October 1,2014

This appeared a few days ago.Where's the plan for interoperability?Posted on Sep 22, 2014By John Loonsk, MD, CGI FederalIt is a simple question: “Why doesn’t electronic health information flow after the nation spent $26 billion on electronic health records?" Suggesting a 10-year timeframe or arguing that there is progress if you look hard enough just doesn’t answer it.Congress does not think so either. Despite the HITECH funds’ accomplishing a significant degree of EHR adoption there is still a large amount to do to achieve modest interoperability. And the question posed above is going to politically fester until something significant is done.Part of the interoperability problem is that only a limited amount of the HITECH meaningful use leverage has been used to encourage data exchange. Interoperability took a back seat to adoption of EHRs and other things in meaningful use plans.But another part of the problem is that there is no real technical plan. From a health IT perspective, the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

This year was my 4th year attending the AHIMA Convention. There was definitely a different vibe this year at AHIMA than has been at previous AHIMA Annual Convention. I still saw the humble and wonderful people that work in the HIM field. I also still saw a passion for the HIM work from many as well. However, there seemed to be an overall feeling from many that they were evaluating the future of HIM and what it means for healthcare, for their organization, and for them personally.

This shouldn’t really come as a surprise. Think about the evolution that’s been happening in the HIM world. First, they got broadsided by $36 billion of stimulus money that slapped EHR systems in their organizations which questioned HIM’s role in this new digital world. Then, last year they got smashed by a few lines in a bill which delayed ICD-10 another year. It’s fair to say that it’s been a tumultuous few years for the HIM profession as they consider their place in the healthcare ecosystem.

While a little bit battered and scarred, at AHIMA I still saw the same passion and love for the work these HIM professionals do. I might add, a work they do with very little recognition outside of places like AHIMA. In fact, when EHR systems started being put in place, I think that many organizations wondered if they’d need their HIM staff in the future. A number of years into the world of EHRs, I think it’s become abundantly clear in every organization that the HIM staff still have extremely important roles in an organization.

While EHR software has certainly changed the nature of the work an HIM professional does, there is still plenty of work that needs to be done. We’d all love for the EHR to automate our entire healthcare lives, but it’s just not going to happen. In fact, in many ways, EHR software complicates the work that’s done by HIM staff. Remember that great HIM modules, features, and functions don’t sell more EHR software (more on that in future posts). Sadly, the HIM functions are often an afterthought in EHR development. We’ll see if that catches up with the EHR vendors.

As I’ve dived deeper into the life and work of an HIM professional, I’ve seen how difficult and detailed the job really can be. Not to mention, the negative consequences an organization can experience if they don’t have their HIM house in order. Just think about a few of the top functions: Release of Information, Medical Coding, Security and Compliance. All of these can have a tremendous impact for good or bad on an organization.

What is clear to me is that the HIM professional has moved well beyond managing medical records. If done well, the HIM functions can play a really important part in any healthcare organization. The challenge that many HIM professionals face is adapting to this changing environment. I see a number of real stand out professionals that are doing phenomenal things in their organization and really have an important voice. However, I still see far too many who aren’t adapting and many who quite frankly don’t want to adapt. I think this will come back to bite them in the end.

September 30,2014

AllscriptsWrightington, Wigan and Leigh NHS Foundation Trust (WWL) and Allscripts (NASDAQ: MDRX) are delighted to announce WWL's decision to implement the Allscripts SunriseTM solution as WWL's new health information system. The system will be implemented across all three WWL sites and will completely transform the way WWL delivers healthcare in the future.

I wrote my first patient portal site, built into my first EMR software, back in 1998. At that time I mistakenly thought that portals would take off and patients would embrace them. What I quickly learned was that patient portals aren’t really portals in the sense of Yahoo! or Google but enterprise software’s customer-facing front-ends. The enterprise software in this case is of course an EHR and the customers are the patients. If patients are the consumers then their expectations are that they can conduct “business” with the practice through the portal. This means messaging, getting questions  answers, scheduling appointments, reviewing all records, etc. are minimal value propositions for a patient portal. However, even though portals are terrific opportunities for patient engagement, most portals’ technology architecture do not provide significant enough value for patients. I reached out to Cameron Graham, Editorial Coordinator at TechnologyAdvice, about what he’s seeing in the marketplace when it comes to portals. Cameron oversees market research for healthcare IT, business intelligence, and other emerging technologies and here’s what he had to say about how vendors and clinicians can encourage patients to use their respective portals:

Patient portals have the potential to simplify practice operations and reduce physician costs, but only if patients adopt and use them. We surveyed 430 people who had recently visited their primary care doctor in order to gauge how patients wish to communicate with their physician. Here some of the key takeaways from our survey for vendors and practices.

