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Hospitals Offering Broad Access To Health Data, But There Are Limits

Posted on October 5, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study released by the ONC concludes that hospitals are almost universally offering patients ability to view their data electronically, with large numbers offering patients the ability to view and share their data digitally as well.

While the data reveals that hospitals have become more ready to offer electronic access to patient records, it also suggests that they are struggling to provide a full array of electronic access options. The fact that some hospitals still haven’t gotten there may be just a phase, but it may also suggest that issues still remain which they need to address before they offer a full range of patient data functions.

On the one hand, the results of the study are promising. The ONC data demonstrates that there’s been a very substantial uptick in the deployment of patient data access technologies between 2012 and 2015. The data shows that in 2015, 95% of U.S. hospitals gave patients the ability to view their health information electronically, 87% allowed them to download their health information and 69% offered the trifecta (patients get to view, download and transmit the health information).

These numbers represent huge changes that took place during the period studied. For example, in 2013 no state had 40% or more of its hospitals offering patients the ability to view, download or transmit their data, and now all states have at least 40% of their hospitals offering all three options. Meanwhile, the volume of hospitals offering view and download availability has grown 70% when compared to 2012, the ONC reports. And the proportion of hospitals providing view, download and transmit capabilities increased seven fold from 2013.

These numbers track closely with data reported by the American Hospital Association earlier this year, which found that 92% of hospitals responding to its survey offered patients access to the medical records in 2015, up from just 43% in 2013. The AHA also found that 84% of hospitals allowed patients to download information from their records, 70% let patients suggest changes to their medical record and 70% had made it possible for patients to send a referral summary electronically.

All that being said, however, I find it a bit troubling that roughly 30% of hospitals aren’t offering the all three major functions mentioned above. It appears that a failure to offer patients the ability to share their data is what disqualifies most of the 31% from being included in the list of broadly-functioning data sharing candidates. And that’s just too bad.

I guess I shouldn’t be surprised that a substantial subset of hospitals haven’t enabled such sharing, given that many still seem to see the data as proprietary. (I can’t prove this but I’ve heard many anecdotes to that effect.) But I’m still disappointed to find that many hospitals haven’t enabled such a lightweight model of interoperability.

$34.7 Billion Spent on Meaningful Use

Posted on July 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS has put out the latest data on meaningful use participation and payments. They broke the Medicare dollars out by meaningful use stage 1 and stage 2. Meaningful use stage 1 cost nearly $20 billion. Meaningful use stage 2 cost $3.4 billion. The amounts were less for stage 2, but that’s still a massive drop off.

Less than half of eligible providers participated in stage 2 that participated in stage 1 (308k compared to 145k). Participating hospitals dropped from 4600 hospitals to 3096. This illustrates well what we’ve been saying for a while as far as hospitals still largely participating in meaningful use and most doctors choosing not to participate.

Also interesting to note is that at its peak, meaningful use was paying about $10 billion per year. In 2015, they spent $2.8 billion.

What I didn’t see in this report was any numbers on the cost savings that the meaningful use program provided. All the OIG estimates for meaningful use talked about how much money would be spent, but they also calculated how much money would be saved as well. As I recall they estimated about $36 billion in spending, but about $16 billion in savings. That would put the cost of the meaningful use program at $20 billion instead of the full $36 billion which it looks like we’ve now pretty much spent.

I like that HHS puts out this accountability as far as where the meaningful use money was spent. Shouldn’t we have some accountability as far as the savings as well? Do they not have a way to calculate it? Are they afraid that there weren’t cost savings? Or that meaningful use actually added costs? Maybe it’s in another report and I just missed it. If you know of that other report, I’d love to see it.

What do you think of these numbers? What’s been the benefit of the $34.7 billion that’s been spent? I’d love to hear your thoughts in the comments.

Data Sharing Largely Isn’t Informing Hospital Clinical Decisions

Posted on July 6, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Some new data released by ONC suggests that while healthcare data is being shared far more frequently between hospitals than in the past, few hospital clinicians use such data regularly as part of providing patient care.

