Health Law 2.0

We’re constantly giving you the scoop on the latest in orthopedic devices from our clinical and design perspective, but have you ever wondered about the steps that go into manufacturing these devices? There’s a lot of work in the process that turns an idea into an actual physical product, and often times it’s something we don’t think about.

During our recent trip to Northeast Indiana, we had the opportunity to visit a number of manufacturing sites and learn the high-tech processes and technology that go into producing orthopedic implants and instruments. Here’s how it works!

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We’re constantly giving you the scoop on the latest in orthopedic devices from our clinical and design perspective, but have you ever wondered about the steps that go into manufacturing these devices? There’s a lot of work in the process that turns an idea into an actual physical product, and often times it’s something we don’t think about.

During our recent trip to Northeast Indiana, we had the opportunity to visit a number of manufacturing sites and learn the high-tech processes and technology that go into producing orthopedic implants and instruments. Here’s how it works!

Read More

Scientists at the Stanford University School of Medicine are developing a new type of retinal prosthesis which aims to simplify the complex surgery associated with existing, bulkier implants. The prosthetic comprises a pair of goggles and an implanted retinal sensor made up of an array of light-sensitive photodiodes.

The goggles incorporate a miniature camera, a pocket computer for processing the camera data, and an LCD screen embedded into the goggles for displaying the data. The LCD screen beams images using laser pulses of near-infrared light to a photovoltaic ultra thin silicon chip implanted beneath the retina. The chip, in turn, translates the infra-red pulses to neural pulses in the retina which can be processed as images in the brain. The key selling point for the new implant is the elimination of wires and cables and the relative simplicity of implantation.

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Scientists at the Stanford University School of Medicine are developing a new type of retinal prosthesis which aims to simplify the complex surgery associated with existing, bulkier implants. The prosthetic comprises a pair of goggles and an implanted retinal sensor made up of an array of light-sensitive photodiodes.

The goggles incorporate a miniature camera, a pocket computer for processing the camera data, and an LCD screen embedded into the goggles for displaying the data. The LCD screen beams images using laser pulses of near-infrared light to a photovoltaic ultra thin silicon chip implanted beneath the retina. The chip, in turn, translates the infra-red pulses to neural pulses in the retina which can be processed as images in the brain. The key selling point for the new implant is the elimination of wires and cables and the relative simplicity of implantation.

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

The Good Boss

One of my assignments as a young captain was serving as the convoy commander for our combat engineer battalion. We were moving over 250 vehicles across the state of Colorado. Given the size and type of vehicles (Hummers, dump trucks, semi-tractors carrying bulldozers), we covered a good 15 miles of highway end to end.

I missed a turn and inadvertently split my convoy in two. Applying a few off-road techniques, I’d put the pieces back together within a couple of hours. But not before catching the attention of the battalion commander.

At our next stop, I steeled myself for one of the famous ass-chewings our commander was known for. We both stepped out of our Hummers. He looked at me and said, “Carry on, Marx!” He spun back around and climbed into his vehicle.

That was it. And you know what? For me, that’s all it took and he knew it. He purposefully chose a different form of discipline for that situation. Later, he told me that he could tell by the look on my face that I had learned the lesson and understood the gravity. He did not have to say anything more. And he didn’t.

Earlier this year, I posted the Bad Boss. It is always easier to point out the negative over the positive. So what is the Good Boss?

I don’t believe there is a magical checklist of Good Boss attributes. There are too many variables and permutations. Put simply, the Good Boss first and foremost does not follow a checklist. She understands every person is unique and should be treated as such. Just like my commander following my convoy fiasco.

I crowdsourced for input. Here is a compilation of attributes of a Good Boss. This is not research or academia or consultant or stats based on one person’s experience. It is not a checklist. These are ideas, and I imagine they reflect the thinking of your staff as well. Ponder the following and adopt as your situation dictates.