1. Physicians need to raise awareness about patient portal availability and benefits.

In our survey, 39.9% of patients said they didn’t know whether their primary care physician offered patient portal software. Given the high rates of EHR adoption among primary care physicians, and the increasing amount of EHRs that contain integrated portals, this is likely due to a lack of marketing. The responsibility for such marketing falls on physicians. Practices should consider implementing in-office programs to walk patients through available portal software, or deliver clear instructions to them prior to an appointment. Physicians should not assume that patients will investigate their websites or find such software on their own, even if told about it. At the very least, physician’s should provide each patient with an instruction sheet at the end of an appointment. Meaningful Use stage 2 requires that five percent of a practice’s patients utilize such a service. This threshold will only rise going forward, making effective promotion of such tools even more important.

To help promote increased patient awareness, vendors should consider investing in their own marketing campaigns, outside of any physician-led campaigns. Vendor involvement with EHR and health IT software is usually limited to the installation phase. However, it is in vendor interest to encourage patient awareness of such technology. Supplying practices with marketing materials, providing post-implementation support for customers, or even compiling an online list of each practice using their software could go a long way toward boosting awareness.

2. Patients still prefer hearing from physicians by phone, rather than through a portal, but younger patients are open to online appointment scheduling.

Our results found that just 13.6 percent of patients want to be contacted through a patient portal for general communications, while 14.1 percent wish to receive lab results and diagnoses through such a site. On the other hand, 42.7 percent want their doctor to deliver test results over the phone, and 42.9 percent want to receive general communication by phone as well. These preferences were consistent between age groups, except when it came to online appointment scheduling. 63.6 percent of patients aged 18-24 said they preferred using an online calendar to schedule appointments, while only 15 percent of respondents over the age of 65 chose the same.

These results suggest that physicians and vendors need to provide more incentive for patients to use online resources, if they want to move to a digital-first practice model. This could be done through increased marketing to consumers by vendors, or through physician led campaigns touting the benefits of online systems. Alleviating any security-concerns patients may have about posting health information online will likely need to be priority in these efforts. Younger patients may also be more receptive to portals, as they already prefer to schedule their appointments online.

Vendors should also place greater emphasis on the usability and intuitiveness of their patient portal interfaces. This would lower the barrier-to-entry for patients who are unfamiliar with features such as online appointment scheduling, or digital messaging. If vendors can ensure a positive first experience, it will also encourage patients to share their experiences with others, increasing patient portal awareness.

3. Almost half of patients report that their physician did not follow up with them after their visit. This is a significant opportunity for incentivizing patient portal usage.

47.9 percent of patients reported that their physician did not follow up with them after their last visit (outside of payment invoices). Of the physician’s that did follow up with patients, only 9.1 percent did so through a patient portal. Given the importance of patient engagement in modern healthcare, this represents an area for significant improvement.

Once physicians have shown patients how to use a portal, they still need to provide incentive for them to log on. Following up with each patient through these portals (which can automatically alert the patient by email that they have a new message to view) would help accomplish this goal. One of the ways for providers to meet the patient portals requirements for MU Stage 2 incentives is to have patients send them a secure message. The post-visit follow up provides a great opportunity for physicians to accomplish this goal.

To better encourage physician-patient communication (and therefore increased patient engagement), vendors can build in more robust automation capabilities, and place a larger emphasis on this during their training. Offering best-practice guides for engagement could also be a step in the right direction. If physician’s can easily automate the follow-up procedure based on information from the patient’s visit and the electronic health record, engagement rates (and portal usage) will likely increase.

Note: You can Connect with Cameron on LinkedIn or Google+.


Technology in the handsMost healthcare organizations are conservative when it comes to investing in new technologies, but a new report suggests early adoption of social, mobile, analytic, cloud and machine-to-machine technologies are hallmarks of higher growth rates and market leadership.

The findings come from a new study, The Digital Dividend: First Mover Advantage, conducted for Verizon by the Harvard Business Review Analysis Service.

In the report, business leaders self-identified as one of three types of IT organizations:   Pioneers are most open to change and investment in new technologies. Followers only invest once others have proven the benefit of a new technology, while Cautious organizations only invest when a technology is firmly established, if at all.

Of responding organizations in all industries, Pioneers had the highest growth rates, while Cautious firms were most likely to report low or no growth. Among participating healthcare organizations, 27% self-identified as Pioneers, 36% as Followers and 35% as Cautious.

"Healthcare organizations have very mission-critical activities, so it's very understandable they do not move quickly to reap the benefits of technology," said Chris Davis, senior solutions architect at Verizon Enterprise Solutions, in an interview with Information Week.

"We found... organizations that adopt technologies earlier have significantly larger growth rates, year over year, than followers or cautious organizations in all industries, and the same things applied to healthcare,” said Davis.

The report says consumer adoption of technologies like mobile and social is a catalyst for early-adopting IT organizations. For hospitals, health IT and health plans that translates to patients who expect higher service levels and greater engagement with providers.