The ONC report, which is based on a supplement to the 2015 edition of an annual survey by the American Hospital Association, concluded that 96% of hospitals had an EHR in place which was federally tested and certified for the Meaningful Use program. That’s an enormous leap from 2009, the year federal economic stimulus law creating the program was signed, when only 12.2% of hospitals had even a basic EHR in place.

Also, hospitals have improved dramatically in their ability to share data with other facilities outside their system, according to an AHA article from February. While just 22% of hospitals shared data with peer facilities in 2011, that number had shot up to 57% in 2014. Also, the share of hospitals exchanging data with ambulatory care providers outside the system climbed from 37% to 60% during the same period.

On the other hand, hospitals are not meeting federal goals for data use, particularly the use of data not created within their institution. While 82% of hospitals shared lab results, radiology reports, clinical care summaries or medication lists with hospitals or ambulatory care centers outside of their orbit — up from 45% in 2009 — the date isn’t having as much of an impact as it could.

Only 18% of those surveyed by the AHA said that hospital clinicians often used patient information gathered electronically from outside sources. Another 35% reported that clinicians used such information “sometimes,” 20% used it “rarely” and 16% “never” used such data. (The remaining 11% said that they didn’t know how such data was used.)

So what’s holding hospital clinicians back? More than half of AHA respondents (53%) said that the biggest barrier to using interoperable data integrating that data into physician routines. They noted that since shared information usually wasn’t available to clinicians in their EHRs, they had to go out of the regular workflows to review the data.

Another major barrier, cited by 45% of survey respondents, was difficulty integrating exchange information into their EHR. According to the AHA survey, only 4 in 10 hospitals had the ability to integrate data into their EHRs without manual data entry.

Other problems with clinician use of shared data concluded that information was not always available when needed (40%), that it wasn’t presented in a useful format (29%) and that clinicians did not trust the accuracy of the information (11%). Also, 31% of survey respondents said that many recipients of care summaries felt that the data itself was not useful, up from 26% in 2014.

What’s more, some technical problems in sharing data between EHRs seem to have gotten slightly worse between the 2014 and 2015 surveys. For example, 24% of respondents the 2014 survey said that matching or identifying patients was a concern in data exchange. That number jumped to 33% in the 2015 results.

By the way, you might want to check out this related chart, which suggests that paper-based data exchange remains wildly popular. Given the challenges that still exist in sharing such data digitally, I guess we shouldn’t be surprised.

New Federal Health IT Strategic Plan for 2015-2020

Posted on December 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The big news came out today that HHS had released its Health IT Strategic Plan for 2015-2020. You can find more details about the plan and also read the 28 page Federal Health IT Strategic plan online. Unlike many of the regulations, this strategic plan is very readable and gives a pretty good idea of where ONC wants to take healthcare IT (hint: interoperability). Although, the document is available for comment, so your comments could help to improve the proposed plan.

I think this image from the document really does a nice job summarizing the plan’s goals:
Federal Health IT Strategic Plan Summary

When I see a plan like this, the goals are noble and appropriate. No doubt we could argue about some of the details, but I think this is directionally good. What I’m not so sure about is how this plan will really help healthcare reach the specified goals. I need to dive into the specific strategies offered in the document to know if they really have the ability to reach these goals. I might have to take each goal and strategy and make a series out of it.

What do you think of this new health IT strategic plan?

The State of Government Healthcare IT Initiatives

Posted on November 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Brian Eastwood has created a really great article on CIO.com that looks at why Healthcare IT is under fire. His finally couple paragraphs summarize the current challenge for government healthcare IT initiatives:

ONC – as well as HHS at large – admittedly finds itself between Scylla and Charybdis. Too much regulation (medical devices) can do just as much harm as too little regulation (interoperability). Moving too quickly (meaningful use) can cause as much frustration as moving too slowly (telehealth). Politics can explain some industry challenges (reform’s uncertain future) but not others (public perception of Healthcare.gov).

That said, healthcare wants to change. Healthcare has to change. As healthcare continues its rapid, unprecedented march toward modernity, industry leaders have every right to expect – no, demand – a strong, confident voice in their corner. Right now, ONC can barely muster a whisper when, instead, it should be shouting.

I don’t think I’ve seen a better concise summary of the challenges that ONC, CMS, FDA, etc face. This shouldn’t be seen as an excuse for these organizations. We all face challenges in our job and we have to learn to balance them all. The same is true for organizations like ONC.

