Hitsphere Feeds

Karen Dearne: Just How Can NEHTA Operate Without Its Supporting Agreement? The Secrecy Seems To Be Utterly Out Of Hand! | Australian Health Information Technology

Thu, 23 May 2013 02:30:02 -0400

Karen alerted me to this post today. From: Karen Dearne May 23, 2013 Dear Ms Forman I refer to your decision that the MoU on eHealth is an exempt document under section 47B(a) of the FOI Act. I note that you say: "As the MoU is not yet signed by all parties and is considered not to commence until this has happened, the release of the document may pre-empt jurisdictional agreement and may cause damage to relations between the Commonwealth and a State (including a Territory)". This is surprising news, as the previous National Partnership Agreement on E-Health, constituting joint commonwealth-state funding arrangements for the National E-Health Transition Authority's work program, expired at the end of June 2012. A renegotiated e-health agreement was identified as a key priority for the Health Minister when Ms Plibersek took that role. The Department of Health and Ageing advised the Senate Community Affairs committee that "the eHealth MoU, which replaces the National...

This is the initial part of the post - read more by clicking on the title of the article. David.

Morning Headlines 5/23/13 | HISTalk

Wed, 22 May 2013 23:40:35 -0400

Doctors and hospitals’ use of health IT more than doubles since 2012

HHS Secretary Kathleen Sebelius reports that HHS has met and exceeded its goal of transitioning 50 percent of eligible providers and 80 percent of eligible hospitals onto EHRs by the end of 2013.

Hagel says DoD to adopt commercial EHR

Last month Defense Secretary Chuck Hagel testified before a House Appropriations Committee to report that DoD had fallen way behind on its plans to implement an integrated EHR with the VA, that much of the allocated money for the project had been spent with little to show, and that when the decision to launch a vendor search for a commercial EHR was made, he "didn’t think we knew what the hell we were doing." At the conclusion of that hearing, Hagel promised that he would halt the commercial vendor search and report back within 30 days with DoD’s new plan for delivering an integrated DoD/VA EHR. This Wednesday, bending to internal DoD pressure, Hagel reversed course on nearly all that he had said before the House Committee, reporting in a memo that DoD would resume its commercial EHR vendor selection rather than developing an integrated solution with the VA or adopting VA’s existing VistA EHR technology.

All Maine hospitals sign on to electronic health records exchange

All of Maine’s acute-care hospitals have agreed to participate in HealthInfoNet, Maine’s statewide query-based HIE. 34 of Maine’s hospitals are already connected to the network, and the last four are scheduled to go-live by the end of the year. HealthInfoNet is also connected to 376 ambulatory practice sites.

Practice Fusion Continues To Reach Beyond Digital Health Records, Adds Free Expense Tracking To New Booking Engine

Free web-based EHR vendor Practice Fusion launches a patient-facing site that allows patients to compare doctors and book appointments. After the appointment, patients can review their spending history across the entire history of their medical visits.

Readers Write: Pagers Cost Hospitals Billions Each Year | HISTalk

Wed, 22 May 2013 20:18:21 -0400

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

Earlier this month, the Ponemon Institute released a study titled “The Economic & Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare. The research reveals that communication in healthcare lags behind other industries, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

As a result, outmoded communication systems waste clinicians’ time, limit patient interaction, lengthen discharge times, and lead to significant industry-wide economic loss.

The healthcare industry is facing some challenges in trying to balance the convenience benefit of new technologies with the need to keep patient health information protected at all times. While the implementation of electronic medical records and other new technologies is designed to improve efficiency and enhance patient care, it also has the potential to introduce risk, so IT departments must ensure that these new systems meet security and regulatory compliance requirements to keep private information protected.

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

To quantify the impact this has and try to understand the scope, we surveyed 577 doctors, nurses, hospital administrators, IT practitioners, and other healthcare professionals. Overwhelmingly, respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. They also recognized the value of implementing smartphones, text messaging, and other modern forms of communications, but cited restrictive security policies as a primary reason why these technologies are not in use.

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion annually.

According to our findings, clinicians waste an average of about 46 minutes each day due to the use of outmoded communication technologies. The primary reasons cited are the inefficiency of pagers, the lack of Wi-Fi availability, the inadequacy of e-mail, and the inability to use text messaging. On average, we estimate that this waste of clinicians’ time costs each U.S. hospital more than $900,000 per year. Based on the number of registered hospitals in the US, this translates to an industry-wide loss of more than $5.1 billion annually.

We also found that similar deficiencies in communications lengthen patient discharge time, which currently averages about 101 minutes. The majority of respondents said about half of this time could be eliminated if modern communication technologies were allowed. Specifically, 65 percent of survey respondents believe that secure text messaging can cut discharge time by about 50 minutes. Again, based on the number of registered hospitals in the U.S., we estimate that this ‘idle time’ during the discharge process costs more than $3.1 billion in lost revenue per year across the healthcare industry.

One of the primary reasons why smartphones and other newer technologies have not yet been adopted on a broad scale is the perceived security and compliance risks this would create. As a matter of both best practices and complying with HIPAA regulations, healthcare IT administrators are charged with keeping clinical systems and private health information protected at all times. As with other industries, we see that the reduction of risk often comes at the sacrifice of the convenience and productivity benefits of newer technologies.

For example, native SMS text messaging is not encrypted and therefore cannot be used to transmit private health information. Many hospitals have a policy forbidding the use of texting despite the fact that research like ours clearly demonstrates the value it would have on both clinical workflows and patient care. In fact, the majority of respondents to our survey said HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, HIPAA reduces time available for patient care, makes access to electronic patient information difficult, and restricts the use of electronic communications.

There is clearly a tension between giving caregivers access to the best possible technology to do their job effectively and ensuring that security and compliance requirements are met. Unfortunately we see that the pendulum seems to swing in favor of the latter, and while it is absolutely necessary to ensure security and patient privacy, clinician productivity and patient care suffer as a result.

One of the takeaways from our research is that healthcare professionals—both clinicians as well as IT staff—seem to understand these challenges and the benefits of deploying more modern communication technologies. For example, 74 percent of survey respondents said secure text messaging either has replaced pagers or will replace pagers within the next two years at their organization.

This is encouraging, and we think research like this will help the healthcare industry realize that the cost of implementing new, modern communication tools will be just a fraction of the economic and productivity costs of continuing to rely on pagers and other outdated technologies.

Larry Ponemon, PhD is chairman and founder of Ponemon Institute of North Traverse City, MI.

CIO Unplugged 5/22/13 | HISTalk

Wed, 22 May 2013 20:06:58 -0400

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Don’t Sell Me, Bro’!

I haven’t stirred blog waters in a while, so let me throw a rock along the surface and see if it skips or splashes.

I admire those who are skilled in the art of persuasion. We need salespeople to bring ideas to help solve business problems. But timing is everything. Solomon waxed it eloquently in ancient days: “There’s an opportune time to do things, a right time for everything on the earth.”

Let me be straight. The right time to sell is never before, during, or after a speaker’s presentation. Yet this happens too often.

I recently finished the keynote for the Texas HIMSS conference. During Q&A, a salesperson launched into an infomercial. I was on my heels a bit and tried to move on. Instead of giving up, he launched into a second infomercial. I just wasted five minutes of precious audience time and subjected everyone to this windbag. I don’t remember a word he said or his company. This type of approach does nothing but spark tension and resistance.

The above incident broke the camel’s back. I am DONE with it. Hence, the motivation for this post and some practical advice on how to put things in their proper place.

Zeitgeist: “Understanding the intellectual and cultural climate of” the speaker presentation. Just for a moment, take off the sale’s hat and empathize with the presenter. Dependent on content, I have worked 10 to 20 hours to put something respectable together. Once it’s assembled, I rehearse at least the same amount.

For the above-mentioned HIMSS presentation, a colleague and I spent 20 hours putting together the content. We spent additional time with Advisory Board and Gartner to review and improve. I stayed up past 2 a.m. the night prior making last-minute adjustments. I spent three hours before the curtain opened rehearsing again.

As is typical, when I finished speaking, I felt as if I’d completed a big race or mountain summit: exhausted and elated. I’m asking myself how I could’ve done better and I’m beating myself over the lines I missed.

After this presentation, a line formed at the stage to talk. Now don’t get me wrong, I love the interaction when it is an exchange of ideas. Ideas energize me. Interacting with individuals often helps me decompress. But I get indignant when feigned interest is actually a veiled sales pitch.

When you sell me, I completely shut down. I will not remember a word you say. I will toss your business card. One person actually pulled out their iPad to give me a demo of the newest product destined to solve our nation’s woes. Really?

What I love is when attendees come up and we share ideas or perhaps I can answer a couple of questions they had from the presentation. This is like a reward, and I will find energy to connect. I love to help. But don’t sell me, bro’.

To keep this from happening again, I developed some untested recommendations. I am interested in your ideas as well. Please contribute with a comment so we all make better use of this precious time. Both audience and speaker will appreciate these.

Facilitator

Control the microphones. When you hand someone a mic, you have lost control. By holding it for them, you can prevent a hijack.
Provide boundaries. Let the audience know upfront that questions are welcomed and encouraged, with two caveats: infomercials or pontification are shunned.
Assertiveness. If someone violates these rules, protect the speaker and move on to the next question.

Speaker

Be direct. If someone goes into sales mode, actively shut them down and move to the next question or person.
Buddy system. Have a buddy with you as you prepare for the talk. If accosted, the buddy steps in.
An associate. Appoint an associate to stand with you after the talk. If someone goes into sales mode, they can step in and you move to the next person. My wife is great at this during parties. If she senses a sneak attack, you’d better watch out.

What’s worse than being sold post-presentation? Being accosted before the presentation with a sales pitch. When heading into a presentation, the last thing on my mind is listening to someone drone on about their product or service. My thoughts are focused on exceeding audience and organizer expectations. I’m absorbed with logistics perfection: visuals, lighting, and sound. I’m gaining a sense for the flow and vibe of the room. Not to mention I’m straining to remember all my key points! This is a big deal. It is show time.

Don’t sell me, bro’!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Informed Consent as it Relates to Reporting Genomic Results to Patients | Lab Soft News

Wed, 22 May 2013 19:54:47 -0400

The question of how and when to report genomic results to patients and informed consent relating to such results is becoming much more complicated and controversial (see: Patients Should Always Receive Their Genomic Information According to Recent Report). This previous note made reference to a statement by the American College of Medical Genetics and Genomics (ACMG) suggesting that patients should always have access to their genomic information. However, the consenting of genetic testing and the return of these results is much more complicated than normal lab testing. This point was emphasized in a recent article (see: Returning Genetic Incidental Findings Without Patient Consent Violates Basic Rights, Experts Say). An excerpt of it is presented below:

Genetic testing has long required patient consent and patients have had a "right not to know" the results. However, as 21st century medicine now begins to use the tools of genome sequencing, an enormous debate has erupted over whether patients' rights will continue in an era of medical genomics....In a [recent] paper..., [the authors] push back against...[the ACMG] recommendations [that patients always have a right to review genomic results], and offer compelling reasons why patient autonomy must remain firmly in place as science advances...."There are many circumstances in which a patient may decline such testing and information, even if the results could open avenues for intervention. The patient may already be battling another disease, such as advanced cancer, or be late in life and see more burden than benefit in added genetic information. The patient may also fear that 'extra' results in their medical record will invite risk of discrimination."....The authors cite long-standing policy discouraging childhood testing for adult-onset conditions. "Delaying testing and return of genetic information not medically useful in childhood allows the child to reach adulthood and then make a choice based on his or her own values...."As the list [of possible genetic tests] expands, so will the scope of testing without consent…."The authors urge the importance of patients' rights, especially in an era of genome sequencing when extensive genetic information can be generated on any patient.

There is certainly no question that a patient has the right to refuse the performance of genomic testing for whatever reason in the first case because of patient autonomy. A second, and perhaps more interesting question. is whether a patient has the right to selectively receive only a portion of the results of such testing. In its consent form, the consumer genetic testing site 23andMe states that the client, once consenting to genomic testing preformed on his oral mucosa cells, does not have the right to refuse to be informed of any of the test results. I can envision a situation, for example, where the client would stipulate the following to the company: inform me about X and Y but do not report any negative health results. This would be a data management nightmare for the company and it appropriately refuses to do so.

Here's what I envision as one of the major problems of patient consent for genomic testing from the perspective of patient autonomy. Many patients, having given consent for genomic testing and the reporting of such results, will not have a firm grasp of exactly what he or she is consenting to. As in the case of 23andMe, such reporting can't be limited solely to good news. So the concept of informed consent, as we understand it, may not be relevant for genomic testing. It is often impossible to "inform" the patient of the potential significance of all of the information that can be measured and interpreted with a DNA sample. We need to replace the idea of informed consent for genomic testing with some new concept that takes into consideration that much of the significance of DNA testing, both now and in the future, is "unknowable" and therefore can't be consented to in the normal way to by a patient.

Healthcare IT Marketing | EMR and HIPAA

Wed, 22 May 2013 18:41:19 -0400

I’m often surprised by people’s reaction when I say that I’m a blogger. Most then believe that it must be a part time thing that I do for fun at nights. While it started that way, blogging is my full time job. If it weren’t for a large number of companies who’ve supported my work over the years, I’d probably have one blog that I’d post to a couple times a month. I can’t say how much these companies support means to me.

As my blogs have grown and the industry has changed (when I started people didn’t even know what a blog was), I’ve been working to evolve with the industry. While display advertising still does quite well for me and my advertisers, there are a number of shifts happening in healthcare marketing. That’s why I launched Influential Networks, an EHR Job board, EMR and EHR whitepapers, email blasts, and a number of other projects I’m still working to officially launch like my EHR and Health IT video series.

There’s a lot happening when it comes to healthcare marketing, and next week as part of my EHR and Health IT interview series, I’m going to be doing an interview with Don Seamons from Lumeno Marketing and Shahid Shah from Influential Networks. More details on that to come, but it should be a really interesting conversation on the changing healthcare marketing landscape.

With everything I do, my goal is to provide value to everyone involved. For example, those reading the site get value from the free content that’s available to them and also get introduced to companies they may not have known about otherwise. Those companies that advertise benefit from exposure to people reading the content we create. I don’t always nail this perfectly, but I’m sincere in my efforts to provide value all around. Plus, whenever there’s a financial interest involved in something I’m doing, I try to make that clear to the reader. That way everyone knows any bias I may have and can make their own judgement on the content I provide.

With all of this in mind, I want to take a second recognize the new and renewing EMR & HIPAA advertisers.

ZH Healthcare – As most of you know, my blog run on the backs of many open source software products. So, I’m really glad to have an open source EMR company supporting EMR and HIPAA. ZH Healthcare is built on the back of the most successful ambulatory EHR software to date, OpenEMR. If you want the flexibility of an open source EHR, check them out.

Caristix – I love the tagline from their ad, “HL7 interfacing 50% faster.” I think that pretty much describes what Caristix offers to those in healthcare IT. HL7 is going to be with us for a long time to come, so every institution and company should know a great HL7 company. Check out Caristix if you’re looking to do some HL7 integrations.

Chetu – Rather than me trying to describe Chetu, check out this interview I did with Craig Schmidt from Chetu. You can see the breadth of experience they have developing software for healthcare. If you’re looking to outsource some IT development work, check out Chetu.

Renewing Advertisers
The heart and soul of our support is in our renewing advertisers. So, a big thanks to all of the companies listed below for renewing their ads with us. It’s great to look over so many of these companies who have been supporting us for so many years. Here’s to many more years working together. If you enjoy what we do here at EMR and HIPAA, check out the advertisers below and see if they offer something you’re looking for.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012

A number of other exciting things coming in the future. Thanks to all the readers and supporters of EMR and HIPAA.

Finnish Health Innovation Team in Northern Ireland for Telemonitoring NI Learning Visit | eHealthNews.EU Portal / All News

Wed, 22 May 2013 17:00:00 -0400

Building on the activities of eHealth Week 2013, the Centre for Connected Health and Social Care (CCHSC) which is part of the Public Health Agency (PHA), was delighted to welcome delegates from the Finnish Health Care System to the TF3 Telemonitoring NI centre in Holywood to see first-hand the fantastic support being offered to people who live with long-term conditions across Northern Ireland.

Birmingham Telecare Service Celebrates First Anniversary | eHealthNews.EU Portal / All News

Wed, 22 May 2013 08:52:31 -0400

Birmingham City Council has celebrated the first anniversary of their joint city-wide telecare service, which has to date benefitted 7,000 people across the city. The Birmingham Telecare Service, which aims to support 27,000 people by 2015, enables residents with a wide range of support-needs to remain living independently in their own homes.

I Wonder Will We Ever See Accountability Like This. I Won’t Hold My Breath. | Australian Health Information Technology

Wed, 22 May 2013 02:30:03 -0400

The following appeared a few days ago. Bipartisan bill would slash iEHR funding May 16, 2013 | Erin McCann, Contributing Editor Members of Congress are lauding a bipartisan bill that limits funding for an integrated electronic health record system between VA and DoD and requires aggressive progress updates from both agencies, which have, in recent months, come under fire for the dilatory pace at which they're moving forward with the iEHR. At a subcommittee mark-up hearing Wednesday, John Culberson, R-Texas, chairman of the House Subcommittee on Military Construction, Veterans Affairs and Related Agencies, called the bill a bipartisan success. "Our bill this year has dealt with the failure of DoD and VA to develop a single unified medical record in a very straightforward, commonsense way," he said. The bill, Culberson explained, will limit the funding toward the iEHR to 25 percent — of the $344 million requested. The agency will not receive the remaining dollars...