"These various technologies are coming together to create tremendous value that hasn't been seen before," said Davis. "We're at that tipping point where healthcare providers can drastically change the way they conduct their business."

Of the technologies covered in the report, mobility and analytics had the highest penetration in healthcare organizations, while social media, cloud, and M2M were lowest on the adoption list.

The post Health IT First Movers May Enjoy Competitive Edge, Faster Growth appeared first on Healthcare IT Leaders.

Categories: Influential , All

Technology in the handsMost healthcare organizations are conservative when it comes to investing in new technologies, but a new report suggests early adoption of social, mobile, analytic, cloud and machine-to-machine technologies are hallmarks of higher growth rates and market leadership.

The findings come from a new study, The Digital Dividend: First Mover Advantage, conducted for Verizon by the Harvard Business Review Analysis Service.

In the report, business leaders self-identified as one of three types of IT organizations:   Pioneers are most open to change and investment in new technologies. Followers only invest once others have proven the benefit of a new technology, while Cautious organizations only invest when a technology is firmly established, if at all.

Of responding organizations in all industries, Pioneers had the highest growth rates, while Cautious firms were most likely to report low or no growth. Among participating healthcare organizations, 27% self-identified as Pioneers, 36% as Followers and 35% as Cautious.

"Healthcare organizations have very mission-critical activities, so it's very understandable they do not move quickly to reap the benefits of technology," said Chris Davis, senior solutions architect at Verizon Enterprise Solutions, in an interview with Information Week.

"We found... organizations that adopt technologies earlier have significantly larger growth rates, year over year, than followers or cautious organizations in all industries, and the same things applied to healthcare,” said Davis.

The report says consumer adoption of technologies like mobile and social is a catalyst for early-adopting IT organizations. For hospitals, health IT and health plans that translates to patients who expect higher service levels and greater engagement with providers.

"These various technologies are coming together to create tremendous value that hasn't been seen before," said Davis. "We're at that tipping point where healthcare providers can drastically change the way they conduct their business."

Of the technologies covered in the report, mobility and analytics had the highest penetration in healthcare organizations, while social media, cloud, and M2M were lowest on the adoption list.

The post Health IT First Movers May Enjoy Competitive Edge, Faster Growth appeared first on Healthcare IT Leaders.

Categories: Influential , All

Carl Bergman, writing in the EMR & EHR web formum, made a very important point in terms of the accessibility of advance medical directives in EHRs (see: Medical Directives and EHRs),. Here's an excerpt form his note:

If the EHR treats a [medical] directive as a miscellaneous document, odds are it won’t be known, let alone followed when needed. To be used effectively, an EHR needs a specific place for directives and they should be readily available. For example, PracticeFusion recently added an advance directives function. That’s not always the case. To see how about twenty popular EHRs treat directives, I did a Google site search, on the term directive. I got hits for a directives function only from four EHRs: Athenahealthcare, Cerner, Meditech, PracticeFusion. All the others, Allscripts, Amazing Charts, eClinicalWorks, eMDs, McKesson, etc., were no shows. Some listed the MU1 requirement, but didn’t show any particular implementation. This quick Google search shows that the EHR industry, with a few exceptions, doesn’t treat directives with the care they deserve. It should also serve as a personal warning. If you already have directives or do have that talk with your family, you’ll need to give the directives to your PCP. However, you should also give your family copies and ask them to go over them with your caregivers. Some day, EHRs may handle medical directives with care, but that day is still far off. Until then, a bit of old school is advisable.

Here's a useful explanation of advance directives (see: Advance Directives):

What kind of medical care would you want if you were too ill or hurt to express your wishes? Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.

A living will tells which treatments you want if you are dying or permanently unconscious. You can accept or refuse medical care. You might want to include instructions on:

  • The use of dialysis and breathing machines
  • If you want to be resuscitated if your breathing or heartbeat stops
  • Tube feeding
  • Organ or tissue donation

A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so.

All of these insructions obviously need to be readily accessible in an EHR because there is a high likelihood that you may be in a hospital when your living will instructions need to be carried out. 

In a first-of-its-kind study, an international team of neuroscientists and robotics engineers have demonstrated the viability of direct brain-to-brain communication in humans. Recently published in PLOS ONE the highly novel findings describe the successful transmission of information via the internet between the intact scalps of two human subjects - located 5,000 miles apart.
This appeared late last week.Standards Australia quick off mark in review of royalties on SAI Global contractPUBLISHED: 25 Sep 2014 00:05:25 Simon Evans The 74-member Standards Australia organisation that made a last-ditch effort to try and be part of a buyout process for SAI Global has revealed a review of royalties for a key contract with SAI has already begun, and that its chairman is stepping down.SAI’s former parent Standards Australia has just released its 2014 annual review which is the last presided over by chairman Alan Morrison. In it the firm outlines that it expects larger amounts will be due to the organisation from a revised royalties deal with SAI, but it doesn’t specify how much.SAI last week revealed that after a protracted sale process which began in May with an indicative $1.1 billion proposal, it ended up without any whole-of-company bids. Uncertainty over the key contract with Standards Australia for the publishing and sale of 6900 standards was one...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

September 29,2014


I’m in San Diego today at the AHIMA Annual Convention. It’s a great event that brings together some really passionate and wonderful Health Information Management professionals. There’s been some interesting Twitter activity at the event. Here’s a roundup of some of the interesting tweets:

Some really great insights. I’d love to hear your thoughts on the tweets above.