What makes this challenge even harder for ONC is that they’re in the midst of a massive change in leadership. Not to mention a leader, Karen DeSalvo, who at best has her time split between important issues like Ebola and her work as National Coordinator over healthcare IT. Considering DeSalvo’s passion for public health, you can guess where she’s going to spend most of her time.

In some ways it reminds me of when I started my first healthcare IT blog: EMR and HIPAA. As I started blogging, I realized that I had a real passion for writing about EMR. The same could not be said for HIPAA. Despite it’s name, I was spending most of my time writing about EMR and only covering HIPAA when breaches or other major changes happened. I imagine that DeSalvo will take a similar path.

Without a dedicated leader, I don’t see any way that Brian Eastwood’s vision of ONC shouting with confidence becoming a reality. A bifurcated leader won’t likely be able to muster more than the current whisper. It’s no wonder that CHIME, HIMSS and other major organizations are asking for DeSalvo to be full time at ONC or for her to be replaced with someone who can be dedicated full time to ONC.

What should be clear to us all is that healthcare IT isn’t going anywhere. Technology is going to be a major part of healthcare going forward. Why the government wouldn’t want to make a sound investment with strong leadership is beyond me.

What’s Happening with All the Departures at ONC?

Posted on October 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many ways, it’s expected that there will be a fair amount of change in the leadership of an organization when the leader leaves. The new leader often wants to bring in their people with whom they’ve worked with before and trust. Plus, I’ve previously noted that the Golden Age of EHR is over and so it’s not surprising that many people would leave ONC as the MU money is running out and the future of ONC is uncertain.

You’ll see the letter below that Karen DeSalvo just sent out about the latest ONC departure: Judy Murphy, Chief Nursing Officer (CNO) at ONC. This is the fourth high level leader that’s left ONC in the past few months. For those keeping track at home, Doug Fridsma MD, ONC’s Chief Science Officer, Joy Pritts, the first Chief Privacy Officer at ONC, and Lygeia Ricciardi, Director of the Office of Consumer eHealth, are the other 3 that have left ONC.

When Karen DeSalvo announced the ONC reorganization, here’s the leadership team she outlined:
Office of Care Transformation: Kelly Cronin
Office of the Chief Privacy Officer: Joy Pritts
Office of the Chief Operating Officer: Lisa Lewis
Office of the Chief Scientist: Doug Fridsma, MD, PhD
Office of Clinical Quality and Safety: Judy Murphy, RN
Office of Planning, Evaluation, and Analysis: Seth Pazinski
Office of Policy: Jodi Daniel
Office of Programs: Kim Lynch
Office of Public Affairs and Communications: Nora Super
Office of Standards and Technology: Steve Posnack

Three of the people on this list have already left ONC. That’s a pretty big hit to an organization that will likely have to do some hard work to ensure they’re included in future budgets in a post-MU era. It’s hard to fault any of these people who have an opportunity to make a lot more money working in industry. It will be fun to see who steps in to replace all these departures (including Dr. Jon White and Dr. Andy Gettinger who DeSalvo talks about in her letter below).

Must be an interesting time in the hallways of ONC.

Letter from Karen DeSalvo to ONC team about the departure of Judy Murphy, CNO of ONC:

ONC Team:

I am writing to let you know that Judy Murphy, our Chief Nursing Officer (CNO) and Director of the Office of Clinical Quality and Safety (OCQS), will be leaving ONC to take on an exciting new position as Chief Nursing Officer with IBM Healthcare Global Business Services. Her last day will be October 17.

Judy came to ONC in December 2011 and continued her established tradition of giving passionately and tirelessly to the entire health IT community. As Deputy National Coordinator for Programs and Policy, she led the HITECH funded program offices to achieve key milestones, such as the RECs providing assistance to 150,000 providers and helping 100,000 of them meet the meaningful use incentive requirements (exceeding the goal by 150%). She ensured that dedicated resources were available to help 1,300 critical access and rural hospitals exceed the same goals by 200%. She helped grow the MUVer (Meaningful Use Vanguard) Program to 1,000 providers and the Health IT Fellows Program to 45, giving us real boots on the ground to help providers adopt and use EHRs.

