Where Might Health Information Technology Best Reduce Healthcare Waste?

Like other industries, healthcare is fascinated with the possibilities of using technology to help increase efficiencies and deliver solutions to populations. Replacing expensive physicians and other healthcare workers with apps and online tools is appealing. Unfortunately, our efforts to use health information technology (health IT) to reduce healthcare waste have not resulted in meaningful savings. Evidence-based medicine tools have not consistently improved diagnostic or treatment decisions. Congress, government agencies and others have tried to push health systems and payers to publish cost and quality information to help patients make more informed decisions with minimal impact. Highlighting data to promote shared … Read More

Frequency and Outcomes of Preoperative Stress Testing in Total Hip and Knee Arthroplasty from 2004 to 2017

“The American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines for perioperative cardiovascular evaluation for noncardiac surgery aim to improve the effectiveness of perioperative care, optimize patient outcomes, and improve resource use. The guidelines have consistently deemphasized preoperative cardiac testing prompted solely by the upcoming surgery in the absence of signs or symptoms that would warrant testing outside of the preoperative setting. [..] Using MarketScan inpatient claims data from 2003 to 2017, we selected patients according to International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM, … Read More

Scaling Up Provider-Payer Workflows

Published 2020.9.30 I am involved in several health information technology (health IT) interoperability efforts including the Da Vinci project (a private sector initiative that addresses the needs of the Value Based Care community by leveraging the HL7 [a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services] FHIR platform), Office of the National Coordinator for Health IT Fast Healthcare Interoperability Resources (FHIR) at Scale Taskforce (ONC FAST, a group of “motivated … Read More

Ideas About Resourcing Health Care in the United States: Can Economic Evaluation Achieve Meaningful Use?

“Managing health care spending is critical considering that the U.S. health care economy exceeds $3.5 trillion. Between $760 billion and $935 billion is wasted on low-value care that costs considerably more than its clinical benefits are worth. Giving Equal Weight to Valuation of Health Care Services and Technologies [..] payer reimbursements for health care providers and biomedical manufacturers could not be more different. Medicare and other payers that adhere to Medicare payment structures use prospective payments based on diagnosis-related group for hospital services, and fee schedules based on relative value units for physician services. Payments have created a fundamental divide … Read More