This is the initial part of the post - read more by clicking on the title of the article. David.

AusHealthIT Poll Number 168 – Results – 22nd May, 2013. | Australian Health Information Technology

Wed, 22 May 2013 01:14:34 -0400

The question was: Are You Confident Placing Advanced Care Directives On The PCEHR Directly Will Not Lead To Unanticipated Problems? I Am Sure 13% (4) Just A Remote Chance 19% (6) Could Just Be Risky 13% (4) Seems Pretty Risky To Me 48% (15) I Have No Idea 6% (2) Total votes: 31 Looks like a little more than half of readers have some concerns . Again, many thanks to those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.

Morning Headlines 5/22/13 | HISTalk

Wed, 22 May 2013 00:15:51 -0400

Local Health IT Firm Healthland Acquires Software Co.

Healthland acquires Jackson, MS-based post-acute care EHR vendor American HealthTech for an undisclosed sum.

Change in Directors or Principal Officers, Financial Statements and Exhibits

NextGen Healthcare board member Ahmed Hussein resigns after multiple failed attempts to take control of the company through proxy fights. He currently holds more than $100 million in company stock, which means that he can reinstate himself to the board in the future through cumulative voting rules.

Healthcare Innovation Council Calls Out CMS’ EHR Program as "Emperor Has No Clothes"

The Healthcare Innovation Council, an independent group of healthcare experts, has called upon Congress to reconsider the CMS Meaningful Use program since it is not furthering Congress’s goal of improving patient care. The group calls for a reboot of Meaningful Use before all of the money is spent. They are asking for a shift in focus away from hospital adoption of technology and toward improving the design and implementation of the EHR systems.

VMC’s electronic medical records system will increase efficiency, reduce medical errors

A Silicon Valley editorial praises Santa Clara Valley Medical Center’s $220 million Epic implementation, calling it a robust system that should lead to more efficient billing and significantly improve quality of care.

Ode to EMRs, in song format | Neil Versel's Healthcare IT Blog

Tue, 21 May 2013 19:03:39 -0400

Two North Carolina physicians have decided to have a little musical fun with their EHR-related frustrations. Pediatrician Ken Roberts , M.D., and hematologist-oncologist Jim Granfortuna, M.D., at Moses Cone Health System in Greensboro, N.C., have produced this little ditty entitled, “Ode to Electronic Medical Records, or Our Song of Epic Proportions.” Cone Health just happens to have an Epic Systems EHR.

Roberts and Granfortuna don’t seem like they’re anti-EHR, just anti-EHR that makes their work more difficult. From the song: “Now we ain’t saying the EHR is bad/When all the bugs are fixed I know we’ll all be glad/It’s just by then us pioneers will all be dead.”

News 5/22/13 | HISTalk

Tue, 21 May 2013 17:02:27 -0400

Top News

Healthland acquires post-acute care software vendor American HealthTech of Jackson, MS.

Reader Comments

From Dortlund: “Re: GE Healthcare. Charging a premium on top of annual maintenance for MU Stage 2 and ICD-10.” Not to mention spelling “after hours” as “afterhours” for some reason.

From CMIO: “Re: clinical informatics exam. I applied, paid, and took a board prep course and plan to take the practice test this summer. I did not do a fellowship, but I want to be on the inaugural class of the new board based on three years as CMIO. It is worth it for me, as this is my career and this is my credential.”

From NoLongerPhamis: “I LOVED the last Slideshare about GEHC/IDX. Almost fell out of my chair laughing. The part about seamless integration of marketing materials was spot on. I was there.” This was in a recent episode of Vince Ciotti’s HIS-tory.

Acquisitions, Funding, Business, and Stock

Healthcare consulting firm Information Resources Associates, Inc. merges with ESD.

Virtual visit technology vendor ConsultingMD raises $10 million in funding from Venrock.

Pittsburgh-based wound care EHR vendor Net Health acquires Integritas, which offers EMR/PM solutions for urgent care, occupational health, and hospital employee health.

Quality Systems, Inc. investor and board member Ahmed Hussein, mostly known for criticizing his fellow board members and launching proxy fights in an attempt to take control of the company, resigns. He owns more than $100 million in QSII shares.

Sales

Orange Accountable Care, a subsidiary of Orange Health Solutions, will deploy Sandlot Care Manager, Sandlot Dimensions, and Sandlot Metrix.

Wellmont Health System (TN) expands its relationship with MModal to include MModal Fluency Direct and Fluency for Imaging as its clinical documentation platforms.

St. Joseph’s Imaging (NY) selects Merge Healthcare’s Outpatient Radiology Suite.

The ERx Group, a staffing provider for rural acute care and critical access facilities, will use T-System’s clinical, financial, and operational technology and services.

Southeast Alabama Medical Center selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

Western Maryland Health System (MD) will use Dimensional Insight’s business intelligence solution, The Diver Solution.

People

Long-term care EHR provider MatrixCare names Denise Wassenaar (Alliance Pharmacy Services) chief clinical officer.

Imprivata, expecting to go public within two years according to its CEO, names John Halamka, MD (Beth Israel Deaconess Medical Center) and former Phase Forward CFO Rodger Weismann to its board.

Stoltenberg Consulting appoints Douglas Herr (maxIT Healthcare) VP of Epic practice and client relations.

Announcements and Implementations

Peak Health Solutions partners with ChartWise to offer a solution that includes Peak’s clinical document improvement consulting and education program and ChartWise’s CDI software.

Stillwater Medical Center (OK) integrates its Philips IntelliVue patient monitors and Meditech ED management solution using the Accelero Connect healthcare integration platform from Accent on Integration.

North Shore-LIJ Health System adds cameras in operating rooms at its Forest Hills Hospital (NY) to remotely audit surgical teams for performing timeouts prior to procedures and to alert hospital cleaning crews when a surgery is nearing completion.

Fox Business News is running a week-long series called “How Private are Your Medical Records?” on “The Willis Report.” Monday’s episode featured Deborah Peel, MD of Patient Privacy Rights and Mark Rotenberg of the Electronic Privacy Information Center.

Covenant Health (TX) and MemorialCare Health System (CA) are named winners of the 2013 Crimson Physician Partnership Awards presented by The Advisory Board Company, saving a combined $20 million by presenting comparative performance information to their physicians.

CampDoc.com releases an electronic medication administration record module for its summer camp EHR.

Government and Politics

The Consumer Partnership for eHealth and the Campaign for Better Care submit a letter to the six Republican senators who last month questioned whether the implementation of the HITECH Act was money well spent. The consumer groups argue that MU is working and that delaying Stage 2 implementation and Stage 3 rulemaking will be detrimental to patients, will stifle innovation, and will delay progress towards interoperability.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

ONC posts positions (1, 2) for medical officer reporting to the Office of the Chief Medical Officer.

Twila Brase, RN, president and co-founder of Citizen’s Council for Health Freedom, says EHRs are burdensome and inaccurate, adding that they are turning doctors into data clerks. She adds, “Documenting a full clinical encounter in an EHR from scratch can be pure torment. The full chart doesn’t fit on the computer screen. Each element is selected by a series of clicks, double-clicks, or even triple-clicks of a mouse button. Hunting, clicking, and scrolling just to complete a simple history and physical exam is a tedious and time-wasting experience."

A Health Innovation Council commentary article says HITECH is causing, “A massive disruption of providers’ patient care focus as they chase Meaningful Use dollars; increased burdens on physicians, nurses and clinicians since EHRs as currently designed require more, not less, of their time and effort; and an unprecedentedly huge expenditure by providers on EHR hardware and software at a time when providers are under severe financial pressures.” The group recommends that the HITECH program either be redesigned to emphasize patient care, safety, and efficiency or be shut down completely and spend what’s left of the money on rewarding provider care improvement by whatever means they choose. What is minimally noted in the press release is that the Health Innovation Council was formed and is run by Anthelio Healthcare, the former PHNS, a healthcare IT consulting services vendor.

In the UK, Health Secretary Jeremy Hunt announces creation of a $400 million fund to help hospitals with the cost of replacing paper-based clinical documentation and prescribing with electronic systems.

Other

MyMedicalRecords.com files another patent lawsuit, this time against the recent Allscripts acquisition Jardogs. The complaint states that the FollowMyHealth Universal Health Record infringes on MMR’s personal health record patents.

LSU Health Shreveport (LA) and Siemens Healthcare inform 8,330 patients of an unintentional disclosure of PHI stemming from an error in a computer data entry field. LSU and Siemens, which prints and mails bills on behalf of LSU Health physicians, have now identified and corrected the error that caused the names and treatment information for one patient to incorrectly align with another patient’s mailing address.

Palomar Pomerado Health CMIO Ben Kanter, MD presented A Darwinian View of the Electronic Medical Record at a HIMSS SoCal meeting.

UPMC will outsource its transcription services to its development partner Nuance at the end of June, laying off 100 transcriptionists who have been offered jobs by Nuance.

Moore Medical Center (OK) is destroyed by a 200 mph tornado, but the 30 patients housed in the 46-bed hospital all survived, as did all of the hospital’s employees.

A Silicon Valley newspaper editorial lauds the $220 million Epic implementation at Santa Clara Valley Medical Center (CA), saying it will improve billing efficiency and quality of care, also avoiding the 1 percent Medicare penalty and instead reaping $11 million in HITECH funds.

Weird News Andy says he’ll take one today if it can help find his car keys. A New York Times article says helper robots will be used to help care for the elderly.

Sponsor Updates

ISirona employees participate in the Emerald Coast Mud Run benefiting Heart of the Bride, which supports orphans around the world.
Valence Health offers a May 29 Webinar in its monthly series called Care Coordination and Patient Outcomes: Utilize Innovative Automated Population Health Solutions.
DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.
An Imprivata-commissioned survey of Canadian HIT executives reveals key barriers for clinicians when accessing patient data, including a lack of systems integration, privacy and security concerns, and slow access.
McKesson’s Horizon Lab 13.5 becomes for the first LIS to receive EHR Module certification for MU Stage 2.
Ingenious Med updates its impowermobile charge capture software to include the ability to create a virtual superbill at the point of care.
Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.
DirectTrust.org and EHNAC extend accreditation to ICA under its Direct Trusted Agent Accreditation Program.
IHT2 hosts Health IT Summit Denver July 24-25.
In a GetWellNetwork-sponsored Webinar May 29, administrators from Hasbro Children’s Hospital (RI) share details of how it improved patient satisfaction and workflow by joining patient-centered care technology with a meal ordering system at the bedside.
Kareo posts a Webinar that answers the top six Stage 2 MU questions and offers three reasons to check out CMS eHealth.
Several HIStalk sponsors earn a spot on the Informatics 2013 Top HCI 100 list, including 3M, ADP AdvancedMD, Allscripts, API Healthcare, Beacon Partners, Capario, CareTech Solutions, Covisint, Craneware, CTG, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, ESD, GE Healthcare, Greenway, Iatric Systems, Impact Advisors, Infor, Intellect Resources, MModal, McKesson, MedAssets, Medseek, Merge, NextGen, NTT DATA, Nuance, Optum, Orion, Passport Health, Philips Healthcare, Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, TELUS Health Solutions, The Advisory Board Company, The SSI Group, Vitera Healthcare Solutions, Vocera Communications, Wolters Kluwer Health, and ZirMed. Porter Research submitted, compiled, and reviewed sales figures to create the list.
The Philadelphia Alliance for Capital and Technologies recognizes InstaMed as its Technology Growth Company winner and Halfpenny Technologies a Life Science Growth Company finalist at the Alliance’s 2013 Enterprise Awards.
Imprivata launches a migration program that enables customers using the Citrix SSO feature to migrate to Imprivata OneSign SSO. Also, Imprivata participates in a breakout session on desktop virtualization and SSO at this week’s Citrix Synergy conference in California.
Emdat profiles Illinois Bone and Joint Institute, which realized a 50 percent year-over-year cost savings in documentation and correspondence costs using Emdat alongside its EMR.
Beacon Partners hosts a May 31 Webinar integrating business intelligence and analytics through the healthcare enterprise and offers a white paper on why risk assessments help reduce an organization’s risk of a data breach.
Awarepoint’s RTLS platform will be featured in an industry-wide interoperability demonstration at the Association for the Advancement of Medical Instrumentation 2013 Conference and Expo June 1-3 in Long Beach, CA.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

IMS MAXIMS Aims to Reduce 25,000 Preventable Deaths a Year | eHealthNews.EU Portal / All News

Tue, 21 May 2013 17:00:00 -0400

IMS MAXIMS, a leading provider of clinical information systems, is implementing software into NHS trusts that will ensure risk assessments take place that will help to significantly reduce the number of preventable deaths caused by VTE in UK hospitals every year.

The Healthcare Conundrum; doing what’s wrong for business by doing what’s right | HealthBlog

Tue, 21 May 2013 16:28:53 -0400

I read with interest this morning an article by Erin McCann, Associate Editor at Healthcare IT News . Ms. McCann shines a bright light on the sad fact that under today’s reimbursement system, better care doesn’t always yield better business results. That...(read more)

Smart EMR & CDS | EMR and HIPAA

Tue, 21 May 2013 10:45:08 -0400

For those who don’t know, I’ve started a series of EMR, EHR and Healthcare IT video interviews with some of the leaders of our industry. You can attend the video interviews live and can ask questions on Twitter. If you want to receive email notifications of upcoming interviews, just subscribe on this page. Tomorrow I’ll be doing another video hangout on Hospital EHR and Healthcare Analytics with Dana Sellers and James Kouba.

The following video embed is from an interview I did with Sean Benson and Andre L’Heureux from Wolters Kluwer Health. We had a great discussion about the gap or white space between EMR software and what clinicians want them to do. We also talked about the challenge of integrating EMR with CDS systems. Plus, I asked them what EMR vendors could do to make the Smart EMR of the future possible. Their answer was quite interesting. We also discussed the challenge hospitals face of clinical knowledge management in their organization. Then, we wrapped up the conversation with a look at the WKH Innovation Lab’s sepsis project.

I think there’s a lot to be excited for when it comes to creating smart EHR and getting the most from clinical decision support systems. Enjoy the Smart EMR and CDS video interview embedded below.

Becoming Somebody: Regina Holliday Doesn’t Give Up When it Comes to Speaking Up For Patients | HL7 Standards » HL7 Blog

Tue, 21 May 2013 10:28:45 -0400

Part 2 in a series. Read Part 1: Brick Walls Are No Match For Regina Holliday’s Medical Advocacy “Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’” ― Mary Anne Radmacher Think about the last time you saw, heard or experienced something [...]

Breakthrough in Patient and Staff Safety During Cardiac Interventions | eHealthNews.EU Portal / All News

Tue, 21 May 2013 03:00:00 -0400

Royal Philips (NYSE: PHG, AEX: PHIA), the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands) and Main-Taunus Cardiac Center (Bad Soden, Germany) today announced the results of a clinical study that demonstrate that the safety for patients and clinicians can be significantly enhanced during cardiac interventions.

Excellent Papers On Doing Large Scale E-Health and EHR Quality and Safety. Must Read Stuff. | Australian Health Information Technology

Tue, 21 May 2013 02:00:09 -0400

The following papers were published a few days ago. J Am Med Inform Assoc 2013;20:e9-e13 doi:10.1136/amiajnl-2013-001684 Perspectives Ten key considerations for the successful implementation and adoption of large-scale health information technology Kathrin M Cresswell, David W Bates, Aziz Sheikh Abstract The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians. The full article -...

This is the initial part of the post - read more by clicking on the title of the article. David.

Mitochon Shuts Down Free EHR Service | EMR and HIPAA

Mon, 20 May 2013 18:02:38 -0400

The news just came out the Mitochon is shutting down their Free EHR service. They aren’t closing as a company (more details below), but they will no longer be offering EHR software. Here’s the full shutdown message:

Effective mid June 2013, Mitochon intends to exit the EHR market and cease our physician service.

We are sensitive that our providers’ medical practices will be affected by this. However this difficult decision has been driven by the need to focus on other lines of business, and the increasing liabilities we are incurring while supporting our free EHR service.

We will keep our active subscribers updated in the coming days as to how we will address the important issue of clinical data retrieval as well as possible alternate systems and solutions we are in discussion with.

It is with a heavy heart that we are existing the EHR market. The Mitochon team appreciates the support all of our clients have shown to us over the past few years and will work diligently to ensure this transition will be as smooth as possible for their practices.

Best Regards,
Dr. Andre Vovan & Mr. Chris Riley

Mitochon has been a great supporter of EMR and HIPAA over the years, and so I’m sorry that Dr. Vovan won’t be able to see his vision come to fruition with the Mitochon EHR. He was one of the first people I met who was talking about a community based approach to caring for patients. It’s interesting to see many of the topics he told me years ago are being talked about so much now in the world of ACOs.

As for the Mitochon EHR software, I won’t be surprised if some other players in the EHR space decide to take over the code and EHR business from Mitochon. There are actually a number of companies that have been white labeling the Mitochon EHR and it won’t surprise me if one of those companies takes over the codebase and users.

What’s likely more interesting is where Mitochon plans to take the company. Ever since I first met Mitochon years ago, their goal had been to build their own ad network and supply other third party networks. Now their focus will be exclusively on their content delivery and advertising network business. As Chris Riley, CEO, mentioned to me in an email, being in the EMR business and trying to partner with EMR vendors can often be a big issue.

Mitochon has some patents around CPT and ICD level targeting of ads. So, it will be interesting to see if Mitochon can become the pharma ad network for EMR companies. Although, there are a lot of non EMR opportunities for Pharma advertising as well. It will be interesting to see where Mitochon takes the company going forward.