Her long-standing reputation of patient advocacy and maintaining a “patient-centric” point of view helped in ONC’s creation of the Office of Consumer eHealth, as well as identify annual strategic goals to promote consumer engagement. With the office, she helped launch the now very successful “Blue Button: Download your Health Data” campaign initiative.

Most recently, as CNO, she championed a Nursing Engagement Strategy for ONC and initiated the joint ONC and American Nurses Association Health IT for Nurses Summit which was attended by 200 RNs and NPs. In addition, her astute organizational and project management skills were put to use strengthening portfolio management and project performance management at ONC.

In her time here, she received several awards spotlighting her work, including the HIMSS Federal Health IT Leadership Award, the AMIA President’s Leadership Award, and the Distinguished Alumni Achievement Award from her alma mater, Alverno College, in Wisconsin.

We are planning a smooth transition of Judy’s current duties. Judy’s CNO responsibilities will be entrusted to the other nurses at ONC until a replacement CNO can be named.

Dr. Jon White will be on a part-time detail to ONC from the Agency for Healthcare Research and Quality (AHRQ) to serve as interim lead of OCQS and serve as ONC’s Acting Chief Medical Officer, reporting to Deputy National Coordinator Jacob Reider, while ONC searches for permanent staff to fill these positions. Dr. White directs AHRQ’s Health IT portfolio and will continue in that role part-time.

Dr. Andy Gettinger, from Dartmouth Hitchcock Medical Center, has agreed to lead the OCQS Safety team and the patient safety work. Dr. Gettinger comes to us with vast experience in many areas of health IT and we are excited to welcome him to the team. Judy is working closely with Jon, Andy, the extraordinary OCQS team, and me to ensure a seamless transition of her responsibilities.

Please join me in wishing Judy all the best in her new role, thanking her for her public service to our nation, and welcoming Andy and Jon to our team.

kd

CMS Issues Final Rule on EHR Certification Flexibility, MU Stage 2 Extension, and MU Stage 3 Timeline

Posted on August 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I can’t figure out what government process leads to final rules being regularly published at the end of the day on Friday. I know that Neil Versel from Meaningful Health IT News has hypothesized that they release it late on Friday when they want to bury the news. Maybe that’s the case, but the EHR certification flexibility doesn’t seem like something they’d want to bury. Regardless of the odd timing, CMS has just published the final rule that provides flexibility around EHR certification in the meaningful use program.

In their announcement, I’m not noticing any changes from what was in the proposed rule, but with some time we’ll know for sure if there’s any gotchas hidden in the final rule. No doubt many a meaningful use expert have just had their Labor Day weekend ruined by the announcement of this final rule.

Unfortunately, after the proposed rule was published most people loved the flexibility, but decided that it was too late for them to really benefit from the changes. I’ll be interested to see how many organizations will really benefit from these changes.

More importantly, the rule still includes the nebulous asterisk, “Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.” For EHR vendors that are already 2014 certified, this little asterisk feels like ONC is letting all the EHR vendors who didn’t perform well off the hook. It’s basically rewarding EHR vendors who can’t or have chosen not to keep up. Maybe that’s why the rule was published late on a Friday.

One could make the case that ONC was more worried about the doctors/hospitals whose EHR vendors failed to become 2014 certified, than the EHR vendors themselves. However, that part of the story is not likely to be told. Plus, it doesn’t take into account how a doctor/hospital whose EHR vendor is 2014 Certified will feel having to do the substantially harder MU stage 2 while their colleagues only have to do MU stage 1. (UPDATE: This EHR Certification Tool that CMS created seems to say that even if you’re on a 2014 Certified EHR and scheduled to do MU stage 2, that you can do Stage 1 or stage 2 objectives with 2014 CQMs. The chart linked at the bottom of this post says it as well. Seems like they’re being pretty open in their interpretation of “due to delays in 2014 Edition CEHRT availability”. Clear as mud?)

