………..……..…...44
Making the selection ………………………………………….54
Request for proposal ………………………..……….……….59
Case study: The Networking Element
Budgeting and financing for HIT …….………..…………66
Creating the Contract …………………….…………..………72
Moving forward: Implementation …….………..………81
The law and HIT ……………………………….…………..……91
Case study: Using technology from Day One
Glossary and resources ………………………………………98
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WSJ Health Blog: Senator Grassley letter to EMR vendorsFocus on EHR
“Over the past year, I have received complaints from patients, medical practitioners and technologies engineers… for example, faulty software that miscalculated intracranial pressures and interchanged kilograms and pounds…
In addition, it has been reported that HIT/CPOE manufacturers rely on a legal doctrine known as “learned intermediaries,” to shift responsibility for errors in the HIT systems to physicians, nurses, pharmacists, and other health care providers…”
3M
Allscripts
Cerner
Cognizant
Computer Sciences
More Info: WSJ Blog; Letter
Letter was sent to these HIT companies
Eclipsys
Epic Systems
McKesson
Perot Systems
Philips Healthcare
Hold harmless
Learned intermediaries
Adequate training
Complaint tracking
Financial incentives
Settlement agreements
Key contract issues of interest
Editorial: This month Charlie McCall, an ex-HBOC executive, was convicted of accounting fraud related to revenue recognition in 1999.
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Dr. David Blumenthal outlines how ARRA is designed to attack the barriers to patient-centered careTracking HITECH
We cannot restrict private and secure messaging across providers or networks
More Info: HHS
Key premise: Information should follow the patient and be private and secure
The HITECH Act calls for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…promotes a more effective marketplace, greater competition...[and] increased consumer choice” among other goals. (Section 3001(b))
Commercial barriers
Economic barriers
Technical barriers
Info Exchange
HITECH incentives encourage information exchange
EHRs sharing information that follows patients and HHS investments in infrastructure including HIE connections
$564M targets info exchange across boundaries as part of a national framework
Editorial: Here’s a clear statement by ONC about the top level strategy talking points.
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HIT Policy Committee recommends a simple Meaningful Use framework to get startedTracking HITECH
Early Emphasis on Primary Care
Key role of primary care
Fewer specialty measures available
Number and complexity of specialties
Begin with a Simple FrameworkCore measures – all providers
Use CPOE for all orders (process)
Avoid use of high-risk medications in the elderly (quality)
Percent of patient encounters with insurance eligibility confirmed (efficiency)
Adult primary care measuresReport percent of diabetics with A1c under control
Pediatric primary care measuresReport up-to-date status for childhood immunizations
Specialty measuresCross all specialties: closing the loop on referrals
Specialty-specific measures
More Info: HHS
Editorial: In general this is a good idea. A slightly broader focus to include a measure for BP control would be welcome. This lowering the bar might encourage more companies to enter the meaningful use market.
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National Quality Forum publishes its Quality Data Set to help rationalize HIT interoperabilityTracking HITECH
QDS framework provides a standardized set of data that should be captured in patients’ electronic health records and is applicable to all care settings a patient is likely to use in his or her lifetime.
QDS acts as a dictionary for quality measurement, providing a standardized core set of data.
QDS enables quality measurement from a variety of electronic sources, including electronic health records (EHRs), personal health records (PHRs), registries and health information exchanges (HIEs).
More Info: NQF
What is the Quality Data Set?
Editorial: The HITEP panel is chaired by Paul Tang, MD from PAMF. It is building on prior work in 2008 which identified 11 data categories and 39 data types.
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Information Week on different models of Health Information ExchangesFocus on HIE
Maine statewide: 700 clinicians serving 560K patients; expected to shortly double
Oracle central repository of continuity of care records on about 1/2 the population
Browser access by clinicians
More Info: Information Week
NYC Primary Care Information Project
OR / Canada border: 3 hospitals connected to Harborview in Seattle, WA
150,000 patients in centralized databank
Initial focus on remote pharmacy services
NYC underserved: 1600 physicians growing to 2500 and 1.3M patients
Free eClinicalWorks EMR with record exchange via messaging
MA/RI: six hospitals connecting through Microsoft Amalga patient repository
Patients connect through Microsoft HealthVault PHR with device connectivity
Editorial: HIEs are growing in importance as the national infrastructure gets created. One difference to track is the centralized repository versus the federated model of request-response. Another is whether there is a specific application focus like an EMR or PHR.