More on robot usage in health care : Hospital visits take on new meaning with therapeutic robots | FutureHIT

Mon, 20 May 2013 14:49:43 -0400

Portuguese and Spanish researchers in the field of social robotics are working on the use of robots to interact with children who are hospitalized for the treatment of cancer, thereby providing emotional support.

The researchers are keen to take robots out of the laboratory and place them in a real environment. Until now, most of the research on social robotics has taken place in very controlled environments. As Professor Salichs from UC3M points out, 'The introduction of a group of autonomous social robots into surroundings with these characteristics is something new, and we hope that the project will help us to advance in the development of robots that are able to relate to people in complex situations and scenarios.'

via cordis.europa.eu

Another cause for guarded optimism about health care robotics? My hope is that it will augment the efforts of often overworked staff and allow them to better prioritize the focus of their precious attention and energy. In addition to their potential social value, robots could act as in situ surveillance devices to watch for nascent or emergent health crises. My fear is that they will be used as justification for cutting costs through staff reductions, as self-checkout lanes have done in supermarkets.

Thanks to ACM TechNews for the pointer to the CORDIS story.

Why Having A Pet Tends to Improve Your Heart Health | Lab Soft News

Mon, 20 May 2013 14:35:30 -0400

There is a correlation between having a pet such as a dog or cat and an improved health status. Exactly how this works was the subject of a recent article (See: American Heart Association: Pets, especially dogs, are good for the heart). Below is an excerpt from it:

An animal companion may not just warm your heart, but also help you maintain a healthy heart....Pet ownership, particularly dog ownership, is probably associated with a decreased risk of heart disease," [said the] director of the cardiac care unit at Baylor College of Medicine....[T]here are 78.2 million owned dogs and 86.4 million owned cats in the United States. Thirty-nine percent of U.S. households have at least one dog, while 33 percent have at least one a cat. The AHA's committee reviewed previous research on how pets affect human health, and they found studies that showed owning a pet was associated with fewer heart disease risk factors and increased survival among patients. In particular, owning a dog was shown to reduce cardiovascular risk, perhaps because dog owners are more likely to engage in physical activities just by walking them. One study of over 5,200 adults showed that dog owners were more active than non-dog owners, and were 54 percent more likely to reach recommended levels of physical activity....[A cardiologist said that] "there are plausible psychological, sociological and physiological reasons to believe that pet ownership might actually have a causal role in decreasing cardiovascular risk." [He also] pointed out though if people buy a pet but sit around all day, smoke, eat whatever they want and don't monitor their blood pressure, heart benefits aren't likely."

So walking your dog improves one's health by providing an incentive to walk him around the block a few times a day. This probably won't help if the owner engages in other unhealthy habits. You all know what they are. I also believe that caring for a pet has unique psychological benefits such as relieving stress. These benefits have been shown to be more effective than ACE inhibitors in lowering blood pressure (see: Pet Dog or Cat Controls Blood Pressure Better than ACE Inhibitor):

[A professor of medicine] assessed the effect of social support on heart rate, blood pressure and renin reactivity in response to mental stress in a group of 48 stockbrokers, all of whom were being treated with lisinopril, an angiotensin converting enzyme (ACE) inhibitor used to treat hypertension. She found that in 24 participants selected at random to add a dog or cat to their treatment regimen, these cardiovascular measures remained significantly more stable during stressful situations than in 24 participants in the non-pet-owner group, who served as controls.

The bottom line is that rather than spending money on drugs and surgery for yourself, redirect it to the veterinary bills for your dog and cat. It's a better investment.

Weekly Australian Health IT Links – 20th May, 2013. | Australian Health Information Technology

Mon, 20 May 2013 02:30:02 -0400

Here are a few I have come across the last week or so. Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment. General Comment The Budget came this week and we saw the funds committed to e-Health last year continue and then an apparent drop of in 2014/15 and deeper drops following . Other than that we learn that we have just over 150,000 people registered to the PCEHR, some trials of secure messaging between differing providers and Tasmania looking for some new systems. Hopefully a quiet week. ----- http://ehealthspace.org/news/budget-2013-ehealth-round Budget 2013: eHealth round-up Posted Wed, 15/05/2013 - 13:51 by Fran Molloy The 2013 Federal Budget, delivered by Treasurer Wayne Swan last night, will deliver new spending of around $13 billion and make savings of an estimated $44 billion over the next four...

This is the initial part of the post - read more by clicking on the title of the article. David.

Clinical Workflow & Technology Integration Summit | Medical Connectivity

Mon, 20 May 2013 01:33:19 -0400

On June 7th, 2013 the Texas Children’s Hospital and Smith Seckman Reid are producing an educational workshop on medical device connectivity. Nursing is the predominate perspective explored in this event. (One of my pet peeves is all the focus physicians get from vendor’s marketing departments. Yet, when it comes to systems in hospitals, the predominate user – by far – is nursing.)

TCH, an early adopter of clinical documentation into EMRs and alarm notification, has some of the most extensive experience with medical device connectivity in the US. They’re hosting and presenting at this one day seminar. Here’s the blurb on the event, with links to where you can register. Besides the great content, the next best thing is the cost – free. The only downside is there’s room for just 150 attendees.

The context for this even is the planning, implementation and opening of a new building at TCH. This was a maj0r new building with both ambulatory and inpatient facilities, and lots of new technology and systems. Besides expanding the physical plant, TCH was looking to improve patient care and outcomes.

The day opens with a focus on workflow and assessing needs. TCH delves into their vision of technology in the service of improved workflow and past experience about the system’s they’ve implemented. Next, myself, Debbie Gregory and Joyce Sensmeier will be on a panel discussing the issues from an industry perspective. In the afternoon, TCH presents “executing the vision,” and their experience with the opportunities and challenges of the new systems and how they impacted operations in their new building.

Should be a terrific event.

Tim Gee is Principal of Medical Connectivity Consulting. He is a master connectologist, technologist and strategist working for medical device and IT companies and various provider organizations. You can learn more about Tim here.

Is this Cisco commercial reflective of the real world? | Neil Versel's Healthcare IT Blog

Mon, 20 May 2013 00:54:24 -0400

Cisco Systems is running this commercial about the “Internet of everything,” with a focus on connected healthcare.

It all sounds great, but how much of this is grounded in the real world today and how much is wishful thinking? I mean, connected medical records? It sounds so idealistic.

EMR Selection Time, Mobile EMR, and Difficult EMR Selection | EMR and HIPAA

Sun, 19 May 2013 23:41:39 -0400

More Time Spent Selecting the Right EMR Vendor is a Prudent Investment ow.ly/kRPvC

— Billy Cline (@RecruiterBillyC) May 20, 2013

A prudent investment is an understatement. The very best use of your time in an EMR implementation is in the selection process. Although, I’ve also seen some clinics go too far and run into the issue called “paradox of choice.”

EMR – Electronic Medical Records Going Mobile getreferralmd.com/2012/04/emr-el… #mhealth #digitalhealth #HIMSS

— Jonathan Govette (@ReferralMD) May 19, 2013

Mobile EMR has always been a wonderful idea, but how many are really using their EMR on a mobile device. Let’s also not confuse mobile EMR with remote EMR. Certainly many doctors are using the same EMR from multiple clinics. That’s common and beautiful. However, far fewer are using their EMR on a mobile device. The most common response I get from doctors about a mobile EMR is “I can access my EMR on a mobile device, but the experience is terrible.” I expect this will dramatically change over the next 3-5 years, but won’t likely be the full EMR. Instead, I think it will be a really focused set of EMR functions on the mobile device. I’m not sure anyone has nailed that experience yet. Although, a lot of EMR vendors are working on it.

Choosing an an EHR is about as much fun a root canal and as straightforward as buying a vehicle. #EHR #EMR #Electronic

— Dr. Vicki Roberts (@fmsemo) May 19, 2013

Everyone that’s read this site for a while knows how much I love analogies. Both of these are pretty spot on. The root canal is necessary and can relieve a lot of long term pain, but it’s no fun going through the process. Buying a car is hard because there are so many choices and so many details that it’s hard to know what really differentiates the complex item you want to buy.

Agfa HealthCare to Highlight IMPAX Cardiovascular IT Solutions at EuroPCR | eHealthNews.EU Portal / All News

Sun, 19 May 2013 17:00:00 -0400

Agfa HealthCare will highlight its comprehensive IMPAX Cardiovascular suite of products at the EuroPCR congress, the official congress of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), from May 21-24, in Paris, France. The focus will be on demonstrating how IMPAX Cardiovascular delivers the benefits of digital cardiology to the cardiologist's fingertips.

Hospital Chargemasters and Open Data from CMS -- The conversation continues | HealthBlawg

Sun, 19 May 2013 09:27:20 -0400

When CMS recently released hospital chargemaster and payment data for the 100 hospital codes most frequently billed to Medicare, there was much written and said about the significance of the data release. Some found this to be significant; others (including...

You should follow me on Twitter: @healthblawg

Integrating Telemedicine And EMRs | EMR and HIPAA

Fri, 17 May 2013 14:52:51 -0400

Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient. The record could then be ported over to the patient’s PHR. The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes. To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

Epic Founder Faulkner Gives Hospital Executives Exactly What They Want | Lab Soft News

Fri, 17 May 2013 14:02:18 -0400

Judith Faulkner, founder and CEO of Epic, is warming up to the media according to an interview in Forbes by Zina Moukheiber (see: An Interview With The Most Powerful Woman In Health Care). Here's the reason that she offers in the interview:

I’m recognizing that when we were small, we could stay under the radar, but now it’s harder. I get so many requests for interviews. If I talk to everyone, we can’t do our job with our customers and work on our software. It would be hard to stay focused.

Here's one of the many reactions to the piece by David Shaywitz, also of Forbes (see: Two Quick Reactions To Epic Faulkner Interview: SV Should Show Judy More Love; We Should Shouldn't Let Hospitals Off Hook)

Interoperability issues associated with Epic may reflect tacit preferences of hospital systems. Tory Wolff and I have discussed the interoperability challenges associated with Epic, and it’s potentially negative impact on the innovation ecosystem (see here and here). Faukner’s comments don’t particular assuage my concerns, but certainly highlight Epic’s laser-focus on delivering what customers want – and make no mistake, the customer isn’t the patient but the hospital. This is critical to appreciate. Thus, while it’s easy (and appropriate) to critique Epic for impeding data sharing, it’s probably also important to remember that if hospitals were all that keen to share data better, I suspect Epic would rapidly find a way to accomplish this. It’s almost as if Epic provides hospitals with plausible deniability. While it may be convenient to blame EMRs in general, and Epic in particular, for data access challenges, I suspect we also need to dig deeper, and hold hospital systems themselves far more – what’s the word? – accountable.

I couldn't agree with Shaywitz more. In fact, here's a quote from my note of September 14, 2011 (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics)

Now comes a little secret that is not discussed much. Hospital CEOs and CIOs have little interest or enthusiasm for multivendor interoperability, either within their hospitals or hospital systems or across the outside hospital systems that they compete with. Customized interfaces between heterogeneous systems are a pain in the rear-end for the CIOs. They would thus rather have shrink-wrapped integration delivered by a vendor like Epic, the so-called "enterprise solution." Moreover, CEOs don't want to encourage broad patient and clinical data portability because it gives the payers (insurance companies and the federal government) a strategic advantage during negotiations about reimbursement.

So, when the feds raise the topic of interoperable EMR software, most hospital CEOs and CIOs will stand up and cheer. However, when they go out to purchase EMR software, they largely select Epic, particularly the larger ones that can afford it. Faulkner provides the non-interoperable product that they really want. She can also runs political interference for them. She donates generously to the Democratic party, she is tight with the Wisconsin congressional delegation, and takes no prisoners in her political feuds (see: Epic Flexes Its Political Muscle in Wisconsin with Boycott). And she can now try to block any inconvenient initiatives in the arise in the Health Information Technology Policy Committee.

Epic will provide some measure of interoperability to her hospital clients but slowly and most efficiently among Epic client hospitals. This is what her hospital clients want and this is what she will give to them. Here are the (slightly garbled) Epic "rules of the road" in terms of working with other HIT vendors, quoted from the Forbes interview:

We don’t let anyone write on top of our platform, come read our code and study our software. I worry about intellectual property at that point. With our customers, we make sure we have signed agreements. They know they have to respect our software. Customers can do it in a controlled environment, but not the whole world. You’ll see us do more and more of that.

Guest podcast: Suzanne Leveille from OpenNotes | Neil Versel's Healthcare IT Blog

Fri, 17 May 2013 01:07:37 -0400

I now present the latest health IT-related podcast from Sivad Business Solutions, an interview with Suzanne Leveille, research director of OpenNotes, a project to give patients online access to the entirety of their own medical records, including the visit notes from clinicians. Leveille describes a trial at Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. She reported that not one of the 105 participating physicians asked for the access to be shut off after a year. In some cases, patients even discovered errors and prevented adverse events.

Here is the description from Sivad:

A pleasure to welcome Suzanne Leveille to the program today. Suzanne is a professor of nursing at The University of Massachusetts-Boston, and the research director for OpenNotes.

OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss them with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes. Our evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

Some highlights from the conversation include: the dramatic improvement between patient and doctor communications; how they overcome potential push back and resistance from physicians; patients became more engaged in their personal health care; OpenNotes has been pleasantly surprised at the patient engagement; how advanced technologies and mobile technology are going to impact the future of this idea; and how they are planning to spread the word and get more patients and doctors improving communications and care with OpenNotes!

Should Hospitals Develop Lab Formularies Like Those in the Pharmacy? | Lab Soft News

Thu, 16 May 2013 20:14:13 -0400

I recently learned about the concept of a lab formulary, an analogue of the pharmacy formulary. The latter is a list of the stock drugs carried by the pharmacy in a hospital. Prescriptions for hospital patients can only be written by physicicans for the drugs listed in the formulary. The comparable notion on the lab side is that only tests contained in the lab formulary can be ordered by physicians. Here is an article that describes the concept in greater detail (see: Constructing A Lab Formulary). Below is an excerpt from it:

Given healthcare's increasing emphasis on cost control and quality measurement, laboratorians need to reconsider their roles within healthcare organizations. A lab that provides what appears to be a commodity service may be at risk of being marginalized at best or outsourced at worst. But a laboratory that plays a highly visible role in promoting high-quality clinical care can strengthen its status within a hospital or healthcare system. One approach worth considering is to think of the laboratory test menu as a "laboratory formulary" analogous to the drug formulary maintained by a hospital pharmacy. Despite what outsiders might think, the role of the hospital pharmacy goes far beyond simply stocking drugs and fulfilling orders. For one thing, it is not feasible to stock every drug in every formulation that a physician might order. For another, it would not be in patients' best interests for pharmacists to fulfill blindly all orders they receive.

...[T]he appropriate role of the laboratory professional goes far beyond simply maintaining analytic quality and fulfilling laboratory orders. It includes determining what test methodologies will be offered and in what forms, specifically point of care, in-house laboratory and referral laboratory. It also includes redirecting physicians when they order tests that the laboratory knows to be suboptimal....The stereotype of a lab professional, whether technologist, clinical lab scientist or pathologist, is one of an introvert who likes to hide away in the lab... But the stereotype still risks being self-fulfilling....As lab professionals find creative ways...to share diagnostic testing expertise with medical staffs, we, too, will see an increase in professional status. And more importantly, patients will benefit through more efficient and accurate diagnostic testing.

I have not heard any strident calls for the use of a lab formulary so perhaps I am stirring up controversy where none exists. One of the major drivers for the development of pharmacy formularies has been the need to switch physicians to the less expensive generic drugs to contain drug costs. If a particular generic drug is the only option available in a hospital, this goal can be more rapidly achieved. The ire prompted by such a shift from the clinicians is transferred from the pharmacist to the hospital pharmacy committee that maintains the formulary. Since there is no "generic equivalent" to lab tests, such a goal can't be used as an incentive for the development of a lab formulary.

I can envision that one major rationale for the development of a lab formulary: the desire to place some limits on the inappropriate ordering of expensive molecular and genomic tests. However, even the most expensive of these tests may be appropriate under the right circumstances. Rather than a blanket ban on such tests, it would seem more appropriate to publish the clinical criteria for the ordering of such tests and then require the approval of a pathologist when these clinical criteria are not met. In other words, publishing criteria for ordering expensive lab tests, and then enforcing them, would be a suitable substitute for a lab formulary.

Angelina Jolie, BRCA1, Public Health and Patent Law | HealthBlawg

Thu, 16 May 2013 16:56:35 -0400

Going public with her story of a prophylactic double mastectomy after testing positive for BRCA1 (a gene linked to breast cancer) via an op-ed piece in the New York Times, Angelina Jolie is clearly trying to get the message out...

You should follow me on Twitter: @healthblawg

The Angelina Effect and the Next Megatrend: Intersection of Biology and Technology | HL7 Standards » HL7 Blog

Thu, 16 May 2013 09:58:34 -0400

Big Day in Genomics Angelina Jolie’s very open revelation, “My Medical Choice” in the The New York Times, was brave, and a “big day for genomics”, according to Leslie Ziegler of Rock Health. Jolie, in a powerful and personal narrative, explains why she chose a preventative double mastectomy after genetic testing found the BRCA1 gene. She was estimated to have [...]

