Jim Wanner of KeyMark, Mark Brousseau of IAPP-IARP-TAWPI and Bo Minogue of MAVRO Imaging at the vendor showcase Tuesday at IAPP-TAWPI's Healthcare Payments Automation Summit at the Boston Sheraton.
Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts
Wednesday, September 22, 2010
HPAS Vendor Showcase
Posted by Mark Brousseau
Jim Wanner of KeyMark, Mark Brousseau of IAPP-IARP-TAWPI and Bo Minogue of MAVRO Imaging at the vendor showcase Tuesday at IAPP-TAWPI's Healthcare Payments Automation Summit at the Boston Sheraton.
Jim Wanner of KeyMark, Mark Brousseau of IAPP-IARP-TAWPI and Bo Minogue of MAVRO Imaging at the vendor showcase Tuesday at IAPP-TAWPI's Healthcare Payments Automation Summit at the Boston Sheraton.
Wednesday, May 13, 2009
Confusion Over ARRA Funding
Posted by Mark Brousseau
A Dell survey of 662 public-sector IT professionals indicates a need for clearer, more customized information related to the flow and impact of American Recovery and Re-Investment Act (ARRA) funds. The survey results also suggest mounting IT challenges among public-sector healthcare and government organizations. Among the findings of the survey:
... 79% of public-sector IT professionals indicated they don’t have enough visibility or are only somewhat aware of the impact and flow of ARRA funds on their organizations.
... 78% said ARRA-related information is non-existent, too generic or not understandable and that tailored tools are needed to better navigate the recovery package.
... Higher education IT professionals rank resources as largest IT-related impediment to modernizing America’s educational institutions.
... Federal, state and local government IT professionals said a lack of standards, budgets and resources for IT deployment and management each has a “high impact” on infrastructure modernization.
... Healthcare IT professionals indicated that budgets, interoperability and disparate networks are the “largest IT impediments” to modernizing America’s healthcare system.
Frank Muehleman, vice president and general manager, Dell North America Public Business Group, noted that Dell sees three consistent themes from customers who want to use the ARRA to invest in IT: they want cost and energy efficiency, they demand transparency, and they are focused on IT that is simple to deploy and manage.
What do you think? Post your comments below.
A Dell survey of 662 public-sector IT professionals indicates a need for clearer, more customized information related to the flow and impact of American Recovery and Re-Investment Act (ARRA) funds. The survey results also suggest mounting IT challenges among public-sector healthcare and government organizations. Among the findings of the survey:
... 79% of public-sector IT professionals indicated they don’t have enough visibility or are only somewhat aware of the impact and flow of ARRA funds on their organizations.
... 78% said ARRA-related information is non-existent, too generic or not understandable and that tailored tools are needed to better navigate the recovery package.
... Higher education IT professionals rank resources as largest IT-related impediment to modernizing America’s educational institutions.
... Federal, state and local government IT professionals said a lack of standards, budgets and resources for IT deployment and management each has a “high impact” on infrastructure modernization.
... Healthcare IT professionals indicated that budgets, interoperability and disparate networks are the “largest IT impediments” to modernizing America’s healthcare system.
Frank Muehleman, vice president and general manager, Dell North America Public Business Group, noted that Dell sees three consistent themes from customers who want to use the ARRA to invest in IT: they want cost and energy efficiency, they demand transparency, and they are focused on IT that is simple to deploy and manage.
What do you think? Post your comments below.
Wednesday, March 11, 2009
Saving Healthcare Dollars Through IT
Posted by Mark Brousseau
Approximately 64 percent of physicians say healthcare technology does save their patients money, according to a recent survey of 705 U.S. physicians by Epocrates. The areas of technology where the most savings occur include: electronic formulary reference tools, e-health records, and e-prescribing.
What do you think? Post your comments below.
Approximately 64 percent of physicians say healthcare technology does save their patients money, according to a recent survey of 705 U.S. physicians by Epocrates. The areas of technology where the most savings occur include: electronic formulary reference tools, e-health records, and e-prescribing.
What do you think? Post your comments below.
Stimulating EHR Usage
Posted by Mark Brousseau
President Barack Obama has pushed hard for healthcare IT and would like every American to have an electronic medical record by 2014. To that end, the recently passed economic stimulus package provides temporary bonus payments ranging from $44,000 to $64,000 for physicans and up to $11 million for hospitals that meaningfully use electronic health records. In all, the stimulus package has more than $100 billion allotted to healthcare.
What do you think? Post your comments below.
President Barack Obama has pushed hard for healthcare IT and would like every American to have an electronic medical record by 2014. To that end, the recently passed economic stimulus package provides temporary bonus payments ranging from $44,000 to $64,000 for physicans and up to $11 million for hospitals that meaningfully use electronic health records. In all, the stimulus package has more than $100 billion allotted to healthcare.
What do you think? Post your comments below.
Medical Banking Alive and Healthy
By Mark Brousseau
“Medical banking is alive and very healthy,” John English, professor, Vanderbilt University, said today during the Seventh National Medical Banking Institute in Nashville, TN. “In fact, medical banking has come further in the three years that I have been exposed to it than I thought it would.”
What do you think? Post your comments below.
“Medical banking is alive and very healthy,” John English, professor, Vanderbilt University, said today during the Seventh National Medical Banking Institute in Nashville, TN. “In fact, medical banking has come further in the three years that I have been exposed to it than I thought it would.”
What do you think? Post your comments below.
Friday, June 27, 2008
Healthcare Gets a (Digital) Backbone
Posted by Mark Brousseau
The digital backbone that connects health providers, payers and vendors is expanding, according to Behind the Numbers: Healthcare Cost Trends for 2008, a new report from Pricewaterhouse Coopers’ Health Research Institute (www.pwc.com/hri).
Connecting the health system electronically will aid payers in better managing both performance and compliance throughout the continuum of care, the report concludes. Clinicians and business offices are increasingly using technologies such as personal computers, electronic health records, wireless systems, biometric devices, and imaging software to coordinate and improve care. For example, widespread adoption of electronic medical records and other health information technology is estimated to save $162 billion a year by improving care management, reducing preventable medical errors, lowering death rates from chronic disease, and reducing the number of employee sick days, the report finds.