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GE positions new division in the Health Information Exchange platform marketFocus on HIE
Investing $90M to create new eHealth business
Focused on regional and statewide health information exchange networks
Part of $250M Healthyimagination Fund of a $6B project
Service areas
Patient health records through LifeSensor, developed by InterComponentWare (ICW)
Health information sharing through its Centricity HIE infrastructure
Structured clinician views through a new eHealth clinician portal
Patient ID and matching through its own Master Patient Index (MPI) technology
More Info: GE
Editorial: GE could excel in this area. They bring significant assets including their financing arm. The ICW relationship makes sense also. They will jointly approach the international market.
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New body area network is an advance in personal health communicationsFocus on Care Communications
Toumaz in collaboration with Imperial College, London, is
designing health applications using ultra-low power microchip and
wireless technology
Providers can monitor the human body continuously, wirelessly, at low-cost
Multiple vital signs in real-time via PCs, PDAs and cell phones
Information, not raw data
End-to-end, from body to provider
More Info: Toumaz
Editorial: This might be breakthrough technology. It allows for very thin batteries and very light-weight, but robust devices. The focus on end-to-end is intelligent positioning.
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Text messaging reminders improved medication adherence in adolescents Focus on Care Communications
Mount Sinai Hospital in New York recruited 41 adolescent liver transplant patients
Text message reminders sent at pre-determined times requesting confirmation
Alerts sent to caregivers after 30-minutes without intake confirmation
Results suggest significant improvement in medication adherence and reduction in rejection episodes
More Info: Pediatrics
Editorial: This is an interesting architecture and workflow that has broader application. The confirmations and notifications can add value in gaps-in-care messaging.
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AHRQ reports on the impact of Consumer Health Informatics (CHI) applications on health outcomesFocus on Care Communications
146 studies reviewed including 121 randomized controlled trials
Studies were very heterogeneous and of variable quality
Positive impact was cited in most categories
Intermediate health outcomes
Doctor-patient relationship
Clinical outcomes
Insufficient evidence to assess economic impacts
Conclusions for select CHI applications
May effectively engage consumers
Enhance traditional clinical interventions
Improve both intermediate and clinical health outcomes
1. What is the evidence of impact of CHI applications on health outcomes?
2. What are the barriers that clinicians, developers, consumers, and their families or caregivers encounter that limit utilization or implementation of CHI applications?
3. What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, and net value with regard to consumer health informatics applications?
4. What critical information regarding the impact of consumer health informatics applications is needed in order to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?
More Info: AHRQ
Report is a 500+ page encyclopedic review of consumer health informatics studies
Editorial: The 176 references alone are worth the download.
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AHRQ study confirms a lack of standards for calculating medication adherence and a variety of data sources usedFocus on Care Communications
15 AHRQ grantees report on issues related to studying medication adherence
Days covered and fill adherence
Medication possession ratio within an e-prescribing system
Adherence by class
Patient self-reported adherence
Determining reasons for non-adherence
More Info: AHRQ
Editorial: This is a well-organized report on the current developments in medication adherence research and HIT.
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Study suggests that medication adherence may be handled by physicians without adding time to the visitFocus on Care Communications
Adult primary care visit frequency, quality, and duration increased between 1997 and 2005
Modest relationships were noted between visit duration and quality of care
The average visit lasted 18 minutes in 1997, while visit time had increased to nearly 21 minutes by 2005
Providing counseling or screening required additional physician time
Providing appropriate counseling or screening generally took 2.6 to 4.2 minutes
Ensuring that patients were taking appropriate medications seemed to be independent of visit duration
There were improvements in beta blockers for coronary artery disease or appropriate medications for heart failure
Adult primary care visit duration (1997-2005).
More Info: Arch. Internal Med.
Editorial: This is encouraging, particularly to the projects that are beginning to engage physicians in adherence issues through their EMR.
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InformationWeek focuses on Smartphone applications for healthcareFocus on Care Communications
A junior at Princeton received a grant to work on an iPhone app for diabetics to record what and how much they eat, insulin injections, blood sugar readings, and activity levels
Glide Health encourages its 1M patients to store medical history data as audio or text on smartphones and securely share with medical professionals
The Louisville School of Medicine deploys mobile medical apps to its 600 med students, including ePocrates
Blue Cross of Northeast Pennsylvania is deploying smartphone apps to 5,000 to 10,000 patients to carry medical histories
Charlie Kimball, a race car driver, uses the Documents To Go iPhone app from DataViz to record his food, exercise, and blood sugar log in an Excel spreadsheet for his diabetes control
More Info: InformationWeek
Editorial: General technology press continues to highlight healthcare opportunities for new, emerging architectures.