The Institutionalization of Healthcare; Consequences of Big Medicine? | Lab Soft News

Wed, 15 May 2013 19:13:10 -0400

I posted a note five days ago about how the cost of healthcare seems to be gradually declining (see: Decrease in Healthcare Costs May Persist as Economy Revives). A reader, Ajit Alles, responded with a comment that decreasing expenditures of health my result in a lower quality of care, which I responded to in another note (see: The Correlation between the Cost of Care and the Health of a Population). He has responded to this second note with the following comment:

As follow-up, I agree that we spend way too much on end of life care, but that won't be reduced without a cultural shift. People expect miracles from medicine based on what they hear on the news and see in TV dramas. We could spend less and get better results, but people have to first start accepting that modern healthcare has limitations, not the least of which is funding. The new push for genomic healthcare is a good example of unrealistic ideas being pushed for profit. If everyone thinks that they are going to get personalized gene targeted healthcare they are dreaming! I know I'm a curmudgeon in this regard, but we first need to have good basic healthcare before we get cadillac genomics....We in for-profit medicine must share the blame for pushing "new and improved" medicine that is unaffordable and only (marginally) benefits the few people who can afford it. I recently heard of a family that wants some genomic test done on their child with cancer. The test looks at sequence variation in multiple genes and provides a "report" of very limited utility since most of the variations have no specific treatment. The test costs about $25000 and is not covered by insurance ....The family can afford to pay for this so it's being done with the encouragement of the oncologist. There are others who peddle proteomics reports to desperate patients. Enough said. This is the road to ruin.

I would like to respond specifically to his suggestion that "[those of us] in for-profit medicine must share the blame for pushing new and improved medicine that is unaffordable and only (marginally) benefits the few people who can afford it." I agree that many providers participate in "for-profit" medicine. However, the nature of the healthcare enterprise is now changing to what has been called "Big Medicine" or "Big Med" (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"; The Transition to "Big Med": Need for Emphasis on Standardization and Cost; Health Systems Use Their Regional Dominance to Muscle Insurance Companies). With the rapid decline of private physician practices, many of the key decisions about the future of healthcare will be made by the federal government, large hospital systems, health insurance companies, and Big Pharma. So while we indeed have a for-profit health system in this country, most of the resources will flow from institutions like the federal government and health insurance companies to large institutions like large hospital systems. The great majority of physicians will be hospital employees. I refer to this as the institutionalization of healthcare delivery. We need to better understand the consequences of this shift.

I think that this change will have a major effect on the incentives experienced by physicians. In previous notes, I have made the point that cancer patients receive better care if the treating oncologist is salaried and does not benefit directly from selecting the most expensive treatment. This idea becomes apparent, as one example, in the treatment of ovarian cancer patients where a private oncologist is incentivised to maximize revenue from patient "chair time" whereas salaried academic oncologists seem to be more inclined in select the preferable intraperitoneal infusion of chemotherapeutic agents (see: Patients with a Cancer Should Seek Treatment in Cancer Hospitals). This is the best therapy but complicated and with lengthy patient visits. Here's are a couple of additional articles about how oncologists are compensated for additional reading (see: Will the Sequester Cause Oncologists to Lose Money Prescribing Chemotherapy?; Who Pays Your Oncologist?).

For private oncologists, the so called "oncology concession" goes to their group practice and they themselves directly benefit financially from their clinical decisions (see: The Oncology Concession Under Attack by Health Insurance Companies). For a salaried oncologist, the "oncology concession" goes to the hospital whose executives may choose to pay their oncologists the internist market salary, retaining the difference. The hospital may then choose to reward its executives at a higher level for developing a bigger cancer center (see: Cancer Business Highly Remunerative for Sloan-Kettering Executives).

I believe that health system executives will be more highly compensated and physicians will be less so as a result of institutionalization. After all, it is the executives who are making macro compensation decision and it would be natural for them to reward themselves. Moreover, these same executives will also have critical decision-making power in terms of how "new and improved" medicine is delivered. I believe that most of decisions will be based on how such care is compensated by the various institutional payers.

Robots in healthcare: scary, promising, or both? | FutureHIT

Wed, 15 May 2013 12:56:53 -0400

Robot Aids in Therapy for Autistic Children
Wall Street Journal (05/01/13) Shirley S. Wang

University of Notre Dame researchers will present study findings at the annual conference of the International Society for Autism Research showing promise in the use of robots for teaching social skills to autistic children. The study, involving 19 autistic children, is believed to be the largest trial to date using robots in this way. The children interacted with a two-foot-tall robot therapist that was programmed to ask novel questions and engage children in conversation. The study participants showed greater conversational improvement with the robot than with a human therapist alone, and parents reported more significant improvement at home as well. Children interacted in six sessions with the robot as well as with a human therapist, who provided instruction on specific skills when interacting with the robot, such as making eye contact or taking turns talking. Simplified social interactions with a robot might be beneficial to children with autism, who tend to be very interested in technology but find complex social interactions challenging. The researchers hope the children will carry over the social skills to interactions with people as well, rather than just interacting with the robot.

via technews.acm.org

Monday's ACM TechNews produced this very brief but tantalizing summary of a Wall Street Journal article.

This is one of those stories that leave me very ambivalent. In some ways, my automatic reaction to our collective desire to depend more on automation in direct patient care is fear. I am afraid we are going to abandon our elderly and otherwise hopelessly disabled kin to the unfeeling arms of robots, androids, whatever. This will spare us the feelings aroused by an out-of-control psychotic spouse, an incontinent and demented parent, or a profoundly developmentally disabled child, when we must intervene and our interventions are resisted, not appreciated, or insufficiently effective.

With this story, I see the situation is not so simple. Autistic children have difficulty relating to humans with whom they are intimately involved, and their difficulties are often reflected in others' responses to them. Machines are insensitive by nature, and can be programmed to reward positive behavior and ignore the negatives. This may be a situation, as the investigators assert, where robotic intervention is not only appropriate as an alternative but can even improve the patient's situation holistically.

I don't have a WSJ subscription so I can't follow the link ACM provides to the full story, and I don't have time at the moment to poke around on the Web for alternate sources of information about this research project. I would like to learn more, and will try to pursue this when I have more time.

Your Turn! Enter the $10K Windows 8 & HealthVault Challenge. | HealthBlog

Wed, 15 May 2013 12:12:03 -0400

I don’t often turn over space on HealthBlog to other authors. An exception was during my sabbatical when Gareth Hall kindly filled in for me. Another exception is when one of my colleagues has something really cool or important to share. Then, I feel...(read more)

Bitter Pills: In Defense of The CMS Move Toward Meaningful Billing | HL7 Standards » HL7 Blog

Tue, 14 May 2013 17:29:36 -0400

Last week in a bold and historic move (and a bitter pill indeed for many healthcare executives finding themselves explaining the obscure financial inner workings of a hospital) the HHS/CMS released the national charge master data. The release seems to be a response to Steven Brill’s epic TIME magazine article on medical billing: Bitter Pill: [...]

NHS clinicians save up to 45 minutes a day through simplified access to patient data | HealthBlog

Tue, 14 May 2013 14:49:00 -0400

Even in some of the most digitally advanced hospitals and clinics I visit, I frequently hear clinicians grousing about access to patient care data and systems. It’s not unusual for todays’ healthcare settings to have multiple repositories of patient data...(read more)

The FDA Patient Network Website - Pretty Darn Patient-Centered | HealthBlawg

Tue, 14 May 2013 10:00:00 -0400

The FDA launched an impressive patient network website this month, after nearly four years of research, focus groups, usability testing and more. The twin goals for this website are promoting the educational mission of the FDA, and promoting opportunities for...

You should follow me on Twitter: @healthblawg

The Interoperability Paradigms of HL7 FHIR | HL7 Standards » HL7 Blog

Tue, 14 May 2013 09:22:51 -0400

I recently had the pleasure of attending a presentation by Grahame Grieve, the originator of FHIR, on the details behind this evolving health IT standard. I have written a couple of blogs previously to introduce FHIR, including 5 Things to Know About HL7 FHIR and Review of The HL7 FHIR Session at HIMSS13. This standard [...]

Enterprise-Wide Medical Deivice Integration and CIS Workflow | Medical Connectivity

Mon, 13 May 2013 23:26:39 -0400

Last month I spoke at the first CIS Qatar International Conference in Doha Qatar. My topic was the Importance of Enterprise Wide Medical Device Integration in CIS workflow. You can download a copy of my presentation here.

This was the first such conference in Qatar with over 1,500 people attending. The ballroom only had capacity for 1,200 so they had remote screens and audio for the 300 overflow attendees. Several hospitals in Qatar are in the process of implementing Cerner’s EMR, so there is a lot of keen interest in all things EMR.

The conference program was focused on implementation issues and what it takes to realize the benefits of EMR adoption. My presentation provided an overview to medical device connectivity and clinical documentation and introduced use cases as a way to assess current and future workflows to ensure effective workflow automation from medical device connectivity.

Medical Device Connectivity in the Middle East

There were a lot of great HIT and health care thought leaders from the Middle East at the conference. Not surprisingly, the intersection of IT and biomed came up in a number of conversations. In many Middle Eastern countries, numerous hospitals are in development or being constructed. These health ministries that are building hospitals have found ready access to experts to specify and help select HIT solutions and to specify the numbers and types of medical devices needed for the expected patient populations to be served by the hospitals. What is missing is any recognition and resulting planning for HIT and medical device systems to work together smoothly by opening day of a new hospital.

There are two challenges presented by medical device connectivity for new hospital construction. Between conventional HIT and medical device systems lie connectivity workflow automation systems for clinical documentation, alarm notification, clinical decision support systems for things like tight glycemic control, and numerous other such systems. Many of these are rapidly emerging product categories that may be missed by those specifying new hospitals. When specifying connectivity for new hospitals, buyers must be presented with the key workflow automation trade-offs and connectivity specifications to ensure the best possible connectivity solutions are selected.

The the other challenge is the operational gap that occurs when IT shifts from mission-critical to safety-critical operations. Like those the US market, hospitals in the Middle East are still grappling with the convergence of IT and biomed and the fact that what was once a mission-critical IT infrastructure becomes a safety-critical infrastructure with the introduction of medical device systems. Elsewhere, I’ve referred to this gap as the “governance gap” where current HIT operations must become more rigorous to safely support life-critical medical device systems.

After the new hospital is built and opened, a much bigger challenge arises. Everything pretty much works as specified when it’s first installed. But as IT and medical device components and systems are upgraded, discontinued and replaced, and as the physical plant undergoes the inevitable renovation and new construction, a lot of things change – a lot. And the skill sets of personnel and the policies and procedures used to manage HIT operations must be revised to a safety-critical level to maintain adequate levels of productivity and patient safety.

Patient safety is something for which CIOs and hospital IT departments have never been directly responsible. When medical device systems, like patient monitors and infusion pumps, communicate over the enterprise IT infrastructure and are integrated – perhaps interoperable – with HIT applications, patient safety is on the line.

HIPAA not an excuse for lack of innovation in hospitals and clinics | HealthBlog

Mon, 13 May 2013 09:52:38 -0400

As a 20-year practicing physician and a former hospital CIO/CMIO, I am well aware that healthcare is an extremely complex, highly regulated industry. I often tell young entrepreneurs that healthcare isn’t for the faint of heart. Getting traction in anything...(read more)

Health Wonk Review: money talks, but IT helps | Neil Versel's Healthcare IT Blog

Fri, 10 May 2013 14:43:02 -0400

The latest edition of Health Wonk Review is hot off the digital presses, with Joe Paduda taking hosting duties on his Managed Care Matters blog. And managed care does matter in this trip around the health blogosphere, with most of the attention on healthcare costs and insurance coverage.

On the quality front, which is my primary interest these days, there is some interesting discussion about whether the new Medicare hospital readmissions policy truly will produce better care or will prod some into providing the minimum level of service to readmitted patients.

(Frankly, hospitals have been overtreating for years. If a minimal level of service gets the job done for the patient, that’s a good thing. And the policy is supposed to cause hospitals to do the right thing in the first place, knowing that they will lose out later if they don’t. I’m all for that.)

My post on consumer ignorance of telemedicine is in there, as is a good one from Vince Kuraitis and Leslie Kelly Hall about the duty providers have to share information with patients. EHRs and wearable sensors also make this edition of HWR. Not bad from an IT perspective.

The federales' open data policy and the Medicare hospital chargemaster data dump ... Please don't inundate us with junk. | HealthBlawg

Fri, 10 May 2013 07:51:55 -0400

So just about everyone is pretty pumped about the White House announcement of its new open data policy. Todd Park gives us the skinny on the latest in Open Government -- The Executive Order and related Open Data Policy --...

You should follow me on Twitter: @healthblawg

Stop Saving the NHS: new book | Future Health IT

Fri, 10 May 2013 06:47:37 -0400

Well I have done it. My book Stop Saving the NHS and Start Reinventing it has been published in Kindle and paperback. It's aimed at NHS leaders and managers, but will probably interest anyone who is interested in the shape of 21st century healthcare.

In the fight against superbugs, biosensors may have an answer - FierceHealthIT | FutureHIT

Thu, 09 May 2013 15:25:03 -0400

New biosensors have the potential to detect antiobiotic resistance in bacteria, according to new research from the Journal of Visualized Experiments (JoVE).

"Antibiotic resistant bacteria is a serious problem," Vitaly Vodyanoy, M.D. said in an announcement. "It is very important [when treating a patient] to distinguish between normal and resistant bacteria; if you have a case of resistance you have to take special measures to cure it."

Vodyanoy used bacteriophages, simple viruses that can target and kill bacteria, mixed with specific antibiodies, which can be used to produce a color change in a sample that indicates antibiotic resistance. This technology can be used by clinicians treating patients and also be used to help disinfect hospital facilities.

via www.fiercehealthit.com

This sounds promising to me. The story goes on to mention potential application of the biosensor technology to Clostridium difficile, the superbug that took my father's life earlier this year. The more I learn about "C. diff", the more I appreciate the challenges involved in battling superbugs.

There are good reasons why everyone should care. Check out the inhabitat "hamburger" link below (or click here) for one good example. The odds of you coming down with a superbug infection in your lifetime are increasing rapidly.

Rogue Wave: The Synergistic Convergence of Multiple Disruptive Information Technologies | FutureHIT

Thu, 09 May 2013 09:30:44 -0400

Reading a page on the McKinsey site called Clouds, big data, and smart assets: Ten tech-enabled business trends to watch, I came across something that resonated with an obsession of mine over the past three decades of my involvement in high tech: the synergistic convergence of multiple disruptive information technologies. I firmly believe that this is the driving force behind the massive and increasingly rapid changes in modern society and culture.

Starting around the turn of the century, I wrote a series of scenario planning papers called Rogue Wave in which I first published my thoughts on this concept. I felt the metaphor of the rogue wave was especially apropos. Here's how I introduced the metaphor in my papers:

Rogue waves have been the bane of seafarers (and the joy of surfers) since time immemorial. Rogue waves happen when the crests of two or more wave patterns happen to synchronize, momentarily producing a much larger wave than any of the participating wave patterns could have produced alone. Rogue waves are the bane of seafarers because their energies can be tremendous, and therefore potentially very destructive to a ship holding to a particular course—detrimental not just to the ship’s ability to hold the course, but to the very ship itself. The inertial energy of the vessel’s mass interacts with the momentum of the wave patterns, stressing the vessel in unexpected and massive ways.

But to surfers, a rogue wave is a dream come true. Rogue waves can take you farther and faster than any normal wave, providing a much wilder, longer, and more satisfying ride, but only if you are ready to ride when the moment comes to catch the wave.

Contrary to our perceptions, ocean waves of all kinds, including rogue waves, are created not by the movement of water, but by the flow of energy. It is the energy flows that create the rogue wave, inundating the sailor’s vessel and providing the surfer’s wild ride. There are wave patterns in society as well—energies that move through our existence, and sometimes turning the status quo on its head. Technological evolution, religious and ideological movements, population bulges and dips, economic boom and recession, all are examples of the wave patterns buffeting human society.

The recently trending term Black Swan is a metaphor that characterizes the effects of Rogue Wave phenomena.

Disruptive technology is a concept introduced by Clayton Christensen in his book the Innovator's Dilemma. He contrasts them with sustaining technologies, which reinforce the status quo in the course of deriving maximum value from it. On the other hand, disruptive technologies threaten and ultimately overturn the status quo. They are game-changing by nature.

Discovery-based planning, another concept introduced by Christensen, is based on the premise that disruptive technologies require learning strategies as opposed to the execution strategies that work well with sustaining technologies.

…in disruptive situations, action must be taken before careful plans are made. Because much less can be known about what markets need or how large they can become, plans must serve a very different purpose: They must be plans for learning rather than plans for implementation. By approaching a disruptive business with the mindset that they can’t know where the market is, managers would identify what critical information about new markets is most necessary and in what sequence that information is needed. Project and business plans would mirror those priorities, so that key pieces of information would be created, or important uncertainties would be resolved, before expensive commitments of capital, time, and money were required. [italics added]

Information is the critical element in learning strategies. Information technologies are critical tools for deriving value from information. Such technologies facilitate the capture, storage, search and retrieval, analytics, and many other aspects of information processing, and thus are critical drivers of learning strategies.

Moreover, new information technologies themselves are often disruptive by their very nature, changing the learning strategy game even as they facilitated by it. And information technologies, just like all others, are beneficiaries of their own disruptive effects and those of other new information technologies. In a world where multiple new disruptive information technologies have been emerging in parallel for at least the past five decades, four of them paced by Moore's Law, the disruptive effects are synergistic, increasingly so over time.