Providers are beginning to invest substantially in their own health information technology (IT) systems. During the past few years, most hospital systems have been allocating an average of 25 percent of their capital spending on health IT, according to Fitch Ratings, a New York ratings agency. While initial spending on IT has been shown to add to costs, the longer-term effect is one of reduction in costs. Health IT investment typically reaches a tipping point in terms of cost, according to Pricewaterhouse Coopers’ research released in 2007. That tipping point tends to reflect continued investment after which hospital operating costs are reduced. Building the digital backbone requires connecting to physicians, and an increasing percentage of physicians themselves are going business electronically as well, Pricewaterhouse Coopers found.
What do you think? Post your comments below.
The digital backbone that connects health providers, payers and vendors is expanding, according to Behind the Numbers: Healthcare Cost Trends for 2008, a new report from Pricewaterhouse Coopers’ Health Research Institute (www.pwc.com/hri).
Connecting the health system electronically will aid payers in better managing both performance and compliance throughout the continuum of care, the report concludes. Clinicians and business offices are increasingly using technologies such as personal computers, electronic health records, wireless systems, biometric devices, and imaging software to coordinate and improve care. For example, widespread adoption of electronic medical records and other health information technology is estimated to save $162 billion a year by improving care management, reducing preventable medical errors, lowering death rates from chronic disease, and reducing the number of employee sick days, the report finds.
Providers are beginning to invest substantially in their own health information technology (IT) systems. During the past few years, most hospital systems have been allocating an average of 25 percent of their capital spending on health IT, according to Fitch Ratings, a New York ratings agency. While initial spending on IT has been shown to add to costs, the longer-term effect is one of reduction in costs. Health IT investment typically reaches a tipping point in terms of cost, according to Pricewaterhouse Coopers’ research released in 2007. That tipping point tends to reflect continued investment after which hospital operating costs are reduced. Building the digital backbone requires connecting to physicians, and an increasing percentage of physicians themselves are going business electronically as well, Pricewaterhouse Coopers found.
What do you think? Post your comments below.
Friday, June 20, 2008
Weak EHR Adoption Called Troubling and Sobbering
Posted by Mark Brousseau
An interesting article from Government Health IT on the slow adoption of electronic health records (EHRs):
4 percent of U.S. doctors use EHRs, new study finds
Nancy Ferris
A milestone study of the adoption of health information technology has produced findings that one of the study’s authors calls troubling and the other calls very sobering.
The survey of 2,758 U.S. doctors, sponsored by the Office of the National Coordinator for Health IT (ONC), found that only 4 percent had a fully functional electronic health record system. Another 13 percent had a basic or partially functional EHR system.
A 2006 study, also sponsored by ONC, found that as many as 9 percent of doctors had fully functional EHR systems. However, Dr. Karen Bell, director of ONC’s Office of Health IT Adoption, said the survey parameters were different.
“There is an increase,” Bell said at a press conference to discuss the results, which were reported in an online edition of the New England Journal of Medicine.
The earlier survey, undertaken by the same team, found that 24 percent of doctors had some sort of computerized record system, but the question allowed them to count billing systems and other kinds of systems not directly related to health care.
Dr. David Blumenthal, director of the Institute of Health Policy at Massachusetts General Hospital and a co-author of the study, said, “We need to get moving a lot faster than we have been if we are going to take full advantage of this technology and realize its promise for medicine."
His colleague, Massachusetts General researcher Catherine DesRoches, said she found reason for hope in the findings. Forty-two percent of the doctors surveyed said their practice had bought an EHR system but had not yet implemented it or they were planning to buy one in the next two years.
“Physicians who use these systems like them,” she said, and they reported that the technology supported better patient care.
But, DesRoches said, doctors are uncertain whether they will get a financial return on their investment in EHRs, and they are fearful of new legal liabilities that could arise. Cost, she said, is the No. 1 barrier to doctors’ adoption of the technology.
Although ONC had touted the previous survey as a benchmark from which to measure future EHR adoption, Bell said the more recent one is “a true benchmark.” She said an agency of the Centers for Disease Control and Prevention will repeat the survey using the same survey instrument in the future.
An interesting article from Government Health IT on the slow adoption of electronic health records (EHRs):
4 percent of U.S. doctors use EHRs, new study finds
Nancy Ferris
A milestone study of the adoption of health information technology has produced findings that one of the study’s authors calls troubling and the other calls very sobering.
The survey of 2,758 U.S. doctors, sponsored by the Office of the National Coordinator for Health IT (ONC), found that only 4 percent had a fully functional electronic health record system. Another 13 percent had a basic or partially functional EHR system.
A 2006 study, also sponsored by ONC, found that as many as 9 percent of doctors had fully functional EHR systems. However, Dr. Karen Bell, director of ONC’s Office of Health IT Adoption, said the survey parameters were different.
“There is an increase,” Bell said at a press conference to discuss the results, which were reported in an online edition of the New England Journal of Medicine.
The earlier survey, undertaken by the same team, found that 24 percent of doctors had some sort of computerized record system, but the question allowed them to count billing systems and other kinds of systems not directly related to health care.
Dr. David Blumenthal, director of the Institute of Health Policy at Massachusetts General Hospital and a co-author of the study, said, “We need to get moving a lot faster than we have been if we are going to take full advantage of this technology and realize its promise for medicine."
His colleague, Massachusetts General researcher Catherine DesRoches, said she found reason for hope in the findings. Forty-two percent of the doctors surveyed said their practice had bought an EHR system but had not yet implemented it or they were planning to buy one in the next two years.
“Physicians who use these systems like them,” she said, and they reported that the technology supported better patient care.
But, DesRoches said, doctors are uncertain whether they will get a financial return on their investment in EHRs, and they are fearful of new legal liabilities that could arise. Cost, she said, is the No. 1 barrier to doctors’ adoption of the technology.
Although ONC had touted the previous survey as a benchmark from which to measure future EHR adoption, Bell said the more recent one is “a true benchmark.” She said an agency of the Centers for Disease Control and Prevention will repeat the survey using the same survey instrument in the future.
Wednesday, June 11, 2008
Social Security Checks Going Debit
Posted by Mark Brousseau
The move toward electronic payments has now impacted Social Security checks:
Social Security checks now offer debit card option
By Kathy Chu, USA TODAY
For millions of Americans, accessing their Social Security benefits is now just a card swipe away.
A new debit card being offered by the Treasury Department gives nearly 4 million recipients who have no bank accounts an alternative to paper checks that they must cash, usually at a price.