On Sept. 1, we started the 20 Question for Health IT project, which spanned 20 weekdays and included insights from different contributors on various health IT topics, ranging from the always-popular interoperability to off-the-radar topics such as Bitcoin and even a joint clinician/patient EHR system. After taking a step back to view all 20 questions in one place, I am quite pleased we were able to attract so many different, intelligent perspectives from across the health IT landscape.

I would like to thank the 19 other contributors to this project. Please take a minute to send your thanks by following them all on Twitter — I’m confident they’ll continue to educate and inspire us to tackle the difficult questions needed to improve health IT.

You can view each question in the following presentation – please share it with your colleagues and connections to continue the conversation.


Categories: News and Views , All
Medical imaging is at the forefront of diagnostics today, with imaging techniques like MRI (magnetic resonance imaging), CT (computerized tomography), scanning, and NMR (nuclear magnetic resonance) increasing steeply over the last two decades. However, persisting problems of image resolution and quality still limit these techniques because of the nature of living tissue.
More than three quarters of oncology specialists in Europe, South America and Asia believe their patients are not always well enough informed about the treatment options available to them, survey results have revealed at the ESMO 2014 Congress in Madrid, Spain. The results come from an online survey of 895 doctors from 12 countries in Europe, South America and Asia.
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 CommentAnother very quiet week with the biggest news being the new Health IT being implemented in the Defence domain and some movement from Apple in the Health IT Space.Minister Dutton seems to have gone to ground on the PCEHR. Wonder when we will hear something?-----http://www.theaustralian.com.au/technology/australian-medical-association-to-scrutinise-apples-healthkit-app-over-privacy-concerns/story-e6frgakx-1227066929754Australian Medical Association to scrutinise Apple’s HealthKit app over privacy concerns The Australian September 23, 2014 12:00AM Chris GriffithHARNESSING Apple’s new HealthKit system for patient care may have benefits but there are also big issues involving privacy and the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

September 28,2014


Because it’s so easy to build software these days we’re seeing a proliferation of healthcare apps — what’s hard to figure out is whether we’re building the right software. Abder-Rahman Ali, currently pursuing his Medical Image Analysis Ph.D. in France, has graciously agreed to give us advice on how to write good software specifications for health and medical technology solutions. Some of you are probably rolling your eyes and thinking that software requirements specifications (SRS) are old and “tired” and we should be writing agile user stories instead. The reality is that in regulated and safety critical environments we still rely on SRS documents but the complex nature of systems of systems is making even those documents difficult to write. So, we’ll be talking requirements instead of user stories for now. The following is Abder-Rahman’s second installment, focused on vague and ambiguous requirements. He can be reached via e-mail or twitter

Sometimes, when we pass by a software requirement that is not clear enough, we may say it is vague, and in another occasion, we may say it is ambiguous. Yes, we added such two features to that same requirement by that same person. But, did that person just use those two terms to refer to that that requirement was unclear? Does he just use those two terms interchangeably? Well, the bottom line, do vague and ambiguous mean the same at all? Or, they refer to two different things? This is what we will investigate in this article of our series.

Before beginning this topic, let us see how dictionaries define the terms vagueness and ambiguous.

Of the ways how Merrian-Webster dictionary defines the term vague is as follows:

Not clear in meaning: stated in a way that is general and not specific

Not thinking or expressing your thoughts clearly or precisely

Not completely formed or developed

Whereas, if we see how the same dictionary defines the term ambiguous, some of how it defines it is as follows:

Able to be understood in more than one way: having more than one possible meaning

I like how Diana Santos distinguishes between those two terms in her book, where she argues that vagueness is related to the language system, and thus, is considered systematic, and is a frequent property of the language. Whereas ambiguity is considered an unsystematic and accidental property.

Diana also stresses that for an expression to be vague between A and B, there should be a shared content. That is, having the same linguistic object doing double duty. In this case, we can consider the cases of “either A or not A” as an instances of vagueness. This Vagueness is automatically reflected in the speaker’s performance since it is an essential property of the linguistic system. But, if we go towards ambiguity, most ambiguities produced by speakers go unnoticed, since as we mentioned, it is considered unsystematic.

Put in another way, invitation to critical thinking takes us to the following; If we want to say that a term or expression is ambiguous, is to say that it has more than one conventional meaning. That is, it can be conventionally understood in more than one way.

