John Glaser, Boston’s Top Hospital Geek, Talks About Obama’s Health IT Plan and Getting Booted from Catholic School

6/22/10

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the entire cost. The federal government says, “No, I’m here to stimulate, and in a pragmatic business way, I account for maybe half the care in the country, so I’m covering my half.” You will get some gain out of it, operationally, other healthcare payers will follow suit, because of their pay-for-performance or incentive plans. Massachusetts has this conversation that you may need to be a meaningful user of electronic health records in order to be licensed to practice. So the government never was planning to cover all of it, they were planning to cover enough of it to get you to start thinking about it and actually cover enough of it to create a snowball effect, where other forces would converge on this. So I think there will be a backing down in meaningful use, but I don’t think you can dodge this and say that it will all blow away and I’m not playing ball.

X: You’ve written previously that you think adoption of EHRs under Obama’s plan will be “bumpy.” Please explain what you mean by that.

JG: It’s very hard, maybe it’s impossible, to predict with great certainty how this will work and how it will all come together. The definition of “Meaningful Use” is just a very different definition than we’ve used for EHRs in the past. So they are introducing new definitions, new payment, new regional [support] centers for EHRs, and state grants. The private sector response to all this will be thoughtful and diverse. How that will all come together, and what percentage of doctors will be meaningful users two years from now? Nobody really knows. So it’s hard to imagine that you’re going to change it all and it’s going to be this seamless, bump-free evolution, that all physician EHR implementations will go well, that all states will rise to the challenge and have solid, efficient infrastructures. Some states will screw it up. It’s just inherent. That means there will be some percentage of doctors and hospitals in some states that won’t be able to get their health information exchanges to work. There will be some privacy problems that will come along the way. Some people will say, “Holy smokes, what were we thinking when we did all of this?” I don’t see how you can introduce a set of changes to a $2 trillion-plus component of our economy and expect that it will be executed flawlessly. And that’s what I mean by “bumpy.”

X: If one has high expectations for this program to bring swift adoption of EHRs, will they be disappointed?

JG: We’ll find out. The President has said every American by 2014 will have an EHR. That won’t happen. The national adoption rate now is about 6 percent of doctors that are using a … Next Page »

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  • http://wellescent.com/health_blog Wellescent Health Blog

    Given the number of private practices, one would think that software as a service (Saas) approaches to EHR access would offer considerable potential. Solving the problem of “meaningful use” for doctors in order to allow access to federal incentives and to prevent payment of penalties would seem to be a fertile area in which to build a business.

  • http://ducknetweb.blogspot.com MedicalQuack

    The adoption of electronic medical records is a complicated issue and party due to the new technology that arrives every week for us to mill over and determine if that needs to be incorporated in to the system. I know I wrote one years ago prior to the big movement to the web, same issue though, just more client/server.

    Secondly until the issues of compensation are settled, it’s a slow go. As the old saying goes nothing happens until the bill gets paid and it’s not the stimulus money that puts meals on the table, it’s the claim revenue and right now there’s many MDs up in the air with a lot going on at once.

    I said we should certify payer algorithms before EHR software a long time ago, as why does one area go through the process without the other side? After all we are back to the money side once again. Certification is important I agree, but again we need ethics on both sides of the table here. Payer algorithm certification should come first as that is what helps keep the rest of the issues up in the air almost single handedly.

    http://ducknetweb.blogspot.com/2010/06/rules-on-ehr-certification-should-take.html

    Further more on health literacy and with patient involvement, we need role models and everyone has health so we all need to participate and role models at the top can create an atmosphere of trust too, we don’t have that.

    http://ducknetweb.blogspot.com/2010/06/hhs-national-plan-to-improve-health.html

    I know I try to speak out pretty plainly as best I can, but when I see the same companies that are paying claims for 15 years of underpayments to doctors and patients being praised and trusted for their analytic, does that not make one wonder how they do business.

    http://ducknetweb.blogspot.com/2010/06/for-top-program-combines-prototype-from.html

    Anyway, if you add this side up to the big nest of non trust and non participants making rules and laws, no wonder so many doctors are skeptical and just seeing what I have from my small corner in life, there’s good reason as nobody appears to be earning any trust around here or making any real efforts to be mentors or role models for anyone else.

    I like technology and what it does and I know electronic medical records are the answer but the other sides of the issues are the obstacles that are holding up the show and prevent real progress.

  • Saumitra

    I agree with Wellescent. May be cloud computing companies could may a foray into EHRs. By the way, I liked this candid interview. Many wouldnt have dared to ask him how he did get kicked out !