Ensures Appreciation and Value

• Thanks subordinates regularly
• Demonstrates gratitude in words and action
• Rewards success
• Personalizes awards and recognition
• Listens often
• Gives the subordinate glory for success

Mentoring

• Takes active interest in the subordinate’s career and guides growth in the job
• Teaches the subordinate how to best interact with customers
• Encourages professional development and provides educational opportunities
• Willing to learn from the subordinate
• Hopes one day the subordinate will step into his position
• Guides the subordinate to their ultimate goal, even if it means losing them

Fairness

• Never steals ideas from subordinates
• Always honest and ethical to the core
• Does not undermine anyone
• Possesses a strong work ethic
• Treats everyone without bias (race, religion, ethnicity, gender, age)

Performance

• Sets high but reasonable standards and removes non-performers
• Gets more out of subordinates than they can get from themselves
• Sustains the continuity of the organization by hiring only “A” players
• Provides insightful and regular feedback
• Elevates performance without the subordinate even noticing
• Provides appropriate tools and training for the job

Team

• Holds individuals accountable to performance standards so the team does not suffer
• Represents team and department with passion and confidence
• Makes the subordinate feel proud to be on the team
• Takes public responsibility for the action of the team when failures occur

Transparency

• Makes themselves transparent and vulnerable
• Admits errors and apologizes without excuse
• Gets to know subordinate as a person (family, hobbies)
• Is in tune with their emotions and not afraid to show it (smile, laugh, cry)
• Shares their wisdom in decision making and is open to other possibilities

Vision

• Encourages vision
• Articulates and lives the mission and values of the organization
• Tells the subordinate when to be practical and when to dream

Positive

• Remains positive when things don’t go as planned
• Always finds the good in bad situations

Individuality

• Does not micromanage and allows for creativity and self-expression
• Welcomes and supports innovation and creativity
• Recognizes individuals strengths and positions people accordingly
• Knows when to be the boss, friend, or mentor
• Knows when to lighten difficult moments

Style

• Leads by influence and not by position
• Jumps In the trenches as needed
• Walks the talk and shows flexibility
• Trusts, respects, and gives benefit of the doubt
• Possesses high emotional and social intelligence

Miscellaneous

• Promotes work-life balance
• Allows for downtime
• Able to charm Joint Commission surveyors!

Is this how your employees describe you? Which of these attributes will strengthen your leadership? Remember, one size does not fit all. Treat everyone in the style that works best for that individual and circumstance.

Be the boss! The good boss.

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.

We need beds. Discharge every patient you can. Most hospital-based physician will be familiar with this refrain. The problem is that it can lead to premature discharges of some patients, particularly post-op ones who may require closer monitoring and sophisticated nursing care. Revenue-driven surgery and poor planning result in some surgical patients being discharged too early concludes a pair of logistical studies conducted by researchers at the University of Maryland (see: Revenue-driven surgery drives patients home too early). Below is an excerpt from the article:

The studies show a correlation between readmission rates and how full the hospital was at the time of discharge, suggesting that patients went home before they were healthy enough. The researchers recommend better planning and other logistical solutions to avoid these problems ....“Discharge decisions are made with bed-capacity constraints in mind,” [said one of the study authors]. “Patient traffic jams present hospitals and medical teams with major, practical concerns, but they can find better answers than sending the patient home at the earliest possible moment,”[he added]. [The studies] found that patients discharged when the hospital was busiest were 50 percent more likely to return for treatment within three days....Surgeons and hospitals are incentive-driven to perform as many surgical procedures as feasible....“The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It’s what they do....“If the hospital says ‘sorry there are no beds available,’ there’s a lot of tension and pressure from both sides to keep things moving.” These problems are much more likely at large hospitals, which tend to provide more advanced, specialized surgeries not accessible at smaller, community institutions,the researchers say. Patients often have to travel a great distance for the procedures, so hospital delays become expensive for both them and the care providers. The study findings cover surgical discharge data from fiscal year 2007 covering more than 7,800 surgery patients who collectively spent 35,500 nights at the facility....Also, he suggests that hospitals increase the flexibility of where patients go post-surgery. Allowing them to be moved to units with empty beds, for example, could also lessen premature discharges.