The 2002 edition of the Rogue Wave paper set forth the Theorem of the Disruptive Value of Information, aka DVI Theorem:

Di = 1 / ( (Tu - Ta) * Ca )

The disruptive effect (Di) of a unit of relevant information is inversely proportional to the temporal distance between its moment of access (Ta) and the moment of its use (Tu) multiplied by the cost of its accessibility (Ca).

Simply put, the theorem states that relevant information is most disruptive when it is instantly accessible for zero cost. The value produced by the formula is a real number between zero and infinity. A value of zero means the information has no disruptive effect on the technological status quo; infinity means it has infinite disruptive effect. Since information always costs something to obtain and always takes some time to access, Di will never reach infinity, but lower cost and more immediate access greatly increase the disruptive effect of relevant information. At the other end of the spectrum, information that costs too much or takes too much time to obtain has little disruptive effect in spite of its relevance.

The DVI Theorem is the key to leveraging discovery-based planning. Entrepreneurial genius is involved in developing the disruptive technology and in identifying the key pieces of information that must be acquired, but the DVI Theorem sets a limit on how effectively the planning strategy can be carried out. Learning too late or too expensively is equivalent to not learning at all.

I'm going to revisit the Rogue Wave concept and the DVI Theorem in future posts and try to refresh and enrich it with things I've learned in the meantime.

What Clinic Owners are Looking for When Hiring New DPT Grads | NPA Think Tank

Wed, 08 May 2013 22:11:36 -0400

I interviewed four different clinic owners from around the country and asked them what qualities they are searching for in new hires, especially of the newly graduated variety. The clinics are different from one another and the owners have different visions for their clinic, yet their responses to my questions were very similar in what qualities they look for in a newly graduated DPT student. And guess what? None of them said you need a 4.0 GPA. Below are the 4 themes I noticed while chatting with each clinic owner.

A HUGE ‘Thank you’ to Jerry Durham of San Franciso Sport and Spine PT, Ann Wendel of Prana PT in Alexandria, VA, Judy Burlingame of Burlingame Physiotherapy in Greenwood Village, CO, and Stephen and Shannon Albanese of Access Physical Therapy with locations in New York and Pennsylvania.

4. Know the mission and vision of the clinic you are interviewing with

It is important that you understand the vision and mission of the clinic you are interviewing with. Ann Wendel and Shannon Albanese stressed the importance of the new graduate being a good fit for the clinic. This means that you share the same passions, understand and agree with the vision of the clinic and can be a part of that team. It is our responsibility as students to recognize a clinic or position that would be a good fit for us. Judy Burlingame made the point that new grads should look for clinics or positions in which they can continue to grow, learn and be mentored. If a clinic does not have a formal mentor program in place- ask! If a clinic is not wiling to give you the time to help you continue to grow, perhaps it is not the correct fit for you.

3. Be yourself and build your personal brand

Building your personal brand does not necessarily mean marketing yourself on social media if that’s not your thing (although it really can’t hurt! In fact- the clinic owners who are on social media love to see student involvement!). Jerry Durham is passionate about having a personal brand and he wants to see students that have one as well. So you may be scratching your head saying “huh?”. A personal brand is who you are- what makes you tick, what draws people to you, your past experiences, what drives you. Write it down. Knowing your personal brand and what you stand for will also help you with knowing if a clinic or position is a good fit for you. Still confused on what a personal brand is? Google Sasha Strauss and watch a few of his videos. Here is one to get you started. The guys really knows his stuff about branding!

2. Be confident, yet humble- you have something to offer!

Many times new grads may feel that may not have enough to offer a clinic. Not true! We are the future of the profession and many clinics want to take a chance on us. However, be humble- we still have a lot to learn. All four clinicians mentioned they look for life long learners. Just because you have those fancy three letters after your name does not mean you know it all. Shannon Albanese of Access Physical Therapy said that she wants to hear short term and long term goals of new grads. She wants to work with new grads and help shape them into strong PTs. Go into those interviews with your head held high, your personal brand ready to roll (see number 3!), know your short and long term goals and understand that you still have a ton to learn!

1. Get Involved outside of the classroom! Seriously.

I don’t think getting involved outside of the classroom can be stressed enough! Clinic owners want to know you are a well rounded individual who is capable of multi tasking. Find a leadership position or extra curricular that speaks to you and go for it. You don’t need to be president of something to have an impact. Perhaps you are more of a “silent leader” type and that is fine, just find something that works for you and that you can bring your passion to.

Understand what is happening in the PT world outside of the walls of your classroom. Read articles that aren’t required for class. I may be biased, but Twitter is an amazing place for this- there are so many wonderful therapists to look up to and they often post articles or start conversations and welcome student input. (Insert shameless plug for the Wednesday night #DPTstudent chat at 9pm EST here).

It is never too early to get involved. In fact, Jerry Durham said he wants a student that was involved from the beginning- even before PT school such as your experiences that lead you to pursue PT! Getting involved also allows you to build your own personal network of like-minded individuals that you can learn from as you grow as a student and as a therapist.

I hope this helped the DPT students out there see what clinic owners are looking for when hiring new grads. Be yourself, show your passion, and for goodness sakes, get involved in whatever way works for you outside of the classroom!

Hospitals Slow to Go Paperless Despite Benefits | Medicine and Technology [part of HCPLive]

Wed, 08 May 2013 20:00:00 -0400

Guest Post: Hospitals Slow to Go Paperless Despite Benefits

If you are walking into an ER, you better have a reliable memory of your last doctor's visit, the medications you have taken, and any x-rays you've had in the last year. Unless you are walking into one of the very few hospitals in the United States that has gone paperless, your wait could be very long. This is because hospitals are still using an outdated method of managing information: paper.

Healthcare is far behind other industries when it comes to information technology and document management. Hospitals and patients could greatly benefit from the conveniences an upgraded IT system could provide. This isn’t wishful thinking or guesswork. The benefits for hospitals and patients have been proven.

In 2009, Johns Hopkins released a now famous statewide study that demonstrated the benefits of hospitals using paperless technologies. The study included over 40 hospitals and 160,000 patients and found a correlation between computerizing records and overall hospital safety and effectiveness.

The hospitals with the top paperless technologies in the state showed a 15% decrease in the odds of patients dying while hospitalized. Imagine if we could see this kind of decrease throughout the rest of the healthcare industry. Assuming this decrease would hold true for all US hospitals, going paperless across the country could save more than 100,000 lives every year.
Read more »

Electronic Health Records – Still not good enough Part 2 | HealthBlog

Wed, 08 May 2013 14:36:09 -0400

As a physician and one of the more visible members of our health industry team at Microsoft, I frequently find myself as the first point of contact for people who want to work with our company. In some cases this is other clinicians or developers...(read more)

Alarm Fatigue Plagues Hospitals. Again. Still. | Medical Connectivity

Wed, 08 May 2013 13:21:03 -0400

On April 8, 2013, the Joint Commission published a Sentinel Event Alert on medical device alarm safety in hospitals. Once again, alarm hazards tops the ECRI Institute’s 2013 Top 10 Health Technology Hazards. Alarm fatigue is unfortunately a topic that is evergreen because it has plagued hospitals for many years and shows little sign of abating. A search of the literature will show the most common consequence of alarm fatigue is a failure to rescue adverse event (in which ~~the vast majority~~ 80% of patients die). A secondary consequence is on patient satisfaction; constant alarms audible throughout the unit make it difficult for patients to sleep.

The root causes of alarm fatigue can be divided into two areas: 1) nuisance alarms caused by false positive alarms, leads-off alarms (most often due to motion artifact, poor lead prep and/or low quality sensors), and alarms that are not clinically actionable (i.e., the alarm goes off and the nurse responds, but there’s nothing for them to do), and 2) noise pollution resulting from annunciating all the alarms in a busy high acuity unit at sufficient sound levels to be heard throughout the unit.

Effectively managing alarm fatigue requires hospitals to do a number of somewhat complicated of things well. The Joint Commission Sentinel Event Alert, and AAMI’s efforts on alarms tend to focus on these basics:

Properly setting alarm limits,
Buying quality physiological sensors, proper prep and placement of physiological sensors, and
Making sure alarms from all monitored patients are audible in the nursing unit.

These clinical and operational best practices will reduce but never eliminate alarm fatigue, especially on busy high acuity units – to do that you need to mitigate the incessant noise from alarms going off across the unit – 24/7.

The Need for Alarm Notification

The patients in a typical high acuity unit generate a lot of alarms; the (thankfully) rare patient generates alarms continuously. Making sure all medical device alarms are audible throughout the nursing unit becomes a big part of the problem. The noise from all these device alarms is broadcast across the unit for everyone to hear and quickly becomes overwhelming, desensitizing caregivers and resulting in alarm fatigue.

In these situations, the ability to route alarms from the medical device directly to the responsible caregiver, and notifying them without exposing the rest of the nursing unit staff to every alarm, can have a huge impact on reducing alarm fatigue to a manageable level. (I currently track around 17 messaging middleware vendors who provide alarm alarm notification features.)

Monitoring Tech “War Rooms”

Some hospitals utilize monitoring techs to pre-screen alarms for caregivers in an effort to filter out false/positive nuisance alarms and to enable a reduction of alarm annunciation volumes in the unit. When this approach is used, monitoring techs watch remote central stations and notify the responsible caregiver when they see an actionable true/positive alarm. Monitoring techs are either gathered in a central location, often called a “bunker” or “war room,” or placed within the unit they are supporting.

Using monitoring techs allows the nurses on the units to turn down alarm volumes and await notification from monitoring techs of alarms via “bat phones” placed around the units, Vocera badges or wireless handsets carried by the nurses. The problem with monitoring techs is that they’re expensive. A 500 bed hospital can spend $2-3 million in operating costs annually on this approach. In many markets, finding and keeping these monitoring techs can be very difficult.

Compared to monitoring techs, an alarm notification solution automatically routes alarms to the caregiver responsible for the patient generating the alarm. These systems also automatically escalate notifications to backup caregivers ensuring a timely response to all alarms. One weakness of alarm notification solutions is that they cannot filter out false/positive nuisance alarms the way a trained and certified monitoring tech can. In the past, products like DataCritical’s StatView, and similar products from Spacelabs and a few others – all now discontinued – displayed physiological waveforms of the alarming parameter associated with the alarm. This would enable the caregiver to quickly rule out false/positives and other nuisance alarms by looking at the same waveforms a monitoring tech would see. However, other than Welch Allyn’s AcuityLink Clinician Notifier, none of the currently available alarm notification solutions include physiological waveforms.

When comparing the use of monitoring techs to purchasing an alarm notification solution, monitoring techs continue to have the advantage of being able to see the physiological waveforms associated with an alarm and make a determination as to whether the alarm is a false/positive alarm or not. Once alarm notification vendors implement support for waveforms (it’s been done before, and cleared by FDA) this advantage of monitoring techs will be neutralized.

Given the ever present and increasing pressures on hospitals to control costs, I expect alarm notification systems to replace monitoring techs in the mid to long term.

Background Info

Here are some additional links that may be of interest:

ACCE page on alarm fatigue
The ECRI Institute’s Alarm Safety Resource page
Mainstream news stories on the consequences of alarm fatigue, here and here
A great story on alarm notification written by Jim Welch
Another alarm notification story from the same magazine written by yours truly
Philips Issues Alarm Notification Warning Letter: a surprising letter to customers in reaction to continued adverse events associated with alarm fatigue

UPDATE:

The Joint Commission has published an infographic about medical device alarm safety that reinforces the root causes and consequences of alarm fatigue.

Sadly their recommendations/solutions in the infographic are totally inadequate. I would estimate that virtually 100% of hospitals and nursing units have already undertaken the activities on the Joint Commission’s infographic list. In fact, their recommendations are just that, a list of activities, without the context of specific goals or objectives that must be accomplished to reduce alarm fatigue.

Eliminating alarm fatigue requires accomplishing three objectives: 1) greatly reduce nuisance alarms, 2) screen out false/positive alarms, and 3) route and manage alarms electronically to reduce noise pollution and ensure a timely alarm response. The 5 recommendations in the Joint Commission infographic are really just some of the activities required to implement the three objectives above.

And be sure to check out this ongoing discussion on alarm fatigue here under the Healthcare Technology Safety Institute’s group page on LinkedIn.

Brick Walls Are No Match For Regina Holliday’s Medical Advocacy | HL7 Standards » HL7 Blog

Wed, 08 May 2013 12:50:05 -0400

In my last post, I talked about the concept of slacktivism in the era of social media. Slacktivism is sort of a pseudo-activism , where participants takes part in gestures – like changing their Facebook profiles photos to that of a cause – that make them feel good, but are meaningless in making any real social change. [...]

So many types of telehealth | Neil Versel's Healthcare IT Blog

Wed, 08 May 2013 03:35:04 -0400

Here’s a short video (720p HD) I put together from the just-concluded American Telemedicine Association’s annual conference in Austin, Texas. No wonder it’s so hard to get a real sense of the size of the telehealth and telemedicine market when there are so many components and so many different definitions. This is a row of banners outside the meeting rooms highlighting the various types, not to mention some of the ATA’s constituencies and important topics at the conference. I did the voice-over at 1:30 in the morning.

The big-data revolution in US health care: Accelerating value and innovation | McKinsey & Company | FutureHIT

Tue, 07 May 2013 16:58:18 -0400

While health-care costs may be paramount in big data’s rise, clinical trends also play a role. Physicians have traditionally used their judgment when making treatment decisions, but in the last few years there has been a move toward evidence-based medicine, which involves systematically reviewing clinical data and making treatment decisions based on the best available information. Aggregating individual data sets into big-data algorithms often provides the most robust evidence, since nuances in subpopulations (such as the presence of patients with gluten allergies) may be so rare that they are not readily apparent in small samples.

via www.mckinsey.com

I found another report on Big Data and healthcare, this time from McKinsey and Company. This report leans in the direction of favoring technology over the personal interactions between patient and physician. I'm still feeling divided. This link goes to an executive summary, but it has a link where you can download the full report.

Ponemon Institute study finds outdated communications technologies cost U.S. hospitals $8.3 billion a year | HealthBlawg

Tue, 07 May 2013 16:46:19 -0400

I spoke with Sean Kelly, CMO of Imprivata, a health IT company with single sign-on and secure SMS solutions that commissioned the study, entitled The Economic & Productivity Impact of IT Security on Healthcare (PDF). The audio file of my...

You should follow me on Twitter: @healthblawg

RP-VITA telemedicine robot may be coming to your hospital | Medicine and Technology [part of HCPLive]

Mon, 06 May 2013 20:00:00 -0400

The next time you go to the hospital, you may run into a telemedicine robot like the RP-VITA. At ATA 2013, InTouch Health & iRobot announced the first hospitals and medical centers that will be using the RP-VITA telemedicine robot. Here's a snippet from their press release:

Austin, TX (May 6, 2013) -- Top academic medical centers and leading healthcare systems across North America are now introducing their patients to RP-VITATM, the first FDA-cleared telemedicine robot that combines state-of-the-art telecommunications and AutoDrive technology. InTouch Health, the leader in acute care telemedicine, today announced at the 18th Annual American Telemedicine Association’s International Conference the first hospitals to integrate this new telemedicine platform into their TeleStroke, TeleICU, TelePsych, and TelePediatric programs. RP-VITA, jointly developed by InTouch Health and iRobot Corp. (NASDAQ: IRBT), a leader in delivering robotic technology-based solutions, is a class apart from any other telemedicine device available, providing a new level of ease of use and independence that frees doctors and nurses to focus solely on patient care and to forget the technology.

The first hospitals that will get RP-VITA include:

Dignity Health
Sacramento, CA

Hoag Memorial Hospital Presbyterian
Orange County, CA

Instituto de Salud del Estado de México
Mexico City, Mexico

Ohio State Wexner Medical Center
Columbus, OH

Providence Saint Joseph Medical Center
Burbank, CA

Ronald Reagan UCLA Medical Center
Los Angeles, CA

St. Mary’s Medical Center
Huntington, WV

#DPTSTUDENT TOPIC FOR WEDNESDAY, MAY 8, 2013: VIEWING PT SCHOOL AS A BUSINESS AND WHAT THAT MEANS FOR US AS STUDENTS | NPA Think Tank

Mon, 06 May 2013 18:04:22 -0400

On more than one occasion I have heard a peer say “We pay so much for this tuition we should at least have (insert noun here)”. It was said again the other day and it really got my business brain thinking. We as students are technically the consumer and the school and faculty provide the service which we pay for. Looking at it as a business, what kind of say do you think we as students (the consumer/customer) have regarding what the school does with our tuition dollars? Any at all? Should we be able to have more of a say?

In the service industry the customer is always right. I’m not so sure that is the case when looking at higher education as a business due to having to uphold academic standards. There are many directions this chat could take and I look forward to seeing where it goes on Wednesday night, May 8th, at 9pm EST!

Guest Article: How to improve health IT products sales into physician practices and hospitals through better funnel management | The Healthcare IT Guy

Mon, 06 May 2013 11:48:28 -0400

A frequent question I am asked by startups and their software focused leadership teams is, “how do we generate sales and what is the appropriate process to follow in creating our sales expectations.” My friend Steve Carbonara has been selling software to healthcare enterprises for years so I asked him to write a companion to his piece on selling to hospitals. Steve is currently the Chief Sales Officer at Cohealo, Inc., a VC backed healthcare services firm that optimizes purchasing and consumption of medical devices and equipment. After 8 years in corporate sales with Misys Healthcare and Allscripts, Steve has worked as a consultant with many start ups and medium sized businesses to optimize their sales processes. If you’re a tech-focused startup there’s a lot of help out there on the technical side but very little on the sales side so I invited Steve to share his advice on how to sell health IT products, especially EHRs, into physician practices and hospitals. Here’s what Steve had to say on improving sales through better funnel management:

In my last article in this series we discussed how to sell Electronic Healthcare Record (EHR) software into the medical community and matching the selling process to the buying process. Today we’re going to focus on creating and managing that funnel of prospects; now that we’re matching up to the needs of our prospects, we’re going to be matching up to their time lines as well. As I have worked with solutions including EHR’s, Personal Health Records (PHR), Business Analytics, Clinical Analytics, Practice Management Solutions (PMS), and other health information technology; this article is transferable across the HIT landscape.