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Physicians focus on social mediaFocus on Social Media
Surgeon uses Twitter to keep families in touch during long surgeries
Internist uses Facebook to encourage patients to communicate with her over secure e-mail
A surgeon tweets during surgeries as an educational device for students
Dermatologist tweets medical facts to her followers
Orthopedist created iPhone app (Dr. Rounds) to collect patient information and email it to his office manager or other physicians
More Info: Miami Herald
Editorial: Security and privacy issues are addressed in each story. In most cases patient names aren’t used or only one initial. And Facebook isn’t used for patient messaging.
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Sharecare.com launches a new healthcare search and social media site backed by big mediaFocus on Social Media
Health Q&A format and social network as foundation of new eco-system
Created by Jeff Arnold and Dr. Mehmet Oz, in partnership with Harpo Productions, HSW International, Sony Pictures Television, and Discovery Communications
Hospitals and Academic Medical Centers: Cleveland
Clinic, Johns Hopkins Medicine, and New York-Presbyterian Hospital
Leading health and wellness authors: Drs. Oz, Roizen,
Ornish and Deepak Chopra (new publishing business model licensing chapters in books)
Associations/Societies: Society of Thoracic Surgeons
Healthcare professionals: Drs. Kaufmann, Hoy, Lisa
Online healthcare resources: Discovery Health,
HowStuffWorks.com, and Oprah.com
Consumers: Daily Strength web site
Not for profits: Challenge America
More Info: Sharecare
Editorial. Jeff Arnold is a visionary who has pulled together an impressive array of health and media assets to compete in consumer health search. This feels similar in style to his creation of WebMD.
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NPR reports on health social mediaFocus on Social Media
About 20 percent of e-patients go to Internet and social-networking sites where they can talk to medical experts and other patients
The Pew study found that 39 percent of e-patients already use a social-networking site like Facebook
But the source patients say they trust the most is their own doctor
PatientsLikeMe has 50,000 members living with conditions like multiple sclerosis, fibromyalgia or bipolar disorder
Patients find out whether their concerns are justified, they make sense, and whether they’re doing the right thing
Press to Play
More Info: NPR; Audio← To ToC
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New company launch to bring “big data” technologies to healthcare researchFocus on Comparative Effectiveness Research
Explorys enables instantaneous search, tagging, and collaboration across very large healthcare datasets
Equity partnership with Cleveland Clinic to leverage its clinical data and network of researchers and clinicians
Solutions provide a secure web interface for clinicians to mine patient population data without IT expertise
Encourages exploration by clinicians
Led by serial entrepreneurs with a successful track record in technology innovation
More Info: Explorys
Editorial: As CER gets more attention in the market, we are likely to see innovations. This one is worth noting because of its access to an important data source, and the experience of its founders.
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IBM announces new Health Analytics CenterFocus on Comparative Effectiveness Research
First center of its kind to address the need for advanced analytics across the
healthcare industry
Collect and analyze data from sensors, patient monitoring
systems, medical instruments, handheld devices and hospital monitors
Apply to health quality in disease management, hospital quality
improvement, patient population studies and performance reporting
Highlight best facilities in improving patient outcomes and
identifying the best drug combinations, modifications and care approaches
Explore patterns of unnecessary care and opportunities for
improving patient safety or quality of care
Developed with leading hospitals such as Duke University
Medical Center, Geisinger Health System, Mayo Clinic, New York's Memorial Sloan Kettering Cancer Center and the University of North Carolina to advance health analytics technology
More Info: IBM
Editorial: This effort is part of a broader initiative around business analytics. It is opening six other analytics solution centers in Berlin, Beijing, Tokyo, New York City, London and Washington, D.C.
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DellCompany Spotlight
A comprehensive solution for health systems to help automate affiliated providers
EMR software from eClinicalWorks or Allscripts delivered as a hosted service
Creative financing coordinated with meaningful use incentives to limit physician need for cash
Assessment, deployment, training and support services utilizing Perot and other resources
Includes practice readiness and workflow reengineering
Includes specially trained Dell technical support staff
Health system architecture design services and support to create an HIE
Community promotion and market development
More Info: Dell; Seminar
Dell Affiliated Physician EMR Solution
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CommentaryEndnote
Kaiser Permanente, Mayo Clinic, Cleveland Clinic have best-leveraged HIT because of their integrated organizational structures, among other things
Our challenge as an industry is to use HIT to help create a solid foundation across our disparate US system
We are reporting this time about how entrepreneurs, like Jeff Arnold, or established companies, like Dell, are putting creative partnerships together to help develop more integrated frameworks
We hope Health Information Exchanges can get on a similar path that is sustainable and can support layers of future growth
Stack, Tony Cragg, 1975
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HIT Trends © 2009 Circle Square Inc.
Michael LakeSan Francisco, CA
www.michaellake.com
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