The new debit card, issued by Comerica Bank, was quietly marketed to nearly 3.5 million recipients of Social Security and Supplemental Security Income this spring. It's now available to any benefit recipient via usdirectexpress.com.
States already load child support payments and unemployment benefits onto debit cards. The federal government has used prepaid debit cards, too, for disaster relief aid. But the Social Security debit card is the largest push to date to switch from costly paper checks to electronic payments.
"Our goal is to move to 100% electronic payments," says Judy Tillman, commissioner of Treasury's Financial Management Service. "It's safer and more reliable for delivery" of funds.
The new debit card will eliminate the need for consumers without bank accounts to use costly check-cashing services, the Treasury Department says. It will also save the government money. The Treasury estimates that if all 4 million recipients without bank accounts signed up for the card, it would save $42 million a year.
As with any other debit card, using it won't always be free. For instance, holders typically will get one free ATM withdrawal per month. After that, they'll be charged 90 cents for each withdrawal. A fee of 75 cents per month also applies if card holders want paper statements mailed to them.
Still, the fees are among the lowest in the industry for such services, says Nora Arpin, director of government electronic solutions for Comerica.
About 80% of the 57.3 million Social Security and SSI recipients already have their benefits directly deposited into their bank accounts. The challenge will be to get the remaining consumers to switch from checks to electronic payments such as direct deposit or the new debit card.
The card "might be confusing if they're not savvy about electronic payments and don't have (experience with) a bank account," says Chris Allen, a director for Hitachi Consulting.
The move toward electronic payments has now impacted Social Security checks:
Social Security checks now offer debit card option
By Kathy Chu, USA TODAY
For millions of Americans, accessing their Social Security benefits is now just a card swipe away.
A new debit card being offered by the Treasury Department gives nearly 4 million recipients who have no bank accounts an alternative to paper checks that they must cash, usually at a price.
The new debit card, issued by Comerica Bank, was quietly marketed to nearly 3.5 million recipients of Social Security and Supplemental Security Income this spring. It's now available to any benefit recipient via usdirectexpress.com.
States already load child support payments and unemployment benefits onto debit cards. The federal government has used prepaid debit cards, too, for disaster relief aid. But the Social Security debit card is the largest push to date to switch from costly paper checks to electronic payments.
"Our goal is to move to 100% electronic payments," says Judy Tillman, commissioner of Treasury's Financial Management Service. "It's safer and more reliable for delivery" of funds.
The new debit card will eliminate the need for consumers without bank accounts to use costly check-cashing services, the Treasury Department says. It will also save the government money. The Treasury estimates that if all 4 million recipients without bank accounts signed up for the card, it would save $42 million a year.
As with any other debit card, using it won't always be free. For instance, holders typically will get one free ATM withdrawal per month. After that, they'll be charged 90 cents for each withdrawal. A fee of 75 cents per month also applies if card holders want paper statements mailed to them.
Still, the fees are among the lowest in the industry for such services, says Nora Arpin, director of government electronic solutions for Comerica.
About 80% of the 57.3 million Social Security and SSI recipients already have their benefits directly deposited into their bank accounts. The challenge will be to get the remaining consumers to switch from checks to electronic payments such as direct deposit or the new debit card.
The card "might be confusing if they're not savvy about electronic payments and don't have (experience with) a bank account," says Chris Allen, a director for Hitachi Consulting.
EHRs Go Beyond Treatment
Posted by Mark Brousseau
An interesting article from Government Health IT on electronic health records:
EHRs go beyond treatment
Health IT promises to streamline agency requests for copies of clients’ medical records
BY Nancy Ferris Published on June 9, 2008
Americans are often asked to supply medical records when they enroll at a school, seek to obtain disability benefits or apply for certain jobs.
Having those records available electronically would make it easier for patients to access them, as long as there is a process in place for authorizing their release from various health care providers’ systems.
The Social Security Administration is leading a project to automate the process for obtaining authorized information from electronic health records. As officials struggle to deal with a growing workload of applications for disability benefits, they say they hope the initiative will make the agency’s job easier and improve service to the public.
SSA receives more than 2 million claims for disability benefits each year, a number that is expected to grow steadily. In each case, the agency obtains names and addresses of the applicant’s doctors and his or her authorization for the providers to release medical records to SSA. The agency then contacts the doctors and waits for the records to arrive by mail — a process that can take months and costs more than $500 million a year.
SSA officials say they envision being able to use the Nationwide Health Information Network (NHIN) to send authorizations to providers electronically and automatically receive the records in return. They are launching a pilot project that involves Beth Israel Deaconess Medical Center in Boston, and they are participating in trial implementations of the NHIN this year.
Not coincidentally, Dr. John Halamka, chairman of the Healthcare Information Technology Standards Panel and a prominent health IT advocate, is Beth Israel Deaconess Medical Center’s chief information officer.
As part of the project, officials will identify HITSP-approved standards that could be used in the process of obtaining medical records, said Debbie Somers, senior adviser at SSA’s Office of Disability Systems.
The agency’s officials know the standards will not completely meet their needs, Somers said, but they are determined to use them whenever possible. They are especially interested in adopting the Continuity of Care Document (CCD) standard, which summarizes the patient’s health conditions, medications and allergies.
At the same time, SSA officials will choose a standard format for electronic medical records used by disability examiners, who spend hours searching through files for specific pieces of information.
“With every hospital and doctor, the record is in a different order and it looks different,” Somers said. With CCD, examiners could pull data into SSA’s system. To make it even easier for them, the agency will highlight certain diagnoses and procedure codes that amount to evidence of disability.
“By the end of August or September, we will actually be requesting real data from [Beth Israel Deaconess] and receiving real live data back, which we can use to [fold] into the medical record,” Somers said.
For the NHIN trial implementations, SSA will work with other project participants to test the system’s ability to send requests and receive electronic medical records from the Military Health System, Veterans Health Administration, Indian Health Service and other providers.
“We hope to still have the same back end on our side but to be able to use the NHIN as a transport,” Somers said.
“It’s really amazing what these first steps are accomplishing,” she said, adding that SSA is on track to have a production infrastructure for retrieving EMRs in place next year.
As a result of the project, SSA could free millions of dollars, people with disabilities could get their benefits faster, and health care providers could be free of dealing manually with records requests from SSA. Halamka has said the resulting cost savings could pay for implementing the technology at hospitals.
Other providers of disability benefits, such as insurance companies, could also find the technology beneficial — along with schools, camps and other organizations that need copies of medical records.