So what is funnel management and how do you maximize your return on investment from your funnel ? Basically, funnel management is learning how to manage your time and your expectations. If you want to have success in this industry of healthcare information technology (HIT) you have to know what it is going to take to make the monthly, quarterly and annual revenue that your firm needs to stay afloat, or to thrive. Some people think that if they sell product and their basic overhead is covered then they are successful, the problem with this assumption is that you have more than basic overhead. Have you thought of marketing costs, commissions for sales people, channel partners revenue needs, reinvestment into the products you sell, incremental revenue growth, market share and market position?

So, to begin good funnel management, you need to make sure you have a good pricing scheme. Pricing is the perceived value of your product as seen by customers based their needs. Did you perform market research to validate your pricing assumptions? Are you priced into the industry but not low enough to keep yourself from going out of business? Are you priced too high and thus above the perceived value of your product? Once you accomplish the goal of pricing yourself as a valuable product, not as a ‘bargain’ product, you will be able to sell within the needs of the industry and make money. This is important as I have seen many companies in this industry try to ‘buy’ their way into the market but it ended up with them being the ‘cheap’ solution, a title you don’t want to win, in any business.

How do you create a value proposition for your product once you define price? Through your market research you should speak with your target market, and learn from them. If you listen, you will understand that they tell you how to sell them, they tell you how to price your product, and they will tell you what was too much and what was cheap. If you listen then you will take their input and build your value propositions around their needs. If you have built your value propositions around your needs instead of market needs, you will not be able to match your sales cycle to the customers buying cycle. If you don’t even know what their needs are, take the time and make the investment, do your homework up front in market research and you will save money in the end.

Building Your Matrix to Success

So, pricing is in place, now we can build the matrix for success that will deliver us the revenue we need. As the CXO of your company you need to look at this from the point of view of your sales person. What does this person you hire need to do to meet your financial goals and earn the money that they need for their family? Once you understand this matrix you will understand how many sales people you will need to hire to meet all revenue goals. Let’s begin.

As the CEO you know your research informed you that your competitors have sales representatives closing an average of $500,000 a year in new business. You learned that they have a typical deal size of $20,000 and that they sell 100 units per deal at $200 per unit. Your basic sales plan lines up easy from here, each sales rep will have a quota of $300,000, you will look to average the same $20,000 per sale deal size with $200 per unit being the price of your widget. This means the sales rep will sell 15 deals this year to hit their number, or just over 1 deal per month.

Why did I go at $300,000 and not $500,000? Because you understood that your competition is a large national company that has been in business for 10 years with name brand recognition and you are new with less marketing spend and much less brand awareness. I would be honest with myself and with my new sales team, letting them know that my expectations are that we are going to work together to build this company and that means we will have to fight for every deal and that you know that each of them will lose more than they win this first year. You align yourself with your team, you build the trust and credibility that they need to have in you and in the end you set the appropriate expectations with yourself and your investors.

So, how many contacts do you need to make a week to begin building a funnel that will drive 15 new contracts and $500,000 in gross sales? I would say 400 new contacts. Why? Where to start:

Because healthcare information technology as a market is saturated
Because the big vendors, like Epic, Allscripts, Cerner and EClinicalWorks have an in with the hospitals and clinics that you can’t match
Because competition will ‘buy’ a deal away from you
Because you’re not obtuse enough to think you can close every deal you’re in.

I would go with the knowledge that the typical direct to consumer marketing effort relates to a close rate of 2-3%, but even if you give yourself credit for being better than that rate you still have to admit that your company may be small and not well known, and it doesn’t have a client base who can sell forward. With all this being said put that number in front of yourself and plan your attack.

Recap: 400 new contacts at 3% close rate provides 12 new clients this year and at $20,000 per deal you will generate $240,000 with your knowledge that you’re better than average and you will pick up the other 3 additional new clients getting you to the $300,000 per sales rep. quota.

What activities define your week if you’re trying to work within 400 active deals?

Well, this depends on your marketing budget, and you have that handy because you finished it while you were performing your market research. If you have an appropriate budget then here is an example:

Activity Type	Activity Defined	Activities/week	Total/year
Cold calls	Dialing for dollars	100	4,800
Warm calls	Networking, the people you know	10	480
Discovery calls	Found interest, don’t rush to tell your story, find out what they need	11	528
Demonstrations	Once you did discovery your demo should reflect need	5	240
Follow up meetings	Unless you demo Iphones people will need time to talk through options, maybe see more demos for their team	5	240
Proposal presentations	Once you got through all data sharing and needs matching to product functionality provide pricing, pricing should not be a first call topic	2	96
Pricing negotiations	Buyers never agree to what you want them to, plan this step to take weeks not minutes	1	48
Reference calls and site visits	Not every buyer will demand this but be ready for it in HIT market	.25	12
Contract signing	Even at this point the deal is not done, be ready for last minute issues to pop up	.31	15

These activities are what each sales rep will do to achieve their goals and each activity builds upon the one prior to it, thus reflecting the sales cycle. Each widget needs to be sold a little differently, so these steps are easily changed to reflect the appropriate steps that your firm demands of your sales team.

The following activities are reflective of your company performing activities that help drive market and brand awareness to help your sales team reach their goals. These activities may be performed by the sales team, the senior leadership or a marketing team; but in the end, they are not part of the sales cycle, but are part of your overall marketing plan, helping sales generate qualified leads

Activity Type	Activity Defined	Total/year
HIMSS conference	Largest national HIT conference specific to the technology personnel of hospitals and a great place to build relationships with other vendors that may be partners in the future	1
HFMA conference	Solid national conference that is more specific to the financial personnel at the hospitals and clinics	1
MGMA conference	Solid national conference that is more specific to the administrators of clinics, very little hospital attendees	1
Regional conferences	Each of the above has regional shows that you can attend with a focus on that local community of members	2
Local conferences	Each of the above has local chapters that feed into the regions and there are some great groups that have monthly meetings	6 to 12
Webcasts	Building trust is defining your value proposition in the market, can you deliver a message that provides value and that drives market interest and sales	4 to 12
Case study creation	Your value proposition statements to your prospects are strengthened through exhibiting these successes with current customers in short write ups defining the value and ROI	4
Blogging	Becoming a thought leader within your specific market begins with defining your stance on the influencers in that market and the conditions presenting themselves to your customers	12-24
Speaking	Speaking is a great option at the local, regional or national level. The more you and your company define the market the more valuable your speaking will become	4
Website optimization	This is a daily/weekly/monthly job that you need to be aware of to ensure that you deliver the appropriate message to your prospects	NA

There’s a lot to do and being engaged in 400 active deals is not easy, time management is not a gift, it’s a talent that you have to develop and then manage. When working with my clients I have put together matrixes exhibiting exactly how much time a sales rep, and thus the company, should focus on each of these activities and what value should be derived from each. Defining how a sales rep should spend their 8 hours a day working for your firm can never go to far, as it sets expectations and defines success and failure so that no one is surprised at year’s end, with failure or with success. Go as far with this exercise as you want, the more detail documented and the more you can hold yourself accountable to your daily, weekly and monthly totals, the better off your firm and your sales representatives will be moving forward.

Join me for my next posting where we will dive deeper into managing the funnel that you just laid the groundwork to build.

An app for the mind | Positive Technology Journal

Mon, 06 May 2013 10:18:35 -0400

With the rapid adoption of mobile technologies and the proliferation of smartphones, new opportunities are emerging for the delivery of mental health services. And indeed, psychologists are starting to realize this potential: a recent survey by Luxton and coll. (2011) identified over 200 smartphone apps focused on behavioral health, covering a wide range of disorders, including developmental disorders, cognitive disorders, substance-related disorders as well as psychotic and mood disorders. These applications are used in behavioral health for several purposes, the most common of which are health education, assessment, homework and monitoring progress of treatment.

For example, T2 MoodTracker is an application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale. Using this application, patients can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Self-monitoring results can be used as self-help tool or they shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame.

Measuring objective correlatives of subjectively-reported emotional states is an important concern in research and clinical applications. Physiological and physical activity information provide mental health professionals with integrative measures, which can be used to improve understanding of patients’ self-reported feelings and emotions.

The combined use of wearable biosensors and smart phones offers unprecedented opportunities to collect, elaborate and transmit real-time body signals to the remote therapist. This approach is also useful to allow the patient collecting real-time information related to his/her health conditions and identifying specific trends. Insights gained by means of this feedback can empower the user to self-engage and manage his/her own health status, minimizing any interaction with other health care actors. One such tool is MyExperience, an open-source mobile platform that allows the combination of sensing and self-report to collect both quantitative and qualitative data on user experience and activity.

Other applications are designed to empower users with information for making better decisions, preventing life-style related conditions and preserving/enhancing cognitive performance. For example, BeWell monitors different user activities (sleep, physical activity, social interaction) and provides feedback to promote healthier lifestyle decisions.

Besides applications in mental health and wellbeing, smartphones are increasingly used in psychological research. The potential of this approach has been recently discussed by Geoffrey Miller in a review entitled “The Smartphone Psychology Manifesto”. According to Miller, smartphones can be effectively used to collect large quantities of ecologically valid data, in a easier and quicker way than other available research methodologies. Since the smartphone is becoming one of the most pervasive devices in our lives, it provides access to domains of behavioral data not previously available without either constant observation or reliance on self-reports only.

For example, the INTERSTRESS project, which I am coordinating, developed PsychLog, a psycho-physiological mobile data collection platform for mental health research. This free, open source experience sampling platform for Windows mobile allows collecting self-reported psychological data as well as ECG data via a bluetooth ECG sensor unit worn by the user. Althought PsychLog provides less features with respect to more advanced experience sampling platform, it can be easily configured also by researchers with no programming skills.

In summary, the use of smartphones can have a significant impact on both psychological research and practice. However, there is still limited evidence of the effectiveness of this approach. As for other mHealth applications, few controlled trials have tested the potential of mobile technology interventions in improving mental health care delivery processes. Therefore, further research is needed in order to determine the real cost-effectiveness of mobile cybertherapy applications.

Big Data & Healthcare Analytics Forum | Medicine and Technology [part of HCPLive]

Sun, 05 May 2013 20:00:00 -0400

Don't miss the Big Data & Healthcare Analytics Forum
June 4-5, 2013
Washington DC

Healthcare IT News and HIMSS Media, the industry’s leading sources for news and leadership in healthcare information technology, have joined forces to present the Big Data & Healthcare Analytics Forum. This two-day event in the nation’s capital will gather leading providers, industry experts, solutions suppliers and key government officials.

As reimbursement shrinks and risk sharing grows, analyzing data to improve decision-making may well determine the winners and losers in this new healthcare landscape. That’s where the forum comes in. Through interviews with hospital CIOs and other providers, we know that questions abound about how to deploy analytics in a fashion that meets an organization’s business and clinical goals. With that in mind, we have designed the Big Data and Healthcare Analytics Forum to provide answers to those questions. Sessions will focus on peer-to-peer learning, case studies and best practices—practical, actionable information that can be taken home and put to use.

http://www.bigdatahitforum.com/

HIMSS13 debrief podcast with Gregg Masters, John Lynn, and Dr. Pat Salber | The Healthcare IT Guy

Sun, 05 May 2013 11:54:45 -0400

Following HiMSS13 in New Orleans I sat down last month in a BlogTalkRadio broadcast with Dr. Pat Salber (@DocWeighsIn @HealthTechHatch), Gregg Masters (@2healthguru @ACOwatch) and John Lynn (@techguy) with a ‘debrief’ of our key HIMSS13 take-aways as well as our latest venture, Influential Networks.

I covered the following topics in the podcast:

The HIMSS 13 cheerleading and “echo chamber”
Are we moving faster with MU than the industry can really accomodate?
How MU is creating false demand and a false market and when we might be able to move back to real innovation
Supply of health IT professionals and whether they’re meeting the demand
Medical device connectivity
Population management
Lack of evidence-driven selection of technology

Listen to internet radio with this week in health innovation on BlogTalkRadio

Reducing Shadow IT in healthcare by embracing “good enough for HIPAA” business-friendly SaaS tools | The Healthcare IT Guy

Sun, 05 May 2013 10:29:11 -0400

I’ve said repeatedly that any cloud / SaaS vendor that wants to be taken seriously in healthcare must be willing to sign a HIPAA Business Associate Agreement (BAA) and I was happy to hear that Box.com is now willing to do so. I’m quite pleased that we’re finally seeing some serious healthcare SaaS offerings from horizontal (non-healthcare-specific) vendors. Only when we move beyond healthcare-specific offerings will we be able to unshackle ourselves from the decades old legacy health IT vendors and that’s great news. While Box.com is only one vendor I think they will be the first of many general industry SaaS providers that will provide secure file sharing, mobile access, document management, and other important collaboration services that incumbent health IT vendors can now build on instead of having to reinvent the proverbial infrastructure wheel.

Last week the Box.com healthcare team invited me to participate in their “Secure Cloud Collaboration in Healthcare” webinar. The full event, audio, and screencast is available on their BrightTalk.com channel.

My point to the audience was that healthcare professionals are very resourceful and if IT doesn’t provide them the proper solutions they will not just wait for progress, they’ll take matters into their hands — creating a growing “Shadow IT” problem. In the webinar I talked about “Shadow IT” and how solutions like Box.com can reduce the problems of end users choosing consumer-grade cloud solutions that are not HIPAA compliant or secure enough for enterprise use.

What’s Next for Healthcare Information Technology Innovation | The Healthcare IT Guy

Sat, 04 May 2013 20:26:36 -0400

Last week the Greater Chicago Chapter of HIMSS invited me to participate in their healthcare technology webinar series. I covered the topic “What’s Next for Healthcare Information Technology Innovation?” and the screencast with audio has been posted here. I covered numerous topics that are helpful for entrepreneurs and engineers that want to create innovative healthcare technology.

Pediatrics 2040: Trends And Innovations for the Next 25 Years | Medicine and Technology [part of HCPLive]

Fri, 03 May 2013 18:00:00 -0400

Don't miss this exciting event this fall:

Pediatrics 2040: Trends And Innovations for the Next 25 Years
October 3 - 5, 2013

Disney’s Grand Californian Hotel & Spa
Anaheim, CA

The current myriad of challenges such as cost containment, care fragmentation, healthcare reform, access to subspecialists, escalating costs and knowledge escalation face today’s pediatricians and pediatric subspecialists as well as hospital administrative leadership.

The emerging medical and technological advances as well as trends in the care of children in the coming era is covered in a comprehensive three-day academic program for all involved in the care of children for the next 25 years.

Learn more about this conference here.

The Analytics Elephant is Sitting in the Waiting Room | PluralSoft: Powering Healthcare Data

Thu, 02 May 2013 13:43:39 -0400

Whether you are an ambulatory practice, an urgent care center, a hospital, an insurer, an integrated delivery system, an accountable care organization, a health information exchange, a provider hospital organization, or whatever healthcare delivery or administration acronym we have managed to dream up now; you share a very common trait with all of your other healthcare brethren. You have an analytics elephant sitting just outside your office!

There is an old joke that poses the question, “How do you eat an elephant?” The punch line is, “One bite at a time!” I will give you a moment to pause in reflection and perhaps chuckle quietly to yourself! This piece of humor is truly applicable to analytics in healthcare; there is indeed an elephant out there that each of us needs to consume.

Before we even think of how we are going to ingest this pachyderm; let us look more closely at our dinnertime “catch of the day.” Our elephant’s anatomy is made up of four components. First, we have a multitude of data sources, of varying quality, and scattered across what seems like an endless series of disparate silos. The beast has multiple categories of measurement; including clinical quality, administrative cost, financial, and operation key performance indicators. For each of the categories, there exist a set of measure families that have been generated by national standards bodies or that have been created to suit regional initiatives. Finally, our pachyderm supports an entire community of would-be information consumers.

If we are to eat the analytics elephant one bite at a time; we wish to assure that the entire healthcare village gets fed well. This goal mandates that every anatomical portion of the analytics elephant must be addressed. The first challenge is to find all of the data that make up the core of the elephant. This information is nestled in multiple disparate sources and will require serious heavy lifting to extract. Since the village is best fed from a common pachyderm; we wish to place all of our data in a single community data foundation. Once we normalize and cleanse this data, it is fair to say that we now have a single version of the truth across the 360-degree continuum of healthcare.

Different consumers of the elephant will have varying tastes as to what part of the beast they prefer to ingest. For this reason we need to acknowledge that providers, payers, quality organizations, government, and all of the other guests at the banquet will each request a different cut of the meat. Our elephant must satisfy the palate with analytics that addresses quality, cost, finance, operations, utilization, and access of care. There will also be those consumers who will come back for seconds; more than likely having a change in taste along the way! Answers always beget new questions, right?

In order to assure that everyone requesting a certain cut of the elephant gets the same quality and portion; it is critical to harmonize our measures. The entire village needs to be eating off the same platter; that is to say, nationally accepted standards must be used and the determination of how the measure is calculated must remain constant. These measures must meet the specific needs of a group, with enough flexibility to be customized.

