Health IT Through the Movies

Day 8 of our 12 Days of Christmas Posts we look to Hollywood for inspiration as we continue to milk some of the year’s biggest health IT stories of 2014. Click the title links to read up on each movie at

The Theory of Everything – The theory of everything is the ongoing search for a an all-encompassing theoretical framework in physics that links all physical aspects of the universe together. Mmm…sounds a bit like interoperability.  The progress in health IT towards wide spread interoperability continued in 2014. FHIR, or Fast Healthcare Interoperability Resources, holds promise in meeting this challenge. Just this month HL7 announced the launch of its Argonaut Project, an initiative to rapidly develop FHIR as a first-generation API and Core Data Services specification to enable expanded information sharing for electronic health records and other health information technologies. The project will accelerate current FHIR development efforts to provide implementation guides and specs to the industry by the spring of 2015. The movie looks at the early career of physicist Stephen Hawking, his relationship with his first wife, and his diagnosis of motor neuron disease. The movie has been nominated for 4 Golden Globes.

The Last Five Years – The HITECH Act turned five in February. As reported by then ONC National Coordinator, Karen DeSalvo, MD, on this milestone birthday, progress in health IT adoption was as follows:

  • Nearly 80 percent of office-based physicians used some type of electronic health record system, an increase of 60 percentage points since 2001 and nearly double the percent in 2008 (42 percent), which was a year before HITECH became law.
  • About half of office-based physicians surveyed said they use a system that qualifies as a “basic system,” up from just 11 percent in 2006.
  • Almost 70 percent of office-based physicians noted their intent to participate in the EHR incentive program.

Through October of 2014, approximately $26B in incentives have been paid to date to 300,000 EPs and 5,000 EHs. The movie itself deconstructs a 5 year love affair between a struggling actress and novelist, and stars the terrific Anna Kendrick of Pitch Perfect fame.

Exodus – At some point this year many began to ask if anyone was left at the ONC. There were key departures, mainly DeSalvo and No. 2 Deputy Director, Dr. Jacob Reider.  Other departures included the ONC’s Chief Science Officer, Dr. Doug Fridsma and Judy Murphy, the agency’s director of the Office of Clinical Quality and Safety.Many argued these personnel changes came at a difficult juncture in the program, with pressure and push back on the timing of Stage 2 and the industry in the midst of planning for the transition to ICD-10 in 2015. The ONC was quick to fill the gaps, including naming Lisa Lewis (the ONC’s Chief Operating Officer), as Acting National Coordinator. Exodus: Gods and Kings, is now playing in a Mega complex near you.

That Awkward Moment – In an address to the American Medical Association’s House of Delegates in November, AMA President Robert Wah characterization ICD-10 as a droid serving Star Wars’ Darth Vader and said the association wants to “freeze it  in carbonite”,  a al Han Solo in The Empire Strikes Back. The ICD-10 Coalition was quick to respond, calling Wah’s comments and attempt at humor “unfortunate because the quality and precision of our national health care data is a serious matter.” You can read the Coalition’s full response here. As for the movie, it details three best friends efforts to understand the pivotal moment in a dating relationship where you  ask yourself “So…where is this going?” Where indeed.

Edge of Tomorrow – Unlike this Sci-Fi thriller with anti-hero Tom Cruise and a buffed out Emily Blount trying to change the outcome of a single day, there will be no 10,000 chances come January 1, 2015 for providers to avoid medicare adjustments if they are not meaningful users of certified EHR technology.  From the CMS fact sheet:

This payment adjustment will be applied to the Medicare physician fee schedule (PFS) amount for covered professional services furnished by the eligible professional during the year (including the fee schedule amount for purposes of determining a payment based on the fee schedule amount). Eligible professionals receive the payment adjustment amount that is tied to the year that they did not demonstrate meaningful use (e.g., A health care professional who is eligible for a payment adjustment in 2018 will receive a 4% PFS reduction regardless if this is their first or fourth year not demonstrating meaningful use). Depending on the total number of Medicare eligible professionals who are meaningful users under the EHR Incentive Programs after 2018, the maximum payment adjustment can reach as high as 5%. The table below illustrates the potential application of payment adjustments to covered professional services for a Medicare eligible professional who  is not a meaningful user beginning in 2014.

CMS issued a statement that as many as 257,000 physicians and other healthcare providers will be subject to 1% adjustment of their pay next year for failing to achieve meaningful use of EHR technology in previous years. CMS will begin sending letters to these clinicians about the penalty in the next several weeks.

Whiplash – If the continual battle over the reporting period for Stage 2 Meaningful Use has you feeling a little whiplashed  you’re not alone.  Lawmakers and associations continue to press for an EHR reporting period of 90 days, versus a full year currently in place. Earlier this week, 30 members of Congress sent a letter to HHS Secretary Sylvia Mathews Burwell urging her to shorten the reporting period in 2015. Backing the effort, led by by Congresswoman Renee Ellmers (R-NC), the letter points out that the final rule published on Sept. 4 by CMS offered flexibility in attesting for Stage 2 during the remainder of 2014 but retained the provision for a full-year of reporting in 2015, a requirement too onerous for providers to meet. AMA, HIMSS, CHIME and MGMA have all issued statements calling on CMS to shorten the 2015 reporting period as well. The movie Whiplash is about a young musician who enrolls at a cutthroat music conservatory  where he is mentored by an instructor who will stop at nothing to realize his student’s dream.  We’ll have to see how this current drama plays out.