Let us take an example. If you hear the word “bank”, what would it mean? Some of the meanings for “bank” are as follows:

  • a noun for piled up mass, such as snow or clouds
  • a noun for the slope of land adjoining a body of water
  • a value for the action of putting something of value away in safekeeping

The book also points out that for a term to be vague means that it is not entirely clear what it does and doesn’t apply to.

Cognitive Linguistics: Basic Readings, sums the above up, by mentioning that the difference between ambiguity and vagueness is a matter of whether two or more meanings associated with a given phonological form are distinct (ambiguous), or united as non-distinguished subcases of a single more general meaning (vague). An example for ambiguity as we mentioned is the term “bank”, where the meanings are quite separate. An example of vagueness is “aunt”, where it can mean “father’s sister” or “mother’s sister”, thus, the meanings are united into one meaning, that is, “parent’s sister”. So, the bottom line is that ambiguity corresponds to separation of different meanings, and vagueness corresponds to unity of different meanings.

So, I think we should now start admitting that there really exists a difference between those two terms, shouldn’t we?

Let us come back to software requirements. As Ben Rinzler mentions, the requirements statements must define a specific and testable outcome. That is, a way to measure that the requirement has been met has to be provided. But, such precision will diminish with vague and ambiguous requirements.

Rinzler continues; a vague requirement is that requirement that does not include enough information to establish exactly how to meet the requirement. On the other hand, an ambiguous requirement can have multiple meanings. Such requirement may sound precise, but defines the desired result in terms that can be interpreted in more than one way.

Let us take an example on both vague and ambiguous requirements to make this more clear.

An example of a vague requirement is the following:

The system shall be able to read updates from MedImg

The above requirement is considered vague since what will be “read” and what happens to the data was not specified.

This requirements can be improved as follows:

The system shall be able to import new tumor patient data supplied by MedImg to the radiology management system, for evaluating the tumor to be malignant or benign

An example of an ambiguous requirement is the following:

The system shall be able to provide historical reports

Here, we have to specify what we mean by “historical reports”.  Thus, the requirement can be improved as follows:

The system shall be able to provide patient tumor data for the past five calendar years

We will end up the article here at the moment, so it doesn’t grow bigger for the reader. The main point to remember is that vagueness and ambiguous refer to two different terms, and they are factors that diminish the requirements’ precision and its ability to be measured and evaluated.

Stay tuned for the next articles, where we will dig more deep on how to deal and work with such uncertain requirements, and how can we present them in a precise manner.


This appeared just a few days ago - Document created 23/09/2014:eHealth Guide for General Practice Getting Started with eHealth – A guide for General Practice is designed for practices or organisations using the eHealth record system through their clinical software.Getting Started with eHealth – A guide for General PracticeThis guide will show you how to:How to link local patient records with their Individual Healthcare IdentifierPatient consent and patient privacy controlsClinical documentsAssisting patients to register for an eHealth recordBecoming familiar with the systemHelp and support contactsDownload: eHealth Guide for General Practice (1.19 MB) How to order brochures and factsheetsIf you are interested in ordering printed brochures from us, please provide the following information within an email to ask@nehta.gov.au OrganisationNameStreet AddressEmail Address (if different from the email address you have used to request brochures)Phone NumberQuantity (minimum is...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

September 27,2014

Here are the results of the poll.Do DoH and NEHTA Understand The Issues Of Clinical Safety That May Surround The Deployment And Use Of Health IT Systems?For Sure 4% (6) Probably 5% (7) Neutral 15% (22) Probably Not 33% (47) No Way 41% (58) I Have No Idea 1% (2) Total votes: 142 This is a pretty clear and enthusiastic outcome. Seems most who read here don’t think DoH and NEHTA are across the safety issues around Health IT. Again, many, many thanks to all those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

September 26,2014

I’m writing this today from Sydney, Australia. This past week I’ve been working with my teammates here on something we’re calling the Clinical Mobility Roadshow. On each of the last four days we’ve been hosting a breakfast event in a different city. We...(read more)
Source: HealthBlog

During today’s #HITsm chat, Karen DeSalvo joined the chat and asked what healthcare IT will be like in 2024. Brian Eastwood, Senior Editor at CIO.com, tweeted the following:

The topic was of interest to me as a health IT blogger myself. However, this was my response:

This of course led to Brian and I contributing to a series of possible 2024 Health IT Headlines we have to look forward to:

I’m pretty sure this wasn’t what Karen DeSalvo had in mind when she asked the question, but I thought it was fun to think about these possible headlines. Plus, I think there’s a fair amount we can learn from thinking about the future in this type of headline fashion. What do you think the healthcare IT headlines will say in 2024?

Dalai's note:  A piece by Dr. Richard Gunderman posted on TheHealthcareBlog.com.  It is unclear whether or not Dr. Gunderman's "discovery" is a real document or not. Still, it would seem to explain a lot of what we are seeing in healthcare today...