“We may be the largest medical record requester, but we are only one,” Somers said. “People need to be able to provide the authorization and have their medical record go wherever it needs to go.”
An interesting article from Government Health IT on electronic health records:
EHRs go beyond treatment
Health IT promises to streamline agency requests for copies of clients’ medical records
BY Nancy Ferris Published on June 9, 2008
Americans are often asked to supply medical records when they enroll at a school, seek to obtain disability benefits or apply for certain jobs.
Having those records available electronically would make it easier for patients to access them, as long as there is a process in place for authorizing their release from various health care providers’ systems.
The Social Security Administration is leading a project to automate the process for obtaining authorized information from electronic health records. As officials struggle to deal with a growing workload of applications for disability benefits, they say they hope the initiative will make the agency’s job easier and improve service to the public.
SSA receives more than 2 million claims for disability benefits each year, a number that is expected to grow steadily. In each case, the agency obtains names and addresses of the applicant’s doctors and his or her authorization for the providers to release medical records to SSA. The agency then contacts the doctors and waits for the records to arrive by mail — a process that can take months and costs more than $500 million a year.
SSA officials say they envision being able to use the Nationwide Health Information Network (NHIN) to send authorizations to providers electronically and automatically receive the records in return. They are launching a pilot project that involves Beth Israel Deaconess Medical Center in Boston, and they are participating in trial implementations of the NHIN this year.
Not coincidentally, Dr. John Halamka, chairman of the Healthcare Information Technology Standards Panel and a prominent health IT advocate, is Beth Israel Deaconess Medical Center’s chief information officer.
As part of the project, officials will identify HITSP-approved standards that could be used in the process of obtaining medical records, said Debbie Somers, senior adviser at SSA’s Office of Disability Systems.
The agency’s officials know the standards will not completely meet their needs, Somers said, but they are determined to use them whenever possible. They are especially interested in adopting the Continuity of Care Document (CCD) standard, which summarizes the patient’s health conditions, medications and allergies.
At the same time, SSA officials will choose a standard format for electronic medical records used by disability examiners, who spend hours searching through files for specific pieces of information.
“With every hospital and doctor, the record is in a different order and it looks different,” Somers said. With CCD, examiners could pull data into SSA’s system. To make it even easier for them, the agency will highlight certain diagnoses and procedure codes that amount to evidence of disability.
“By the end of August or September, we will actually be requesting real data from [Beth Israel Deaconess] and receiving real live data back, which we can use to [fold] into the medical record,” Somers said.
For the NHIN trial implementations, SSA will work with other project participants to test the system’s ability to send requests and receive electronic medical records from the Military Health System, Veterans Health Administration, Indian Health Service and other providers.
“We hope to still have the same back end on our side but to be able to use the NHIN as a transport,” Somers said.
“It’s really amazing what these first steps are accomplishing,” she said, adding that SSA is on track to have a production infrastructure for retrieving EMRs in place next year.
As a result of the project, SSA could free millions of dollars, people with disabilities could get their benefits faster, and health care providers could be free of dealing manually with records requests from SSA. Halamka has said the resulting cost savings could pay for implementing the technology at hospitals.
Other providers of disability benefits, such as insurance companies, could also find the technology beneficial — along with schools, camps and other organizations that need copies of medical records.
“We may be the largest medical record requester, but we are only one,” Somers said. “People need to be able to provide the authorization and have their medical record go wherever it needs to go.”
Wednesday, May 14, 2008
Mike Leavitt On Electronic Medical Records
Posted by Mark Brousseau
The Hill caught up with Health and Human Services Secretary Mike Leavitt to ask him about the status of the president's electronic medical records initiatives. The full transcript appears below:
Q&A with Mike Leavitt
By Jeffrey Young
In 2004, President Bush introduced a sweeping initiative to promote the development of a nationwide system of health information technology. One key goal is to provide every citizen with access to an electronic medical record by 2014. Bush tasked Health and Human Services Secretary Mike Leavitt to helm the gargantuan effort, which represents an attempt to bring together the private and public sectors to create a technological infrastructure for the healthcare system of the future.
Q: Is President Bush’s 10-year plan for electronic medical records on track?
I believe that will be accomplished. I think the goal may be exceeded. There will be a point where this begins to happen quickly. That’s the way technology develops: There are some early adopters, the mechanism has to be put into place, people begin to catch the vision. Once the consumer begins to see its value, it spreads quickly.
Q: Other than electronic medical records, what are the key components of a fully wired healthcare system?
I think it’s important to remember that the goal here isn’t electronic medical records. The goal is to transform the sector of healthcare into a system of healthcare, a system that provides consumers with information about the quality and the cost of their care.
To accomplish that, we need to have information digitized rather than on paper and we need to have that information mobilized so that it can be assembled in many different ways that are useful, not just to consumers but to various parties. If you look at digital health information, the goal looks different depending on who you are and what your interests are.
If you’re a consumer, you’re interested in having all of your health information accessible to you in a timely, useful way. You’d like to have your pharmacy records for the three pharmacies that you do business with in one place. You’d like to have the information from your doctor, from your hospital, from your specialists, from the labs, accessible to you in one place. You don’t want to have to go to your doctor and pick up a big brown envelope and transport it to a specialist for them to see a test that you took three days before. You’d like that to be electronically transferred, like everything else can be in your life.
If you’re a clinician or a doctor, you’re interested in having a clinical record that has more information than likely a consumer is interested in. You’re interested in being able to have decision-support information that would provide backup for decisions that you need to make, and alternatives and options that would help you make better decisions.
If you are a public-health expert, you’d like to be able to gather a lot of data from many different places. Even though it doesn’t have anyone’s name attached to it, it would provide you with statistical backup to look for trends. If you’re a researcher, you’d like to see something quite similar, but you would like to see it from a wider area.
My point is that, if you’re a consumer or a clinician or a researcher, all of this looks different to you. To put it a different way, it will look different depending on the way you view the world.
The goal here is to, first of all, get information transferred from paper into a digital format, then create a means by which it can be mobilized so it can be assembled in various forms, and to provide benefit to consumers, to practitioners, to hospitals, to researchers, to public health, or to those in the business of health.
Q: What will be the biggest advantages to better incorporating information technology into the healthcare system?
In the long run, it will provide better health, lower costs, fewer medical mistakes and a lot less hassle.