All of this makes great sense to me. Now comes the interesting part. How are patients and their relatives supposed to convince a surgeon not to discharge a patient prematurely in the face of pressure from "upstairs". The latter often comes from hospital physician executives. The best argument, echoing the discussion in the excerpt above, is that the patient is not ready to go home and stands a good chance of being readmitted. This is an argument that will resonate with a surgeon if it is likely. A good surgeon, in fact, will have an understanding of which patients will do best at home and which should remain in the hospital for a longer stay. A patient's family should stand their ground and appeal a perceived premature discharge if the facts are on their side. Here's an excerpt from an article relating to premature hospital discharge (see: New Medicare Rules Protect Against Premature Hospital Discharge):

As a result of litigation initiated in 2003, hospitalized Medicare patients will now be better protected against being forced out of a hospital before they can be safely cared for at home or in a nursing home. The new regulations require that patients be given notice of their discharge rights on admission (although it can occur up to two days later) and again at least four hours before discharge. If patients or their families believe the discharge will be premature and not in a patient's best interest, they are entitled to an expedited review of the discharge decision. If they request an expedited review, the patient can remain in the hospital without charge at least until noon of the day following an independent agency's review. The independent review agency is called a Quality Improvement Organization (QIO), and the patient must get in touch with its staff by phone or in writing before the close of business on the day the hospital plans to send the patient home. The QIO demands that the hospital give the patient a detailed, written explanation of her medical condition and the basis for the proposed discharge. 

A community of physicians who are actively involved with our video sharing site EchoJournal now has a collaborative blog where they’re discussing the latest echocardiography videos, clinical concepts and ideas. EchoBlog can be accessed from the EchoJournal website, or directly by going to EchoBlog.com.

If you are a cardiologist, anesthesiologist, radiologist, medical student, or just a person interested in cardiac ultrasounds, EchoJournal is where you can develop your knowledge and consult with others. To learn and discuss, you can watch new cardiac videos that are added almost every day, or you can browse through our video archives. To store or share, you can upload your own clips. The site has a growing membership base, and solid traffic stats. EchoJournal is curated by David E. Winchester, MD, a cardiologist at the University of Florida.

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A community of physicians who are actively involved with our video sharing site EchoJournal now has a collaborative blog where they’re discussing the latest echocardiography videos, clinical concepts and ideas. EchoBlog can be accessed from the EchoJournal website, or directly by going to EchoBlog.com.

If you are a cardiologist, anesthesiologist, radiologist, medical student, or just a person interested in cardiac ultrasounds, EchoJournal is where you can develop your knowledge and consult with others. To learn and discuss, you can watch new cardiac videos that are added almost every day, or you can browse through our video archives. To store or share, you can upload your own clips. The site has a growing membership base, and solid traffic stats. EchoJournal is curated by David E. Winchester, MD, a cardiologist at the University of Florida.

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BiO2 Medical has received CE Mark approval for the Angel Catheter, a nitinol inferior vena cava (IVC) filter permanently attached to a central venous catheter, for the use of preventing pulmonary embolism in critically ill patients. The multi-lumen catheter can be used like a normal central venous system for administering medications, fluids or blood products, blood sampling and monitoring of central venous pressure. At the same time it provides pulmonary embolism prophylaxis by means of the attached IVC filter.

The primary patient population is critical care patients in whom anticoagulation therapy poses a high risk of complications, including major bleeding and death, and in which patients are at highest risk of venous thromboembolism (VTE). The filter can be easily removed when the central line is removed, once the danger of VTE has been resolved.