How To Discourage a Doctor

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me – in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets – feel out of place.

Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.

That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a healthcare consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said.

“The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.

“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.

“Transforming previously independent physicians into employees has increased hospital influence over their decision making, an effect that has been successfully augmented in many centers by tying physician compensation directly to the execution of hospital strategic initiatives. But physicians have invested many years in learning their craft, they hold their professional autonomy in high esteem, and they take seriously the considerable respect and trust with which many patients still regard them. As a result, the challenge of managing a hospital medical staff continues to resemble herding cats.

“Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus.

“How can this goal be achieved? A complete list of proven tactics and strategies is available to our clients, but some of the more notable include the following:

“Make healthcare incomprehensible to physicians. It is no easy task to baffle the most intelligent people in the organization, but it can be done. For example, make physicians increasingly dependent on complex systems outside their domain of expertise, such as information technology and coding and billing software. Ensure that such systems are very costly, so that solo practitioners and small groups, who naturally cannot afford them, must turn to the hospital. And augment their sense of incompetence by making such systems user-unfriendly and unreliable. Where possible, change vendors frequently.

“Promote a sense of insecurity among the medical staff. A comfortable physician is a confident physician, and a confident physician usually proves difficult to control. To undermine confidence, let it be known that physicians’ jobs are in jeopardy and their compensation is likely to decline. Fire one or more physicians, ensuring that the entire medical staff knows about it. Hire replacements with a minimum of fanfare. Place a significant percentage of compensation “at risk,” so that physicians begin to feel beholden to hospital administration for what they manage to eke out.

“Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass. Refer to such decisions as anecdotal, idiosyncratic, or simply insufficiently evidence based. Make them feel that their mission is not to balance benefits and risks against their knowledge of particular patients, but instead to apply broad practice guidelines to the care of all patients. Hiring, firing, promotion, and all rewards should be based on conformity to hospital-mandated policies and procedures.

“Subject physicians to escalating productivity expectations. Borrow terminology and methods from the manufacturing industry to make them think of themselves as production-line workers, then convince them that they are not working sufficiently hard and fast. Show them industry standards and benchmarks in comparison to which their output is subpar. On the off chance that their productivity compares favorably, cite numerous reasons that such benchmarks are biased and move the bar progressively higher, from the 75th “Increase physicians’ responsibility while decreasing their authority. For example, hold physicians responsible for patient satisfaction scores, but ensure that such scores are influenced by a variety of factors over which physicians have little or no control, such as information technology, hospitality of staff members, and parking. The goal of such measures is to induce a state that psychologists refer to as “learned helplessness,” a growing sense among physicians that whatever they do, they cannot meaningfully influence healthcare, which is to say the operations of the hospital.

“Above all, introduce barriers between physicians and their patients. The more directly physicians and patients feel connected to one another, the greater the threat to the hospital’s control. When physicians think about the work they do, the first image that comes to mind should be the hospital, and when patients realize they need care, they should turn first to the hospital, not a particular physician. One effective technique is to ensure that patient-physician relationships are frequently disrupted, so that the hospital remains the one constant. Another is. . . .”

The sound of a door roused me again. The man in the three-piece suit emerged from the office, he and the hospital executive to whom he had been speaking shaking hands and smiling. As he turned, I looked about. Where was “How to Discourage a Doctor?” It was not on the table, nor was it on the chair where I had first found it. “Will he think I took it?” I wondered. But instead of stopping to look for it, he simply walked out of the office. As I watched him go, one thing became clear: having read that document, I suddenly felt a lot less discouraged.

Patient engagement is something that physicians have done for thousands of years as they cared for patients (whether going to their homes or having them come to hospitals or clinics). With new digital health technologies the way providers can engage with patients is changing significantly but we’re not quite sure about the best ways to apply that technology. This is why I’m looking forward to attending MedCityNews.com’s ENGAGE conference next week in Washington, DC. Most of these kinds of conferences focus on providers but I think that biotech, med device, pharma, payers, and others have much to learn as well. I reached out to our Digital Pharma Editor Vik Subbu to tell us what pharma and biotech can learn about patient engagement at ENGAGE. Here’s what Vik said:

The term “digital health” for some pharmaceutical and biotechnology companies has traditionally focused on supporting marketing strategies for their product launches, branding and access to providers.

However, with the incentives provided through the Affordable Care Act – patients, payers and providers are increasingly adopting mobile health solutions to coordinate patient care activities. As a result, mobile health solutions have transformed into effective patient engagement platforms enabling the seamless, multi-dimensional connectivity amongst these key stakeholders to provide a holistic view of patient care. Such platforms can help provide real time feedback and management of a patient’s episodic events, chronic illnesses and general health and well-being.

Why should pharma and biotech look beyond just sales when it comes to patient engagement?