Q: All three of the presidential candidates’ healthcare reform plans depend in part on health IT saving money. How much money could be saved through the efficiencies that should come with from using these technologies?
The best source of that may be the RAND study. The RAND Corporation did a study that said … there was a 30 percent inefficiency in the costs. I’m not predicting a 30 percent reduction but I do believe that over time we can begin to have medical inflation more closely approximate regular inflation. If you could make that change in the glide pattern or the slope of growth, it would make a profound economic difference.
Q: Since the administration’s effort began, what’s done and what’s still to be accomplished?
Three years ago, there were 200 vendors who were producing electronic medical records for sale. None of them had the capacity to be interoperable because there were no standards for interoperability. Interoperability essentially means one computer system being able to talk to another.
We developed a process for developing standards that incorporated the medical family, developers of technology, government entities, insurance companies, et cetera, and have now instituted a means by which those standards are emerging.
We also created a process for certifying systems that meet those standards. Three years ago, there was no process and obviously no means of certifying that people were on the pathway to health IT or to interoperability. We have accomplished that: Some 75 percent of all the systems now available for sale are certified by the CCHIT, which is the Certification Commission on Health Information Technology.
Let me tell you why that’s important. I bumped into, at a pathology bench at Stanford University, a young student who was ready to go out into practice. He said, “I heard your speech about electronic health records and I subscribe to your view. In fact, I’m going to set my practice up next year and I want to buy a system. I only have one question: What system should I buy? I can only afford to do this once and I can’t get it wrong.” It was not possible for me to recommend a system before. Now, I’m able to say to him, “Whatever system you buy, make sure it is CCHIT-compatible. If you do, you’ll be on a pathway to interoperability and your vendor will need to continue to update their system to meet those standards.” I think that’s a significant step forward.
If interoperability was two feet long, we’d be at about the six or eight inches mark. Next year, we will be at eight or 10 inches. Each year, we’ll get a little closer to interoperability. We won’t see full interoperability for some time but we will see functional interoperability beginning to develop real soon.
That’s on records themselves. The next challenge is to lay in a system for a national health information network, where information can be transported between systems. We will see live data transmitted over that system in September. We’ll see real data begin to flow early next year. All of this is being done at a fairly rudimentary level. The sophistication of it will increase as our experience grows.
A second area of real challenge is in adoption among small- and medium-sized physicians. If you talk to a small- or medium-sized physician today, they will ask the question, “Why should I buy this system for $40,000 or $50,000 when the benefit will go to insurance companies and/or consumers/” We have to change the macroeconomics of medical reimbursement so that everyone benefits.
We have just announced and will conduct a Medicare demonstration project that will help us learn how to do that. We’re choosing 1,200 small physician practices throughout the country and we’re going to start paying them more if they have an electronic medical record. The second year, we’ll pay them more if they report a series of quality measures over their system. And the third year and the fourth year and the fifth year, we’ll pay them more if they can demonstrate that they followed the quality measures and report them on their electronic medical record that’s certified. Over that period of time, we’ll get better and better at learning how to share the value of electronic medical records with everyone.
A third step will be actual implementation of certain portions of it on a national basis. The most logical next step is e-prescribing. I’m hopeful that the Congress will act with the SGR [physician sustainable growth rate payment formula] fix, which will likely be at the end of June, to enable HHS to use its leverage as a payer to motivate physicians to adopt and use e-prescribing.
Q: What have been the biggest obstacles that have kept the healthcare system so behind the curve on IT compared to the rest of the economy?
First of all, it’s far more complex than any other sector of the economy. If you look at banks, for example, they’re highly interoperable but they deal with a very basic measure, and that’s the dollar. They have a currency and once you’re managing where those dollars go, it’s easier than if you’re having to develop the means of managing all of the conditions and the information that goes into healthcare. So, it’s substantially more complex. It’s also far more segmented.
There is no such thing as a national healthcare market. It’s a lot of individual communities and the collective network of communities is the national health insurance market. You essentially have to deal with this one marketplace at a time.
Q: Why is it important the federal government be involved in this process? Why can’t the private sector be left to develop this system on its own?
The best illustration of that is the fact that we had 200 vendors producing electronic medical records, all of whom viewed it as in their interests to be separate from the others to create proprietary interest. I believe the government has a role, and it’s to be that of an organizer of the system.
We have a role not just in our capacity as regulators but in our capacity as a payer. Medicare is the largest single payer. Medicaid, through its affiliations with the states, is another very large payer. That gives us the responsibility, in my judgment, to motivate a collective action. There’s no one else who has that amount of influence.
Q: Who should be responsible for covering the costs of developing and implementing IT in the medical system?
I want to make sure that you and your readers understand what’s involved in interoperability. If you were to take five different systems that are different sizes and different complexities, they don’t need to do everything the same. They simply need to do a limited number of functions the same.
Just to give a rudimentary illustration, let’s assume that there were three systems: one that would do 100,000 different things, one that one would 50,000 different things, and one that would do 10,000 different things. We need those three systems only to do about 800 things the same in order for them to [be considered] interoperable.
We have identified those 800 things and were are aggressively working to develop standards that can be adopted by anyone who is developing a new technology, whether it is a device that could monitor health results outside the hospital or whether it’s a clinical system or a system at a pharmacy, and all of these need to converge.
Let me give you a good example. We know that if diabetics have their hemoglobin A1c tested every quarter, that the chances of them having a complication that would cost a lot of money is reduced because we see the complications as they develop and we can get ahead of them. Well, sometimes it’s difficult to get diabetics to test their blood sugar every day, let alone their hemoglobin A1c on a regular basis. I saw a cell phone that had the equipment necessary to check one’s blood sugar, and various other components, built into the cell phone. You could prick your finger, draw the blood with the end of your cell phone, it would then analyze the blood and use the telephone technology to send it back to an electronic health record. That would be a valuable way of managing the chronic illness of diabetes, but if the cell phone collected the information in a form that could not be transmitted through the telephone to the electronic health record, we would have missed out on that opportunity. So the standards not only apply to electronic medical records, they need to apply to devices that may be in the marketplace.
The private sector will be developing the technology. We simply need to provide the basic standards that they can build into the technology so that it can communicate with other technology that may be developed independent of them.
Q: What are the key legislative changes that Congress should consider in the near term?
Congress could do four things in the near term that would have a substantial impact on this vision maturing.