Finally, we need a way to share our analytics elephant bounty with the entire village. We can cook the beast to perfection; but it serves dubious purpose if there is no serving platter to bring it from hearth to table. In any analytics effort there are three principal measures of success; (1) did we identify gaps or places for improvement, (2) can we surface the opportunity to the right person, and (3) can that person take action based upon this knowledge? If you cannot surface and share what you have learned from the analytics elephant; better to have ordered delivery pizza!

Assuming you can access all of your data, measure each piece, utilize the correct measures, identify gaps, and act upon what you have surfaced; the entirety of the analytics elephant can become too much to consume, even for a large and prosperous village. If you try to address everything from everywhere for everyone, you will simply choke your analytics initiative. The answer is that we must all eat the elephant one bite at a time. For our case of the elephant, these bite-size pieces are:

Limit the initial number of data sources – Select several sources that perhaps use a common EHR/HIS system, or a common protocol. These sources should be prequalified with respect to the quality of their data
Limit the measure domains (categories) that you will examine – Do not try to meet the needs of providers, payers, quality organizations, and government simultaneously. Restrain yourself to just one of these domains initially.
Limit the measure families for initial implementation – You will simply not be able to handle the volume of information that comes from a solid analytics platform. Select a population subset such as diabetics, opt for actionable measures such as A1c percentage reduction, and focus on identifying gaps and taking action.
Limit the number of consumers for analytics – This is most easily accomplished by data-marting results back out to the data sources originally used. In this way, immediate benefit can be shown and trust of the results reported will occur.

Most healthcare organizations are in no position to build an analytics solution. Third party vendors abound in the marketplace. Two types are worthy of closer examination. The first is driven through a consulting model, loaded with front end services, and eventually delivering a customized analytics solution. This is usually an extremely large elephant, that tends to be very expensive, takes forever to cook, and is served in its entirety. The second vendor type delivers a product that is integrated to data sources, preloaded with measure sets, and is accelerated through services. This elephant is still very large, but it is cooked and served in bite-size pieces, making it less expensive and easier to digest.

As you move forward with identifying your partner for analytics, ask yourself a very important question. “Does this vendor understand the elephant in my room?” If the answer is yes, then there is only one more question to ask. “Will my organization be forced to choke on the entire elephant, or will my vendor help me eat it one piece at a time?”

#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MAY 1, 2013: LONG TERM VS SHORT TERM CLINICAL ROTATIONS | NPA Think Tank

Mon, 29 Apr 2013 10:53:24 -0400

Some schools are switching to longer clinical rotations that could perhaps turn into a paying job after graduation. Other schools are sticking to the short and sweet, but still long enough to get great experience model. I see the pros and cons for both students as well as clinic owners. What are your thoughts? Let’s talk about it Wednesday, May 1st at 9pm ET!

Good luck to those taking finals! Remember to sleep and still get in a little bit of physical activity!

CHAT UPDATE

Click here for Transcript and Analytics

Here an HIE, There an HIE, Everywhere an HIE | Chilmark Research

Mon, 29 Apr 2013 09:20:30 -0400

In late March, I headed down to Belize with a bunch of high school students to do some service work. Joining the crew was a parent, Harry (not his real name), who happened to be a urologist sharing a private practice with five other urologists. We got to talking about the industry, the rapid changes that are occurring and of course HIT, where the conversation quickly turned to health information exchanges (HIE).

This urologist’s practice has been using eClinicalWorks (eCW) for several years now and despite their proficiency with using this EHR, the practice has never fully recovered the productivity it once had. Regardless, they have come to accept this hit on productivity as just the cost of doing business. (Note: In Massachusetts all physicians must adopt and use an EHR to be credentialed, regardless of meaningful use or any other programs.)

Harry spends two days a week in surgery with most operations taking place in one of four facilities: local, unaffiliated hospital Winchester (who uses Meditech), Beth Israel Deanconess (has a home-grown EHR but encourages affiliate practices to adopt eCW), Childrens’ Hospital (a Cerner shop that also promotes eCW in ambulatory) and Partners which is now moving from its homegrown EHR solution to Epic (BTW, in a recent conversation with a contact at Partners learned that they are spending $1M/day for next five years on Epic switch - ouch!).

All of these hospital organizations want a closer affiliation with these urologists in support of future value-based payments and of course just getting these physicians to do more surgeries at their respective institutions. Thus, all of them want the urologist practice to adopt their interoperability model. Harry stated that Partners, the biggest healthcare organization in metro-Boston and arguably New England, is pushing particularly hard for them to switch to Epic as Epic does not have an HIE offering (Epic Everywhere is not an HIE in our definition nor apparently in ONC’s) and encourages its customers to put all ambulatory affiliates on Epic instead. In addition to these organizations, the Commonwealth is also encouraging this practice to join the statewide HIE.

After the pain and suffering Harry’s practice went through to become proficient on eCW, they are loathed to switch to Epic. Besides, switching to Epic would limit their ability to connect with other healthcare organizations they work with as Epic does not play well with others.

Harry’s situation is not unique and is likely being played out across the country, especially in urban areas where there may be a number of competing healthcare systems each trying to establish their own HIE. In such a situation what is an independent physician practice to do?

Certainly they could sell the practice, as many physicians have already done, to the highest bidder. Not an option for Harry and his physician partners as they like their independence and plan to keep it that way.

They could turn to the statewide HIE and hope that it will provide the depth of services (interoperability) to enable them to connect and share records in support of care coordination with all hospital systems they work with. Ideally, this may be the best approach but unfortunately they’ll be waiting a very long time for this to happen, if it happens at all. Today, most statewide HIEs, including Massachusetts are focused on enabling Direct secure messaging, a simple, political expediency that those in D.C. can point to as a shiny example of information exchange for the nearly half billion dollars spent on statewide HIEs. It is unlikely that most statewide HIEs will evolve beyond Direct providing the type of deep connectivity between a practice and an healthcare system to coordinate care effectively. That’s not to say we are throwing out the baby with the bathwater as there are some states that are doing exemplary work e.g., NY, IN

Then there is the option of just staying the course and hoping that lightweight connectivity directly into eCW will miraculously occur. For Harry and his partners, both Childrens and Beth Israel currently support eCW and interoperability with the acute care EHR will be supported. Partners may be left with no other option then to purchase a third party HIE solution to connect affiliate practices in the highly competitive, metro-Boston market. As for community hospital, Winchester, this hospital is unlikely to survive as an independent and will either be acquired or eventually be forced to shut its doors.

Still Waiting…
While the vast majority of ambulatory practices will ultimately be acquired, there will be a significant number of specialists who will continue to operate independently and with a number of healthcare institutions. The current hodgepodge of HIEs being stood up in various communities and the multitude in a given urban area will put increasing strain on physician practices such as Harry’s, who like any of us, given too much choice will simply forgo a decision.

Maybe, just maybe the efforts of the Interop Workgroup will take practices such as Harry’s to the promise land that will allow them to support coordinated care, in a simple streamlined fashion, amongst a wide range of healthcare organizations in their community irrespective of underlying HIT infrastructures. We have not heard of any such examples to date, but we remain hopeful as the current model being deployed today, while likely addressing the all too familiar 80% of the problem, still leaves a very critical 20% unresolved.

Comfort Zones and a shout out to the GSU EDB Class of 2014 | Legacy Data Access

Sat, 27 Apr 2013 16:47:55 -0400

I have been thinking lately about comfort zones. I went camping with my daughter’s Venture Crew a few weeks ago – hiking (which I do often) and putting up a tent and eating freeze-dried camping food (which I have NEVER done). Everyone that knows me was extremely shocked that I was going camping. This was definitely outside my comfort zone – I am more of a Ritz Carlton/Oxford Castle kind of girl.

We all know that going outside your comfort zone has benefits that outweigh the fear-factor. The opportunities for personal growth when you push yourself to have new experiences spill over into all aspects of your life. Despite the fact that my plate is very full lately and taking time out to spend 30 hours in the woods added more stress to my schedule, I found the camping trip relaxing and rewarding. I came back to a jam-packed week that I was able to coordinate, shuffle, and actually manage well, mainly because I had taken a mental break.

It is no secret that I am finishing my second year at GSU’s Executive Doctorate program. It is a challenging, rigorous, lock-step program that I am privileged to be part of. We are a tight-knit group of 16 experienced executives with various backgrounds and origins but we have a common work ethic and perspective on engaged scholarship. As we break for the summer, I am reminded how we all constantly push each other beyond our comfort zones. We are all physically and mentally at our limit but we have the last, and most difficult, year ahead of us as we are all working on our final dissertation. Still, we forge ahead together, and are forming a bond that will last well beyond our graduation date. I am grateful to this group for not only having my back but also encouraging me to strive to be the best student, manager, and person that I can be.

The culture at Legacy is a bit like this as well. We are constantly pushing our comfort zones around how much we can produce with the resources we have. We know that our customer’s quality standards are very high – the data HAS to be right. Workflow and high data availability are close seconds. We are constantly working together on solutions to improve our implementation process, our tool kit, our build process, and our testing and documentation process. Each time we are challenged in one of these areas, we feel the pressure of our comfort zone being expanded but we look back and see that the resulting product enhancement or process improvement was well worth it.

I am sure I will be doing lots of comfort-zone pushing this summer. I plan to travel a bit, make some personal changes and set some goals. I plan to push my self to make my dissertation timeline goals and keep that work on schedule. I know it will be hard but rewarding in the end.

A Case for an ACO to Compete with Itself | PluralSoft: Powering Healthcare Data

Fri, 26 Apr 2013 17:00:31 -0400

On November 2, 2011, the Centers for Medicare & Medicaid Services (CMS) finalized new rules under the Affordable Care Act establishing the Shared Savings Program, under which doctors, hospitals, and other health care providers may work together to better coordinate care for Medicare patients through ACOs. The Shared Savings Program will reward ACOs that lower their growth in health care costs for assigned Medicare beneficiaries while meeting performance standards on quality of care.

The result of this effort has led to the formation of over 250 MSSP ACOs covering well over four million Medicare beneficiaries. These new Medicare ACOs, though, only tell part of the accountable care story. ACO growth has also continued apart from the Medicare program with 428 total ACOs now existing in 49 states. Additionally, physician groups have overtaken hospital systems and have now become the largest backer of ACOs. The driving factor is this phenomenon has been the persistent desire by providers to take back control of the quality and cost equation.

Due to the legislative nature of the program, MSSP ACOs are structurally similar with common payment arrangements, while private ACOs have more flexibility in designing accountable care contracts. Many private sector ACOs do mimic the shared savings model of the MSSP, but others have moved to full or partial capitation models, bundled payments, retainer agreements, in-kind services and subsidies provided by payers, and pay-for-performance incentives.

As required by the Affordable Care Act, before an ACO can share in any savings generated, it must demonstrate that it met the quality performance standard for that year. The CMS will measure quality of care using 33 nationally recognized measures in four key domains:

Patient/caregiver experience (7 measures)
Care coordination/patient safety (6 measures)
Preventive health (8 measures)
At-risk population:
- Diabetes (6 measures)
- Hypertension (1 measure)
- Ischemic vascular disease (2 measures)
- Heart failure (1 measure)
- Coronary artery disease (CAD) (2 measures)

In terms of measurable clinical quality indicators, we see that 20 of the 33 measures can be measured from information already being collected within ambulatory EHRs and inpatient HIS systems. If we turn to the CMS scoring for an ACO; 30 out of a possible 48 points can be directly attributed to clinical quality measurement (preventive health and at-risk population). That said; any ACOs share of savings will be 62.5% determined by their attainment of the quality measure.

Depending on which model your ACO has signed up for (one-sided or two-sided); you will receive back a maximum of 50%-60% of the savings respectively. That maximum however, is adjusted by your scoring. So let us assume a very simplistic example. Your ACO is taking on full risk with CMS. You save the system $10,000, thus receiving a maximum of $6,000. Even if you receive perfect scores in patient / caregiver experience and care coordination / patient safety; that only equates to $3,000; in that the two non-clinical domains are weighted at 50%. The remaining $3,000 is going to depend on the clinical measures. Each of those two domains counts for 25%.

To further complicate things, the points you receive within each measure have to place you at or above the 30^th percentile for national Medicare FFS / MA populations. On top of that, you need to reach an overall 70^th percentile rating for any domain for the same MFFS / MA populations. Suddenly, it becomes apparent that clinical quality measures can make or break what your ACO receives from a MSSP.

In the event that CMS cannot determine the quality measures within a MFFS / MA population; they have the right to assign a flat percentage of patients within your population that must meet the quality measurement standard. Conveniently enough, for purposes of awarding points there is a 1:1 relationship between percentile scoring and flat percentage scoring. For instance, your ACO receives the same number of points for a clinical quality measure for reaching the 70^th percentile as for having 70% of the patient population exceed or comply with the measure.

This brings an important consideration; does your ACO want to be competing against the quality being delivered by Medicare FFS / Medicare Advantage programs, or does it wish to be competing against itself? You can always do your best, assume others do poorly, and hope you hit a higher percentile. Then again, you can take that target percentile and say that you want your patients to surpass the equivalent percentage and compete against yourself.

Further, there is a degree of uncertainty in the percentile approach. You do not know where you stack up until the end of the reporting period. You also do not know where the FFS / MA programs stack up in terms of their quality. Using the percentage method, you always know where you stack up against yourself. Uncertainty is virtually eliminated through the latter approach.

To truly win as an ACO, in terms of clinical quality measures; you need to continuously measure where you are at in terms of percentage compliance. That only comes about through an analytics solution that has been designed with the ACO in mind. The solution should already have these quality measures built-in and ready to go. You should be able to measure your results throughout the reporting period, making adjustments as needed. Beyond that, the company behind your ACO analytics solution also needs to be committed to the heavy lifting required to find, extract, and cleanse the data that feeds analytics.

Often it is when we compete with ourselves that we obtain the greatest results. Arm your ACO with the right analytics solution and the odds improve even more.

Naughty Curiosity!!! | Dalai's PACS Blog

Thu, 25 Apr 2013 20:18:00 -0400

It seems that Curiosity, the Mars rover, thought no one was looking, so....

Touch Bionics Controlled Prosthetic Hand–First Posthesis Controlled With IPhone Mobile App | The Medical Quack

Tue, 23 Apr 2013 00:43:44 -0400

I think this is a first to have a prosthetic hand being operated with an IPhone app and if you watch the video you kind of get the idea on how this works. The company devices have been around for a while and have connected to computers for adjusting settings, etc. but this makes is a little more convenient with the phone to actually program the phone to do some specific movements. This is the bionic hand and allows people to use the device like a hand that connects to a computer chip to allow the hand to move and function, so now we add on the app for more settings and programming the hand. Touch bionics makes a number of devices and you can read more here. BD

According to Touch Bionics, the i-limb ultra revolution is the “first upper limb prosthesis that can be controlled via a mobile application.” The individually articulated fingers have variable digit-by-digit grip strength and the powered rotating thumb is controlled directly by means of skin electrodes attached to the wearer’s stump that pick up muscle impulses. These electrodes use one of four muscle impulses or triggers, which can be assigned to a particular grip or gesture – much like programming the speed dial on a phone.

What’s novel about the i-limb ultra revolution is its Quick Grips biosim application. Compatible with iPad or iPhone, Quick Grips uses Bluetooth to link the hand to a smartphone app, which can activate 24 grip options at the tap of the screen, including standard precision pinch open, pinch closed, thumb precision pinch open, grasp and handshake. It can also be programmed by the wearer for custom grips.

Other functions of the Quick Grips app include; a collection of favorite grips that fit the wearer’s daily needs, such as typing, holding papers, or using a mouse; the Hand Health Check that activates the prosthesis diagnostic; and Training, which includes activities and games as well as providing graphical feedback of muscle control signals. There’s also a Don or Doff setting that positions the hand for putting on or removing the covering glove.

http://www.gizmag.com/i-limb-ultra-revolution/27150/

Law Firm States They Will No Longer Work With Political Intelligence Firms After Senator Grassley Questions and After Humana Fired Them - Wellpoint Evaluating Their Relationship | The Medical Quack

Mon, 22 Apr 2013 17:40:32 -0400

Here we have part two of the story it seems as Humana already is doing their own investigation and add the Grassley inquiry now as Wellpoint is looking at their affiliation with Greenberg Traurig. CMS is now also looking into the situation and this goes back a a potential tip on the CMS change on the Medicare Advantage plans cuts being changed by HHS. Sounds like the firm may lose another account, and guess we will have to see how all this plays out relative to insider trading and tips. BD

Humana Fires It’s Lobbying Firm Over Possible Insider Trading Violation

The law firm being questioned by a U.S. senator over whether one of its lobbyists obtained and shared confidential government information on Medicare rates will no longer work with so-called political intelligence firms.

Greenberg Traurig LLP has “concluded that providing government relations services to an entity in the ‘political intelligence’ area may lead to misunderstanding and unintended use of those services, even when compliant with legal and ethical standards,” Jill Perry, a firm spokeswoman, wrote in an e-mail. “We will not represent such firms in the future.”

http://www.bloomberg.com/news/2013-04-21/law-firm-quits-political-intelligence-work-after-senator-s-query.html

#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRIL 24, 2013: ADVOCACY FOR OUR BELOVED PROFESSION | NPA Think Tank

Mon, 22 Apr 2013 12:21:09 -0400

The #DPTstudent chat started in late November and we have discussed many, many different topics and the majority of them have one thing in common: it all comes down to advocacy for our profession. Getting our name out there, having the public understand what we do and how helpful Physical Therapists can be. Having the pubic understand our knowledge and our education and the value of PT.