Pharma and biotech companies should consider looking beyond pure sales and marketing uses and become more engaged in the development of mobile health solutions alongside payers, providers and most importantly patients. Being engaged early on can potentially provide meaningful insights on patient care and therapy use that can help better design future products and clinical trials. For example, understanding patient unmet needs based on lifestyle patterns, adverse event reporting from therapies, developing better inclusion/exclusion criteria etc.,

How will pharma and biotech companies benefit in the future from patient engagement?

Remote monitoring, wireless sensors, e-prescribing, social media provide direct patient access and a vast amount of data. If captured and structured appropriately from the outset, pharma and biotech companies can leverage the insights gained from this data for effective, real-time product and business decisions. Patient engagement platforms can be viewed via a connected approach as follows (1) patient gets prescribed a therapy (e-prescribing) (2) patient is able to provide real-time physiological updates to his/her physician (remote monitoring) and (3) the patient is able to share his/her experiences on a particular therapy with fellow patients (social media). Such real-time actionable patient engagement can enable pharma and biotech to observe key datasets related to patient care and in turn make meaningful and actionable business decisions.

As a newcomer in the digital health space with vast experience in life sciences, I envision that digital health will play a vital role on a number of fronts (research, clinical, new products, revenue sources etc.,) for pharmaceutical and biotech industries in the coming years.

The ENGAGE conference provides a perfect forum to initiate this understanding.

European Telemedicine Conference7 - 8 October 2014, Rome, Italy.
The Italian Ministry of Health is organizing, under the Italian Presidency of the Council of the European Union the Conference on eHealth that will take place on 7-8 October 2014 in Rome. The Conference on eHealth will be held in conjunction with the European Telemedicine Conference. The Conference on eHealth and the European Telemedicine Conference will share the following sessions:

20 Questions for Health IT 20

Question number 20 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Brian Eastwood, senior editor at CIO Online:

Healthcare is full of individual instances of data analytics “wins” – Hospital X reducing readmissions, Health System Y cutting prescription costs or Practice Z streamlining its bulk buying of tongue depressor. How does healthcare move from easy wins in analytics to more tangible, repeatable results?

It’s hard to find a healthcare conference without a big data track these days. Most of the presentations focus on what a particular institution did, not how it did what it did. There’s certainly a place for such case studies, as they can inspire healthcare leaders to look at existing problems in news ways. In focusing on ‘what’ and not ‘how,’ though, healthcare runs the risk of keeping the expertise that’s needed to pull off a successful data analytics initiative as siloed as the data itself. We can’t talk about healthcare data analytics without getting down and dirty—discussing how to sell it to executives, how to allocate resources, how to disseminate and interpret the results and, critically, how to make analytics an integral part of an institution’s business strategy.