The first would be standing behind the standards process and developing all of our incentives to support that. Interoperability requires standards. A network, a system, requires standards. If you look at other industries that have been through this — you look at cell phones, you look at ATMs, you look at things as big as airports — they all require standards so that information can be used interchangeably as it develops. It’s vital that Congress support the standards-development process that we have in place that’s now working and that any legislation they do points toward that, as opposed to competing with it.
The second thing I would point to is e-prescribing. That’s a logical next step. We have the technology in place, the standards are in place, we know it saves time and money — and it’s time. The legislation that’s being proposed would provide the secretary with tools necessary to leverage our power as a payer in encouraging the rapid adoption of e-prescribing.
I think a third area would be in helping us leverage our power as a payer to encourage the adoption of electronic medical records. …
When they put [ATMs] into banks, people didn’t use them. They were accustomed to walking up to the counter and dealing with a teller who had become their friend. They first put people in the lobbies to try to bring people over to the machine and teach them how to use it. They would give them toaster ovens and lots of things to incentivize them to use the ATM because it was a more efficient way. At some point, the banks concluded, “We can’t afford to do business with you in the same way if you insist on using the teller at the counter for every transaction. Therefore, we’re going to charge you more if you go to the counter.” Once they did that, people started to move to the ATMs. The same thing was true when we went from dial telephones to touch-tones. There was a transition that had to take place in the way people used the telephone.
We’ll have to go through the same thing with electronic medical records. At first, we’ll have to give people incentives and reasons to use it. But there will be a point where we will have to say we can no longer afford to deal with you in the same way if you’re not going to use the most efficient way of doing business. So, we’ll continue to pay you, but we can’t pay you at the highest level unless you have electronic medical records. There may be, at first, some kind of incentive that helps them transition, but at some point, they have to recognize that they can’t be paid the same if they’re less using a less efficient way of doing business.
The fourth one is, one of the real virtues of electronic medical records is the ability to define quality and cost in a way that’s usable for consumers. The most important tool in doing that is information from claims data. Right now, we have two federal courts that are conflicting on the use of Medicare claims data. A Florida court says we can’t give to anybody to measure quality and a D.C. court says we have to give everything to everybody. Neither of those is the right answer. The right answer is to use the data in way that will help define quality in a controlled and effective way. We need legislation to resolve that dispute. I might add that all of those are part of the SGR legislation.…This isn’t about having people have computers that keep electronic data. It’s enabling the data to be in a form that’s usable to people and that can be mobilized and assembled in a lot of different ways.
One of those ways is giving consumers information about the cost and quality of their care so that they have choices and they can compare. We know when people have choices, they make decisions that drive the quality up and the costs down.
Health information technology is an enabler of better quality, lower costs, fewer mistakes and more convenience.
That’s why we push for electronic medical records. It isn’t just because it’s a tidier way to do business. It’s because it produces value. The actual implementation of the records is a necessary step toward that larger goal. The goal is the value that the records produce, not just the existence of the records.
The Hill caught up with Health and Human Services Secretary Mike Leavitt to ask him about the status of the president's electronic medical records initiatives. The full transcript appears below:
Q&A with Mike Leavitt
By Jeffrey Young
In 2004, President Bush introduced a sweeping initiative to promote the development of a nationwide system of health information technology. One key goal is to provide every citizen with access to an electronic medical record by 2014. Bush tasked Health and Human Services Secretary Mike Leavitt to helm the gargantuan effort, which represents an attempt to bring together the private and public sectors to create a technological infrastructure for the healthcare system of the future.
Q: Is President Bush’s 10-year plan for electronic medical records on track?
I believe that will be accomplished. I think the goal may be exceeded. There will be a point where this begins to happen quickly. That’s the way technology develops: There are some early adopters, the mechanism has to be put into place, people begin to catch the vision. Once the consumer begins to see its value, it spreads quickly.
Q: Other than electronic medical records, what are the key components of a fully wired healthcare system?
I think it’s important to remember that the goal here isn’t electronic medical records. The goal is to transform the sector of healthcare into a system of healthcare, a system that provides consumers with information about the quality and the cost of their care.
To accomplish that, we need to have information digitized rather than on paper and we need to have that information mobilized so that it can be assembled in many different ways that are useful, not just to consumers but to various parties. If you look at digital health information, the goal looks different depending on who you are and what your interests are.
If you’re a consumer, you’re interested in having all of your health information accessible to you in a timely, useful way. You’d like to have your pharmacy records for the three pharmacies that you do business with in one place. You’d like to have the information from your doctor, from your hospital, from your specialists, from the labs, accessible to you in one place. You don’t want to have to go to your doctor and pick up a big brown envelope and transport it to a specialist for them to see a test that you took three days before. You’d like that to be electronically transferred, like everything else can be in your life.
If you’re a clinician or a doctor, you’re interested in having a clinical record that has more information than likely a consumer is interested in. You’re interested in being able to have decision-support information that would provide backup for decisions that you need to make, and alternatives and options that would help you make better decisions.
If you are a public-health expert, you’d like to be able to gather a lot of data from many different places. Even though it doesn’t have anyone’s name attached to it, it would provide you with statistical backup to look for trends. If you’re a researcher, you’d like to see something quite similar, but you would like to see it from a wider area.
My point is that, if you’re a consumer or a clinician or a researcher, all of this looks different to you. To put it a different way, it will look different depending on the way you view the world.
The goal here is to, first of all, get information transferred from paper into a digital format, then create a means by which it can be mobilized so it can be assembled in various forms, and to provide benefit to consumers, to practitioners, to hospitals, to researchers, to public health, or to those in the business of health.
Q: What will be the biggest advantages to better incorporating information technology into the healthcare system?
In the long run, it will provide better health, lower costs, fewer medical mistakes and a lot less hassle.
Q: All three of the presidential candidates’ healthcare reform plans depend in part on health IT saving money. How much money could be saved through the efficiencies that should come with from using these technologies?
The best source of that may be the RAND study. The RAND Corporation did a study that said … there was a 30 percent inefficiency in the costs. I’m not predicting a 30 percent reduction but I do believe that over time we can begin to have medical inflation more closely approximate regular inflation. If you could make that change in the glide pattern or the slope of growth, it would make a profound economic difference.
Q: Since the administration’s effort began, what’s done and what’s still to be accomplished?
Three years ago, there were 200 vendors who were producing electronic medical records for sale. None of them had the capacity to be interoperable because there were no standards for interoperability. Interoperability essentially means one computer system being able to talk to another.