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BiO2 Medical has received CE Mark approval for the Angel Catheter, a nitinol inferior vena cava (IVC) filter permanently attached to a central venous catheter, for the use of preventing pulmonary embolism in critically ill patients. The multi-lumen catheter can be used like a normal central venous system for administering medications, fluids or blood products, blood sampling and monitoring of central venous pressure. At the same time it provides pulmonary embolism prophylaxis by means of the attached IVC filter.

The primary patient population is critical care patients in whom anticoagulation therapy poses a high risk of complications, including major bleeding and death, and in which patients are at highest risk of venous thromboembolism (VTE). The filter can be easily removed when the central line is removed, once the danger of VTE has been resolved.

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Back in February, we wrote about Altapure‘s adaptation of military sonar technology to sterilize clinical environments. During our recent trip to northeast Indiana, we had the opportunity to visit Altapure’s home on the campus of the University of Notre Dame.

Since our last mention, Altapure has been able to not only get their product on the market, but is already working on a newer version of the device that clocks in at 1/3 the size of the current model but has the same power.

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Back in February, we wrote about Altapure‘s adaptation of military sonar technology to sterilize clinical environments. During our recent trip to northeast Indiana, we had the opportunity to visit Altapure’s home on the campus of the University of Notre Dame.

Since our last mention, Altapure has been able to not only get their product on the market, but is already working on a newer version of the device that clocks in at 1/3 the size of the current model but has the same power.

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NIDEK (Gamagori, Japan) has received FDA clearance to market its AFC-330 fundus camera in the U.S. The unit is an all-in-one system that contains both the camera and the processing computer, negating the need for another machine to remain nearby.

The device is the company’s most automated model, and features automatic alignment along the three axis, uses a lower brightness flash, and has dampened mechanical components, among other advances.

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NIDEK (Gamagori, Japan) has received FDA clearance to market its AFC-330 fundus camera in the U.S. The unit is an all-in-one system that contains both the camera and the processing computer, negating the need for another machine to remain nearby.

The device is the company’s most automated model, and features automatic alignment along the three axis, uses a lower brightness flash, and has dampened mechanical components, among other advances.

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I had a really great conversation with Shahid Shah, Jenny Laurello and John Moore at Health 2.0 about the bubble that we’re sitting in right now. John Moore’s response to my question, “When do you think the bubble will pop?” was priceless: “Which bubble?” Yes, we might be seeing multiple bubbles in healthcare IT: EHR, HIE, mobile health, etc.

For this blog, I’m most interested in the EHR bubble. Obviously, the bubble in this case is the creation of the $36 billion in EHR stimulus money that’s being handed out thanks to ARRA and the HITECH act. With over 600+ EHR vendors and a limited number of customers (I think there’s about 700,000 physicians in the US), there are going to be quite a few EHR vendors that won’t make it.

With that said, I don’t think the EHR bubble will pop like it has in other industries. In fact, I think the current IT industry bubble is going to be a much bigger problem. What’s amazing to me is how you can make a decent EHR business with only a few hundred doctors. Sure, a few hundred doctors won’t create 10 times return to investors, but those who take a conservative approach to building their EHR company could get by with what I believe is an astoundingly small customer base. Physicians are just that valuable.

Shahid Shah described EHR as a cottage industry and so cottage EHR companies will survive. I’m not exactly sure how he’d described cottage industry, but I think the regional nature of healthcare is definitely an influence on this. I’m sure many could argue that long term this strategy won’t work, but I believe at least for the forseeable future we’re not going to see the EHR bubble pop for a while.

As I think about the EHR companies I know, they all seem to have plenty of cash to make it through meaningful use stage 2 and likely all the way to meaningful use stage 3 at least. We’ll see how the smaller EHR companies do post meaningful use stage 2, but I don’t see any EHR vendors not making it to meaningful use stage 2. They’ll at least make it to MU stage 2. Then, based on their adoption results (or not) we may see a few EHR vendors run out of money.

What do you think? Are we in an EHR bubble? When will the EHR bubble pop? What other healthcare IT bubbles do you see?