I’ve captured a chart showing the EHR Certification flexibility that this final rule provides:
EHR Certification Flexibility - 2014 Certified EHR

Plus, here’s the latest chart showing the meaningful use timelines:
Updated Meaningful Use Stage 3 Timeline

Other Resources and Responses:
CMS Official Press Release
CHIME’s Response
CMS’ EHR Certification Rule Tool
CMS HITECH 2014 CEHRT Flexibility Chart

We’ll keep adding other responses and commentary on the final rule as we find them.

The Challenge of Clinical Quality Measures – ONC Dashboard

Posted on April 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The incomparable Mandi Bishop just pointed out to me an amazing ONC dashboard that’s tracking issues with the clinical quality measures (CQM). I don’t know how I’d never seen this before, but it’s a treasure trove of amazing information. I’m proud of ONC for being this transparent in their efforts to make the clinical quality measures as effective as possible.

It’s also an amazing illustration of how hard it is to get these clinical quality measures correct. As Mandi pointed out to me, Beta-blockers, for example, can’t be tolerated by Asian-Americans, but that’s a required CQM: prescribe beta-blockers within 24 hours of surgery for cardiac patients. That’s scary to think that a clinical quality measure could actually do harm versus improving quality.

We’ve heard this from doctors for a really long time. Medicine is complicated and each patient is unique. This dashboard illustrates many of those challenges.

Personally I think that the clinical quality measures were a step too far in the EHR incentive program. Although, I’ve long wished that all the incentive money would have been focused on establishing a standard for EHR interoperability and then paying organizations that were interoperable. That would do more impact for good on healthcare than these clinical quality measures.

What are your thoughts and experiences with clinical quality measures?

HIMSS: The FDA Should Tread Carefully With Health IT Oversight

Posted on November 12, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Of late, the FDA has been looking at into how it will regulate health IT generally, and EMRs especially, under the authority of the Food and Drug Administration Safety Innovation Act of 2012.  This, of course, has the vendor community very nervous, as they’re not eager to have an agency as powerful as the FDA breathing down their neck.

In an effort to soften the blow somewhat, the chairman  and CEO of HIMSS  have written a letter to HHS outlining why health IT products, especially EMRs, have unique functions and requirements.

In the letter, they argue that any regulatory efforts that are made should have the following characteristics:

• Holistic Approach: Any regulatory or oversight framework should recognize that health IT is part of a complex patient care ecosystem involving providers, product developers, vendors, a  wide array of use cases, and consumers as patients and caregivers.
• Shared Responsibility: The safety and efficacy of health IT as it fits within the patient care
system can be enhanced through non-punitive surveillance and reporting systems based on mutual trust and shared responsibility by all participants.
• Clear Oversight Direction: Clear and consistent guidance regarding proposed regulatory and/or  oversight activity is essential to ensure that health IT can continue to provide the innovation and tools necessary to achieve the patient safety and quality improvement goals, and cost efficiencies sought by all stakeholders.
• Role of Intended Use/Functionality: Regulation and oversight actions should be based on the  intended purpose and intended user of a particular product or service.

Cutting a nice wide path for EMRs and related clinical data systems, HIMSS argues that health IT products largely used for transmission, storage and management of data should not be considered medical devices. The execs also argue that there’s a big difference between products which are “integral to the functioning of a medical device,” and those that communicate with such devices. (While there’s definitely a move on to integrate EMRs and medical devices, progress has been scant to date.)

We’ll see how successful HIMSS was at shaping the FDA’s expectations next year, when the agency releases a joint report outlining its strategy in cooperation with the FCC and ONC.

In the mean time, the three agencies have formed a workgroup under the ONC’s HIT  Policy Committee which will provide recommendations to the Health IT Policy Committee.  If you’re as worried as HIMSS is, and there’s no reason not to be, the workgroup may offer a chance to make your voice heard. Getting involved, or at least commenting on draft report docs, is probably a good idea.

Honoring Government Furloughs

Posted on October 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With so many government employees on furlough today, I thought I’d honor them by doing the same on this blog. At ONC, only 4 people were not furloughed. That’s amazing. Should we feel bad for those 4 that are still at work?

Next week I’ll be at CHIME most of the week. So, this cartoon about the government sequestration (which caused similar issues to the furloughs) seemed appropriate. If you’ll be at CHIME 2013, I hope you’ll say Hi.
Government Furlough Cartoon