We developed a process for developing standards that incorporated the medical family, developers of technology, government entities, insurance companies, et cetera, and have now instituted a means by which those standards are emerging.
We also created a process for certifying systems that meet those standards. Three years ago, there was no process and obviously no means of certifying that people were on the pathway to health IT or to interoperability. We have accomplished that: Some 75 percent of all the systems now available for sale are certified by the CCHIT, which is the Certification Commission on Health Information Technology.
Let me tell you why that’s important. I bumped into, at a pathology bench at Stanford University, a young student who was ready to go out into practice. He said, “I heard your speech about electronic health records and I subscribe to your view. In fact, I’m going to set my practice up next year and I want to buy a system. I only have one question: What system should I buy? I can only afford to do this once and I can’t get it wrong.” It was not possible for me to recommend a system before. Now, I’m able to say to him, “Whatever system you buy, make sure it is CCHIT-compatible. If you do, you’ll be on a pathway to interoperability and your vendor will need to continue to update their system to meet those standards.” I think that’s a significant step forward.
If interoperability was two feet long, we’d be at about the six or eight inches mark. Next year, we will be at eight or 10 inches. Each year, we’ll get a little closer to interoperability. We won’t see full interoperability for some time but we will see functional interoperability beginning to develop real soon.
That’s on records themselves. The next challenge is to lay in a system for a national health information network, where information can be transported between systems. We will see live data transmitted over that system in September. We’ll see real data begin to flow early next year. All of this is being done at a fairly rudimentary level. The sophistication of it will increase as our experience grows.
A second area of real challenge is in adoption among small- and medium-sized physicians. If you talk to a small- or medium-sized physician today, they will ask the question, “Why should I buy this system for $40,000 or $50,000 when the benefit will go to insurance companies and/or consumers/” We have to change the macroeconomics of medical reimbursement so that everyone benefits.
We have just announced and will conduct a Medicare demonstration project that will help us learn how to do that. We’re choosing 1,200 small physician practices throughout the country and we’re going to start paying them more if they have an electronic medical record. The second year, we’ll pay them more if they report a series of quality measures over their system. And the third year and the fourth year and the fifth year, we’ll pay them more if they can demonstrate that they followed the quality measures and report them on their electronic medical record that’s certified. Over that period of time, we’ll get better and better at learning how to share the value of electronic medical records with everyone.
A third step will be actual implementation of certain portions of it on a national basis. The most logical next step is e-prescribing. I’m hopeful that the Congress will act with the SGR [physician sustainable growth rate payment formula] fix, which will likely be at the end of June, to enable HHS to use its leverage as a payer to motivate physicians to adopt and use e-prescribing.
Q: What have been the biggest obstacles that have kept the healthcare system so behind the curve on IT compared to the rest of the economy?
First of all, it’s far more complex than any other sector of the economy. If you look at banks, for example, they’re highly interoperable but they deal with a very basic measure, and that’s the dollar. They have a currency and once you’re managing where those dollars go, it’s easier than if you’re having to develop the means of managing all of the conditions and the information that goes into healthcare. So, it’s substantially more complex. It’s also far more segmented.
There is no such thing as a national healthcare market. It’s a lot of individual communities and the collective network of communities is the national health insurance market. You essentially have to deal with this one marketplace at a time.
Q: Why is it important the federal government be involved in this process? Why can’t the private sector be left to develop this system on its own?
The best illustration of that is the fact that we had 200 vendors producing electronic medical records, all of whom viewed it as in their interests to be separate from the others to create proprietary interest. I believe the government has a role, and it’s to be that of an organizer of the system.
We have a role not just in our capacity as regulators but in our capacity as a payer. Medicare is the largest single payer. Medicaid, through its affiliations with the states, is another very large payer. That gives us the responsibility, in my judgment, to motivate a collective action. There’s no one else who has that amount of influence.
Q: Who should be responsible for covering the costs of developing and implementing IT in the medical system?
I want to make sure that you and your readers understand what’s involved in interoperability. If you were to take five different systems that are different sizes and different complexities, they don’t need to do everything the same. They simply need to do a limited number of functions the same.
Just to give a rudimentary illustration, let’s assume that there were three systems: one that would do 100,000 different things, one that one would 50,000 different things, and one that would do 10,000 different things. We need those three systems only to do about 800 things the same in order for them to [be considered] interoperable.
We have identified those 800 things and were are aggressively working to develop standards that can be adopted by anyone who is developing a new technology, whether it is a device that could monitor health results outside the hospital or whether it’s a clinical system or a system at a pharmacy, and all of these need to converge.
Let me give you a good example. We know that if diabetics have their hemoglobin A1c tested every quarter, that the chances of them having a complication that would cost a lot of money is reduced because we see the complications as they develop and we can get ahead of them. Well, sometimes it’s difficult to get diabetics to test their blood sugar every day, let alone their hemoglobin A1c on a regular basis. I saw a cell phone that had the equipment necessary to check one’s blood sugar, and various other components, built into the cell phone. You could prick your finger, draw the blood with the end of your cell phone, it would then analyze the blood and use the telephone technology to send it back to an electronic health record. That would be a valuable way of managing the chronic illness of diabetes, but if the cell phone collected the information in a form that could not be transmitted through the telephone to the electronic health record, we would have missed out on that opportunity. So the standards not only apply to electronic medical records, they need to apply to devices that may be in the marketplace.
The private sector will be developing the technology. We simply need to provide the basic standards that they can build into the technology so that it can communicate with other technology that may be developed independent of them.
Q: What are the key legislative changes that Congress should consider in the near term?
Congress could do four things in the near term that would have a substantial impact on this vision maturing.
The first would be standing behind the standards process and developing all of our incentives to support that. Interoperability requires standards. A network, a system, requires standards. If you look at other industries that have been through this — you look at cell phones, you look at ATMs, you look at things as big as airports — they all require standards so that information can be used interchangeably as it develops. It’s vital that Congress support the standards-development process that we have in place that’s now working and that any legislation they do points toward that, as opposed to competing with it.
The second thing I would point to is e-prescribing. That’s a logical next step. We have the technology in place, the standards are in place, we know it saves time and money — and it’s time. The legislation that’s being proposed would provide the secretary with tools necessary to leverage our power as a payer in encouraging the rapid adoption of e-prescribing.