Related posts:

1. Top Health Industry Issues of 2011 – “Top 10″ Health IT List Series
2. Would Any Current EMR Users Be Able to Show Meaningful Use?
3. Quote About Current EHR Software

I’ve come across few articles recently that really validate the notion that the success of healthcare IT is really in the eye of the beholder, or in some cases, the editorialized results of a study.

Take, for example, the following headlines:

“EHR Use Not Linked to Improved Diabetes Care Quality, Study Finds”
and
“App Improves Diabetes Management Among Teenagers, Study Finds”

I find it hard to believe that if formally connected, the second study couldn’t somehow influence the first. In other words, if a mobile health app can improve diabetes management among teenagers, shouldn’t whatever data that app is capturing transmit successfully to the teen patients’ EHRs for easy access by their doctors? And then couldn’t that doctor digest that information, picking out patterns in the patient’s behavior that is either positively or negatively impacting their diabetic condition and overall health, to better inform care protocols?

I’m taking big leaps of logic here, since the first study found that not only was there no correlation between the use of an EHR and “increased adherence to clinical guidelines for care processes and treatments,” but there was actually a “higher probability of meeting certain targets for blood pressure and A lc levels after two years” at practices without such systems. (Seems like these outcomes might be due more to end-user experience than the technology itself.)

The second study doesn’t even mention EHRs, but I wonder how many of the 20 teens participating in the study see doctors who have this type of technology, how many of those doctors know their patients are participating in the study (all I’d assume), and how many are feeding the app’s info into an EHR.

Surely if a smartphone app is helping a diabetic teenager better adhere to medication regimens, then the EHR their doctor could potentially be using would somehow tie in to better clinical outcomes. Another study to start, perhaps?

The second set of headlines that gives me pause (and kinda makes me chuckle) includes:

“Physician Use of Tablets has Nearly Doubled Since 2011”
and
“Not all Doctors and Nurses are Happy with an iPad in the Hospital Setting”

Neither headline surprises me. We all know that adoption of mobile health tools is growing, if not by leaps and bounds then at least steadily. It would make sense that providers are adopting tablets in relation to this. Every technology has its detractors, so of course not everyone is going to be happy with how an iPad works in a clinical setting, just as not every provider is going to want to install an EHR. I do wonder, though, how the same set of users mentioned in the second article would rate a different kind of tablet if given the opportunity to use one.

I find the first sentence to be kind of hard to believe: “It looks as if most doctors and nurses would rather not touch the iPad at work (or deal with any other kind of tablet computing).” If “most” doctors and nurses would rather have nothing to do with tablets at work, than how can physician use of tablets have doubled since last year?

So you see, the “success” of healthcare IT seems to depend on whose writing about it. I have a feeling the American Forest and Paper Association might be behind the very first one.

Related posts:

1. Will Rip and Replace EHR Software Ever Be a Thing of the Past?
2. Emdeon Gets in the Holiday Spirit with Donation of EHR Technology
3. From the Trenches of Healthcare IT Education

Could you please help me find the career paths in health informatics? currently pursuing BSc in Public health Informatics. what do I study to become a good lecturer in Health Informatics?

Quality Systems, Inc. announced this morning that it has acquired The Poseidon Group, an Atlanta-based emergency department information systems vendor. Quality Systems will integrate the Navigator PC and NavigatorWeb EDIS modules into its NextGen Inpatient Solutions small hospital product line.

NextGen Healthcare Inpatient Solutions EVP Steve Puckett was quoted as saying, “This acquisition provides our clients additional value by extending our hospital suite portfolio of advanced solutions to the Emergency Department. This product along with our surgical services suite will help support our rapid growth upward into the community hospital market.”

The acquisition closed May 1. Terms were not disclosed.

What is in your opinion the best Health Informatics course (taking in account also future job opportunities) between the ones offered by Karolinska Institutet, Stockholm and City University, London?

Thanks,

Andrea