This Wednesday we will be talking about what we can do as students to help our profession. We are the future of Physical Therapy and it is our responsibility to take charge and help the profession grow and succeed.

The timing of this advocacy chat could not have come at a better time! The APTA Student Assembly has set up a Flash Action Stragetgy (FAS) to show support for the Physical Therapist Workforce and Patient Act of 2013. Think about it as a flash mob but instead of cool dance moves, we send letters to our legislators to show support for the profession in hopes that congress realizes that not only are we necessary in the medical field, but we are a very driven and passionate group of people! Feel free to dance once you submit your letter. Here is the link to the Facebook Event for FAS.

Talk to you Wednesday at 9pm EST (after you submit your letter)! Brain storm ideas of other ways we can come together as students and make a difference.

CHAT UPDATE

Click here for analytics and transcript.

Inspiring Multidisciplinary Collaboration to Achieve Innovation – TEDMED | EMR and EHR

Mon, 22 Apr 2013 11:00:42 -0400

Heading home from the #TEDMED experience and all I can say is it was quite the experience. #simplehealth

— EMR, EHR and HIT(@ehrandhit) April 19, 2013

I was invited to attend TEDMED as a guest of Xerox and what an experience it was. If you missed my first post about the TEDMED experience, you’ll want to start with that post to provide some context to this one. The first day and a half that I describe in that post was a whirlwind experience and the second half of TEDMED was no different. However, the second day and a half had a bit of a different twist. It seemed to focus less on the technical side of medicine and more on its emotional and philosophical parts, but there were still a lot of lessons learned.

The reality of writing a TEDMED recap is that you could literally write about every speaker that participated and so you’re guaranteed to leave out some noteworthy talk. With that made clear, let me highlight some of the messages and people that struck me and would likely be useful to a healthcare IT crowd.

Close to the end of the TEDMED conference, Raghava KK took the stage with some really twisted perspectives on how to teach diversity and stretch your mind in new ways. This quote from his talk seemed to teach an important lesson for healthcare, “When you teach perspectives, you teach creativity.” In the insular healthcare environment, we could benefit from learning about outside perspectives. No doubt we see isolated examples of creativity in healthcare. Maybe the reason we don’t see more is because the healthcare industry needs more external perspectives.

Victor Wang from GeriJoy was a delightful person; I guess you’d need to be to start a virtual talking dog company. While his product is interesting in its own right, his approach is where we can all learn something valuable. Victor said, “We are leveraging the global supply of compassion and kindness.” I’m still trying to process the possibilities of that statement. Victor and GeriJoy are using people from around the world to share compassion and kindness with elderly people. I see an amazing untapped potential where technology has the power to deliver humanity. A talking dog is just the beginning.

Eli Beer‘s lifesaving flash mob, United Hatzalah, is something special. I loved his description of, “Not viral videos. Viral community building.” The power of community is often forgotten or left untapped.

There was an entire session of TEDMED on death. No doubt this applies to a large number of people in healthcare in a lot of different ways. Amanda Bennett offered a couple insights that seemed to capture some of the essence of the conversation including this gem, “Looking at death has taught me how to live.” Plus, if you’re interested in this topic, her discussion of patient denial is a great one. She even borrowed from software development to say, “Denial is not a bug, it’s a feature.”

Roni Zieger, Former Google chief health strategist, announced his new Smart Patients community at TEDMED. He called this and other similar communities a “network of micro experts.” Think of the power these micro experts have when put together in a network. He also pointed out a concept I’d never seen articulated before, “The biggest value isn’t in the data we can predict, it’s in the unexpected connections.” He even applied it to EHR software where he suggested that EHRs were pre-configured and therefore have a hard time seeing emergent trends. His solution, “We need systems that can reconfigure based on the context.”

Marleece Barber, chief medical officer at Lockheed Martin took us all to task when she asked, “If we can land a man on the moon, can we land your butt on a bike?”

Jessica Richman and her company uBiome are part of a growing concept around citizen science. She posed the inspiring question, “Can a citizen scientist win a noble prize?” She believes that if you can ask and answer questions, all you need are the right tools and anyone can be a scientist. I loved her idea of changing science from being a spectator sport on Discovery Channel to a sport that anyone can participate in.

Many of the concepts that Jessica described remind me of patients wanting to be more involved in their healthcare. The growing ePatient movement is a strong one and requires some really challenging shifts in culture. I’m sure I’ll be doing many posts on Jessica’s concepts in the future, but it seems that scientists have similar views to doctors. At the core of the issues to me is the belief that without years of schooling you’re not smart and can’t evaluate complex issues. I don’t want to understate the value of education, but we also shouldn’t understate the value of micro experts (to steal Roni Zieger’s term). They can both have a place in the process and working together they can be much more than the sum of their parts.

Two of the most heartwarming and inspiring presentations were Charity Tillemann-Dick and Sue Austin. Charity, the recipient of two double lung transplants, is a soprano opera singer who performed an aria for us. Her story of survival and drive to live is beautiful. Her message of organ donation is an important one, but her ability to inspire you to battle anything in life is priceless.

Sue is a scuba diver, but she does so in a wheel chair. Instead of trying to explain it, watch one of her other TED talks including a video of her scuba diving.

Martin Hoffman tweeted something that summed up TEDMED quite well, “Inspire multidisciplinary collaboration to achieve innovation.” I’d say that goal was accomplished for many.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox Blog and follow @XeroxHealthcare.

More Hospitals Merging Affiliations in Arizona With John C Lincoln and Scottsdale Healthcare | The Medical Quack

Mon, 22 Apr 2013 10:59:47 -0400

In order to survive the current economy we keep seeing hospital affiliations and ownerships in the news and today we have one more in Phoenix. I grew up like next door to John C. Lincoln and watch it grow from a single small hospital to the large medical center they have today. With their system affiliating with Scottsdale they will have a total of 5 hospitals in the new network. Smaller hospitals all over the US are competing with the large for profit hospital chains across the US.

According to the article this has been discussed several times and it comes back to working to keep costs down through accountable care organizations. In other words they are doing everything they can to keep costs down while consumers accessing healthcare continues to dwindle down as it is becoming non affordable for many. No word yet on which CEO will remain at the top. Take a look at Texas in a related story with St. Luke’s hospital affiliating with Catholic Health Initiatives in Denver. More history at the links below with details on the Private Equity portions of some of the consolidation and purchases with Catholic Hospitals. Ascension if you remember renewed their contract with Accretive, the 3rd party analytics company what was banned from practicing in Minnesota due to their collection and other practices which were deemed not ethical as the company was working to create models to finance some non profit hospitals who were having some extreme dollar issues. When looking for money and trying to stay open had an impact on how actual patient records ended up on Wall Street with trying to secure additional investors…a bad side effect of folks trying “anything” and “everything” to model a reason to gain investors.

Catholic Health Initiatives To Invest $200 Million in Various Areas of Healthcare Via Newly Created VC Group–Non-Profit Portfolio Algorithms

Ascension Health and Private Equity Firm Oak Hill Capital Form Joint Venture To Buy Catholic Hospitals and Health Systems

Catholic Healthcare groups are growing and again some of the competition that smaller hospitals such as Lincoln and Scottsdale face with competition. It’s all about money and I’m sure there will be even more stories as such as hospitals wrangle and figure out how to try to keep costs down and keep doors open. BD

Scottsdale Healthcare and John C. Lincoln Health Network on Thursday said they plan to join forces in a combined health-care system that will include five hospitals and facilities across Phoenix and Scottsdale.

The boards of both non-profit health-care organizations this week approved a letter of intent that will trigger exclusive negotiations through July 31 to hash out details of the affiliation agreement.

The combined entity would be called Scottsdale Lincoln Health Network, with about 10,500 employees, more than 3,500 physicians and five hospitals from Sunnyslope to north Scottsdale

http://www.azcentral.com/business/consumer/articles/20130418scottsdale-healthcare-john-c-lincoln-health-network-combine.html

Ex-Felons Will Get Health Insurance Coverage Via the Affordable Care Act | The Medical Quack

Mon, 22 Apr 2013 01:25:21 -0400

Many of those in prison probably get the best healthcare that they have every received in their lives. Now when a prisoner is released they too will have Medicaid in states to where the expansion has been applied to both federal and state prisons. Five million ex-offenders on parole or probation will be eligible. Those who do make too much money to qualify may still be able to purchase insurance via the exchanges as well and gain tax credits. We have heard the stories of folks that have committed a crime to get healthcare for sure with those needing surgery or some other type of treatment. They fall into the same rules as everyone else next year that will require all to have insurance. BD

Newly freed prisoners traditionally walk away from the penitentiary with a bus ticket and a few dollars in their pockets. Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act. A sizable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered.

The expansion of Medicaid, a key provision of the health care reform law, is the main vehicle for delivering health insurance to former prisoners.

Since most recently released prisoners are not pregnant or disabled, the vast majority of them do not have Medicaid or health insurance of any kind. As a result, studies show, many do not receive treatment for chronic conditions or continue on medications prescribed in prison. They also do not generally see primary care doctors, relying instead on emergency rooms, an expensive way of delivering medical care.

Ex-cons with jobs who make too much money to be eligible for Medicaid could still qualify for federal tax credits to purchase health insurance through the new state exchanges. Under the ACA, like everyone else, they will be required to have health insurance of some kind starting next January.

http://www.ajc.com/news/news/national/ex-felons-to-get-health-coverage-via-affordable-ca/nXRW9/

Medical Apps, $21 Billion EMR Market, and Sick of EMR | EMR and EHR

Mon, 22 Apr 2013 00:32:01 -0400

Medical Informatics: Apps, not data warehouses, are wave of future clinical-innovation.com/topics/ehr-emr…

— Luis Saldana (@lsaldanamd) April 21, 2013

This is a pretty interesting idea and another way to talk about subjects we’ve talked about many times here. The idea of an app in this case is an app on top of EMR software. I call this making the Smart EMR. It will likely come from these apps. The article is right that many of the data warehouses are clunky and don’t serve the doctors. In fact, there are very few data warehouses focused on the doctors needs at all.

EMR Market Nearly $21 Billion in 2012 ow.ly/keCa8

— EMR Daily News (@EMRDailyNews) April 19, 2013

The last EMR incentive numbers I saw were at $10 billion. Does that mean the government has funded half of the market? These numbers are always a little fishy, but it’s interesting to consider how big the EMR market is.

Britt Barrett asks how many are sick of EMR? Need IT but needs to be user centric. #px2013

— Christina Thielst (@Cthielst) April 18, 2013

I actually know a lot of doctors who love their EMR and wouldn’t practice medicine without one. What I think most doctors are tired of is all the government regulations. We shouldn’t confuse government regulations with EMR.

Adding A Trackpad, or (Jail)Breaking iBad | Dalai's PACS Blog

Sun, 21 Apr 2013 23:55:00 -0400

As a reward for surviving his operation in 2010, we gave Dalai, Jr. one of the original iPads. He never really took to it, preferring his laptop instead. Even so, in those heady, early days of the iPad, I was quite certain it would become THE radiology accessory, as seen in this cartoon which I made even before the iPad was released, and then this one after it was out. Later, I wrote an early review of the radiology viewing software then available. Some of my comments in that piece were rather prescient, especially those concerning the eventual increase in screen-resolution.

My son's iPad ultimately languished in a drawer for several years. On a lark, I dusted it off and used it for a teleprompter with the proper app (dvPrompter), which worked very well. It occurred to me that perhaps it was time to revisit the iPad, and maybe even pop for the iPad 4, with the Retina Display I had correctly predicted, and the Lightning connector which I had not foreseen.

The closing paragraphs of my software review referenced Apple's potential to redefine the PC world (in the more generic sense), with tablets taking over from laptops and desktops. This hasn't quite happened. It is rather ironic that Microsoft itself ran with the idea...right into a brick wall. The Latest and Greatest Windows, version 8, tries to add a touch interface and some flashy graphics to the venerable GUI. But it isn't selling, as noted by Yuval Rosenberg in the Fiscal Times:

Windows 8, meanwhile, hasn’t won over consumers since being launched in October, accelerating the popular shift away from PCs. Microsoft looks to have a flop on its hands – and one that, despite Ballmer’s talk of devices and services, remains very much at the heart of the company’s strategy. "At this point, unfortunately, it seems clear that the Windows 8 launch not only failed to provide a positive boost to the PC market, but appears to have slowed the market," IDC’s Bob O'Donnell said in releasing the quarterly data. IDC’s data doesn’t include tablets or the new wave of laptop-tablet hybrids, so the slump in Windows-based computing may be slightly less pronounced than its figures show, but rival tracking firm Gartner found an 11.2 percent decline in year-over-year PC shipments so Windows 8 clearly hasn’t helped turn the tide.

The new operating system, designed to enable touch screens, has failed to win over users accustomed to the old user interface, or UI. Plus, PCs with touchscreens are still expensive compared to tablets. "While some consumers appreciate the new form factors and touch capabilities of Windows 8, the radical changes to the UI, removal of the familiar Start button, and the costs associated with touch have made PCs a less attractive alternative to dedicated tablets and other competitive devices,” O’Donnell said. “Microsoft will have to make some very tough decisions moving forward if it wants to help reinvigorate the PC market."

And therein lies the problem. I came to the conclusion independently, but CNet's Scott Stein stated it better than I could in a 2012 article, "Why My iPad Can't Replace My Laptop: It's The Trackpad":

Adding a keyboard to an iPad, like the Logitech/Zagg Keyboard Case for iPad 2, solves the problem of text entry. That's great for when you have to write a long essay, or are working on a chunk of your Great American Novel, or just want to jot down some notes. It's not so great when you have to edit a document, or create a blog post with embedded links, or do simultaneous Web research and writing. To do anything more than text entry and a few other commands, you'll have to reach up and touch the iPad's screen, which isn't exactly ergonomic or time-efficient when you have the iPad propped up and a keyboard attached. In fact, it's downright awkward.

This is why touch-screen laptops haven't taken off. No one wants to touch a screen while typing on a keyboard. I want a trackpad when I work, or even a mouse. Touching the screen makes no sense in "laptop" mode. I'd rather use the iPad as a straight-up tablet, which brings me back full circle and defeats the purpose of the keyboard.

So, the key to high-level iPad happiness is a keyboard and a pointing device. Several keyboard cases exist, and work well. There are all sorts of Bluetooth trackpads out there as well, but they don't work with the iPad as yet...because they aren't supported by the IOS (operating system). But, there is a way...

You've probably heard of jail-breaking an Apple product, and I won't bore you with the details. Suffice it to say that with the proper software, one can take control of one's iPod, iPad, or iPhone, freeing it from the shackles of the iTunes store, not to mention the Kupertino Kops and their vision of exactly how your interface should behave. In my research, I found that there IS software to allow the use of a Bluetooth mouse or trackpad with an iDevice...IF it's jailbroken.

Legal opinions in the past few years have declared that it is not illegal to jailbreak the Apple progeny, (but it is of course illegal to then download software for free that should be paid). If you jailbreak, you will void Apple's warranty, but, well, my old iPad 1 is waaaaaay out of warranty...

So I did the deed. I jailbroke my son's iPad.

Once processed, the only initial change to be seen is the appearance of a new app named Cydia, which one could think of as the iTunes Store of a jailbroken, parallel universe, or perhaps a Bizarro world (any Superman fans out there?) Navigating Cydia is an experience somewhat less refined than browsing the iTunes store. The interface is cruder, and not for the faint of heart. To be honest, I felt sort of dirty being there, like wandering through an Earth-Fare and being the only customer without Birkenstocks. But it works, and once you get the hang of it, there is a tremendous amount of stuff that will transform your iWhatever into something the late Steve Jobs would probably haunt you over if he could.

Aside from the various downsides of not being able to upgrade to the latest IOS until the mad geniuses out there upgrade their jailbreaking software, and losing the warranty, there isn't too much of a downside. BUT, if you were expecting everything to be free, you would be sadly mistaken. So...I have yet to spend the $5 for the Bluetooth software. But I will. Eventually.

What I envisioned is a keyboard case for the iPad with a trackpad built in, something like this:

The Crux "Loaded" clamshell iPad case, prototype pictured above, was to have transformed your iPad into a mini-laptop for the small fee of $250. But for whatever reason, Crux seems to have dropped the project. Probably because the small fee of $250 was a little steep for the purpose. Add the cost of a souped-up iPad and you've about hit the $1,000 minimum price of an 11" MacBook Air:

15, 13, and 11 inch Macs, image courtesy Anandtech.com

Personally, I'm thinking the Air would be the better choice after all. I wonder if you can jailbreak an Air...

In the meantime, the Android world does have trackpadded options; Stein cites this Asus Transformer:

Credit: Scott Stein, Josh Miller/CNET

While the radiology apps for Android is not yet as numerous as for IOS, some do exist, and in fact Calgary Scientific's ResolutionMD is the first to receive clearance from the FDA for diagnostic reads.

In the meantime, I'm just going to wait for the iPad 5, before making any purchase decisions. The '5 is said to be thinner and more powerful then ever before. I wish I could say that about myself...

Great Networking Opportunities at eHealth Week 2013 | eHealthNews.EU Portal / All News

Sun, 21 Apr 2013 17:00:00 -0400

13 - 15 May 2013, Dublin, Ireland.
The Guinness Storehouse - Ireland's number one visitor attraction. Come and enjoy an unforgettable evening and a magical journey deep into the heart of the world famous Guinness company. Network with industry leaders as you discover this historical building that is central to Dublin's and Ireland's heritage. This special event is open to all registered eHealth Week 2013 conference attendees.

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