I think a third area would be in helping us leverage our power as a payer to encourage the adoption of electronic medical records. …
When they put [ATMs] into banks, people didn’t use them. They were accustomed to walking up to the counter and dealing with a teller who had become their friend. They first put people in the lobbies to try to bring people over to the machine and teach them how to use it. They would give them toaster ovens and lots of things to incentivize them to use the ATM because it was a more efficient way. At some point, the banks concluded, “We can’t afford to do business with you in the same way if you insist on using the teller at the counter for every transaction. Therefore, we’re going to charge you more if you go to the counter.” Once they did that, people started to move to the ATMs. The same thing was true when we went from dial telephones to touch-tones. There was a transition that had to take place in the way people used the telephone.
We’ll have to go through the same thing with electronic medical records. At first, we’ll have to give people incentives and reasons to use it. But there will be a point where we will have to say we can no longer afford to deal with you in the same way if you’re not going to use the most efficient way of doing business. So, we’ll continue to pay you, but we can’t pay you at the highest level unless you have electronic medical records. There may be, at first, some kind of incentive that helps them transition, but at some point, they have to recognize that they can’t be paid the same if they’re less using a less efficient way of doing business.
The fourth one is, one of the real virtues of electronic medical records is the ability to define quality and cost in a way that’s usable for consumers. The most important tool in doing that is information from claims data. Right now, we have two federal courts that are conflicting on the use of Medicare claims data. A Florida court says we can’t give to anybody to measure quality and a D.C. court says we have to give everything to everybody. Neither of those is the right answer. The right answer is to use the data in way that will help define quality in a controlled and effective way. We need legislation to resolve that dispute. I might add that all of those are part of the SGR legislation.…This isn’t about having people have computers that keep electronic data. It’s enabling the data to be in a form that’s usable to people and that can be mobilized and assembled in a lot of different ways.
One of those ways is giving consumers information about the cost and quality of their care so that they have choices and they can compare. We know when people have choices, they make decisions that drive the quality up and the costs down.
Health information technology is an enabler of better quality, lower costs, fewer mistakes and more convenience.
That’s why we push for electronic medical records. It isn’t just because it’s a tidier way to do business. It’s because it produces value. The actual implementation of the records is a necessary step toward that larger goal. The goal is the value that the records produce, not just the existence of the records.
Monday, January 7, 2008
Healthcare Payments Still Hot
By Mark Brousseau
Without question, healthcare payments processing was one of the hottest topics in financial services in 2007, with tremendous buzz, loads of product tire kicking, and more technology implementations by lockbox providers. This year promises to be no different.
Bill Gamble (bgamble@egisticsinc.com), healthcare strategic account executive for Dallas-based eGistics, Inc., believes there are two major trends to watch for this year in healthcare payments: continued adoption of automated explanation of benefits (EOB) processing solutions, and an increase in Health Savings Accounts (HSAs).
As banks become more adept at selling the benefits of automated EOB processing services, Gamble expects more of their lockbox clients to adopt the technology. “You also will see current competitors in the market target each others accounts with cheaper fees and better service,” Gamble told me. “I also expect some of these banks and service organizations to go after the 55 percent of healthcare accounts that don’t currently use bank or third-party lockbox services.”
Meantime, Gamble sees an increase in HSAs as more companies put a greater burden on employees to cover their healthcare expenses. As banks chase HSA deposits, Gamble expects a new market to rise to handle the increasing number of payments coming from these accounts. For instance, there could be a need for a service to convert paper enrollments to 834 format for payors, as well as a need to convert that information into the format banks require to set up a new account.
Underlying both of these trends, Gamble said, will be the need to archive images of healthcare documents for verification, research and customer support.
What do you think? E-mail me at m_brousseau@msn.com.
Without question, healthcare payments processing was one of the hottest topics in financial services in 2007, with tremendous buzz, loads of product tire kicking, and more technology implementations by lockbox providers. This year promises to be no different.
Bill Gamble (bgamble@egisticsinc.com), healthcare strategic account executive for Dallas-based eGistics, Inc., believes there are two major trends to watch for this year in healthcare payments: continued adoption of automated explanation of benefits (EOB) processing solutions, and an increase in Health Savings Accounts (HSAs).
As banks become more adept at selling the benefits of automated EOB processing services, Gamble expects more of their lockbox clients to adopt the technology. “You also will see current competitors in the market target each others accounts with cheaper fees and better service,” Gamble told me. “I also expect some of these banks and service organizations to go after the 55 percent of healthcare accounts that don’t currently use bank or third-party lockbox services.”
Meantime, Gamble sees an increase in HSAs as more companies put a greater burden on employees to cover their healthcare expenses. As banks chase HSA deposits, Gamble expects a new market to rise to handle the increasing number of payments coming from these accounts. For instance, there could be a need for a service to convert paper enrollments to 834 format for payors, as well as a need to convert that information into the format banks require to set up a new account.
Underlying both of these trends, Gamble said, will be the need to archive images of healthcare documents for verification, research and customer support.
What do you think? E-mail me at m_brousseau@msn.com.
Monday, November 5, 2007
From Transaction Systems To Analytics
By Mark Brousseau
In an article on trends in IT capabilities and advancements in healthcare finance that appears in this month’s issue of HFMA’s magazine, Deb Davis and Jim Adams, both of IBM Global Business Services, identified the move from transaction systems to analytics.
“As advanced clinical systems are implemented, the value of clinical information can be extended beyond the transaction level to be used for risk management, trend analysis, and analytics that include financial and clinical data,” Davis and Adams wrote.
The development of a health analytics roadmap can determine strategic priorities in the analysis and use of data with research, finance, and patient care, they conclude.
Sounds like another example of the convergence of payments and document processing to me. What do you think? E-mail me at m_brousseau@msn.com.
In an article on trends in IT capabilities and advancements in healthcare finance that appears in this month’s issue of HFMA’s magazine, Deb Davis and Jim Adams, both of IBM Global Business Services, identified the move from transaction systems to analytics.
“As advanced clinical systems are implemented, the value of clinical information can be extended beyond the transaction level to be used for risk management, trend analysis, and analytics that include financial and clinical data,” Davis and Adams wrote.
The development of a health analytics roadmap can determine strategic priorities in the analysis and use of data with research, finance, and patient care, they conclude.
Sounds like another example of the convergence of payments and document processing to me. What do you think? E-mail me at m_brousseau@msn.com.
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