Categories: News and Views , All

September 25,2014

Dalai's note:  Here is another piece cross published from KevinMD.com. I have a huge level of antipathy toward "Value-Based" reimbursement. From the beginning, I smelled a rat. How could we in radiology in particular prove the "value" of what we do in a manner that would convince those who hold the purse strings that we should actually be paid for our efforts? If, for example, we tell the ER doc that his order for a CT is inappropriate, we save the system money, and risk a lawsuit. If we let it go through, and it is negative as expected, we are dinged for charging the system for something that didn't produce "value". In other words, we are screwed either way.  What follows is a much better analysis of a sorry situation...
Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum costs $2.50 at the airport and why an Under Armour pair of socks costs $15. Value-based pricing is based on manipulating customer perceptions and emotions, lack of sophistication, imposed shortages and limitations. Finally, value-based prices are always higher than the alternative cost-based prices, and profitability can be improved in spite of lower sales volumes.
Health care pricing is currently a smoldering mixture of ill-conceived cost-based pricing with twisted value-based pricing components. For simplicity purposes, let’s examine the pricing of physician services. As for all health care, the pricing of physician services is driven by Medicare. The methodology is neither cost-based nor value-based and simultaneously it is both. How so? Medicare fees are based on relative value units, which are basically coefficients for calculating the cost of providing various services in various practices, of various types and specialties. The price, which is also the cost since it includes physician take home compensation, is calculated by plugging in a dollar value, called conversion factor. The conversion factor, which is supposed to represent costs, is not in any way related to actual production costs, but instead it is calculated so the total cost of physician services will not exceed the Medicare budget for these services. Buried in this complex pricing exercise is a value-based component. A committee of physicians gets to decide the requisite amount of physician effort, skills and education, for each service. Whereas in other markets the value decision hinges on buyer perceptions, in health care it is masquerading as cost.
The commercial insurance market adds a more familiar layer of complexity to the already convoluted Medicare fee schedule baseline. Unlike Medicare fees, which are nonnegotiable, private payers will engage in value-based negotiations with larger physician groups and health systems that employ them. Monopolistic health systems in a given geographical area can pretty much charge whatever the market can bear, just like the beer vendor at your favorite ballpark does, and brand name institutions get to flex their medical market muscles no differently than Under Armour does for socks. This is value-based pricing at its best. Small practices have of course no negotiation power in the insurer market, but as shortages of physician time and availability begin to emerge, a direct to consumer concierge market is being created, providing a new venue for independent physicians, primary care in particular, to move to a more profitable value-based pricing model.
Unsurprisingly this entire scheme is not working very well for any of the parties involved, except private insurers who thrive on complexity and the associated waste of resources. Upon what must have been a very careful examination of the payment system, Medicare concluded that it does not wish to pay physicians for services that fail to lower Medicare expenditures, and Medicare named this new payment strategy value-based health care, not because it has anything in common with value-based pricing, but because it sounds good. Another frequently used term in health care is value-based purchasing, which is attempting to inject the notion of quality as the limiting factor for cost containment. However, since Medicare is de facto setting the prices for its purchases, there is really no material difference between these two terms.
We need to be very clear here that value-based health care is not the same as quality-based health care. The latter means that physicians provide the best care they know how for their patients, while the former means that physicians provide good health care for the buck. To illustrate this innovative way of thinking, let’s look at the newest carrots and sticks initiative, scheduled to take effect for very large medical groups (over 100 physicians) in 2015. Below is a table that summarizes the incentives and penalties that will be applied through the new Medicare Value-based Payment Modifier.
Value based care: Bad for doctors, bad for patients?
There are several things to note here. First, if your patients receive excellent care and have excellent outcomes, you will receive no perks if that excellence involves expensive specialty and inpatient services, whether those are the accepted standard of care or not. You would actually be better off financially if you took it down a notch and provided mediocre care on the cheap. The second thing to notice is that you will not get penalized for providing horrendously subpar care, if you do that without wasting Medicare’s money.
Another intriguing aspect of this new program is that you have no idea how big the incentives, if any, are going to be. The upside numbers in the table are not percentages. They are multipliers for the x factor. The x factor is calculated by first figuring out the total amount of penalties, and that amount is then divided among those who are due incentives. If there are few penalties, there will be meager incentives. Lastly, those asterisks next to the upside numbers, indicate that additional incentives (one more x factor) are available to those who care for Medicare patients with a risk score in the top 25% of all risk scores.
As with everything Medicare does, this too is a zero sum game. For there to be winners, there must be losers. One is compelled to wonder how pitting physician groups against one another advances collaboration, dissemination of best practices, or sharing of information, and how it benefits patients. Leaving philosophical questions aside, the optimal strategy for obtaining incentives seems to be transition to a Medicare Advantage type of thinking: get and keep the healthiest possible patients, and make sure you regularly code every remotely plausible disease in their chart. Stay away from those dually eligible for Medicare and Medicaid, the very frail, the lonely, the infirm, or the very old, and don’t be tempted to see a random person who is in a pinch, because there is always the chance that he or she will be attributed to your panel following some hospitalization or other misfortune.
The Value-based Payment Modifier is for beginners. It is just the training wheels for the full-fledged risk assumption that Medicare is seeking from physicians and health care delivery systems in general. The grand idea is not much different than providing an aggregated and risk adjusted defined contribution for a group of assigned members, and having the health care delivery system absorb budget overruns, or keep the change if they come in under budget. There is great value in such a system for Medicare and commercial payers certain to follow in its footsteps, and perhaps this is why they decided to call it value-based. Ironically, the equally savvy health care systems are fighting back precisely by building the capacity to create a true value-based pricing model for their services through consolidation, monopolies, corralled customers, artificial shortages, confusing marketing, and diminished physicians.
It is difficult to lay blame at the feet of health systems for these seemingly predatory practices, because transition to a perpetual volume-reducing health care system is by definition unsustainable. The infrastructure and resources needed to satisfy all the strategizing, optimizing, counting and measuring activities required for value-based health care, whether the modest payment modifier or the grown up accountable care organization (ACO), are fixed costs added to health system expenses year after year. However, the incentives or shared-savings are temporary at best, because at some point volumes cannot be reduced further without actually killing people. Either way, in the near future, and for already frugal systems, in the present, all incentives will dry up leaving only massive outlays for avoiding penalties coupled with increased risk for malpractice suits.
And as these titans are clashing high above our little heads, two outcomes are certain: Individual physicians will be paid less and individual patients will be paying more for fewer services. This is how we move from volume to value. Less volume for us, more value for them.
Margalit Gur-Arie is founder, BizMed. She blogs at On Healthcare Technology.

The following is a guest blog post by Lisa Pike, CEO of Versio.
With over a third of healthcare organizations switching to a new EHR in 2014, there is a lot of data movement going on. With the vast amount of effort it took to create that data, it’s a valuable asset to the organization. It can mean life or death; it can keep a hospital out of the courtroom; and it can mean the difference between a smooth-running organization and an operational nightmare.

But when that important data needs to be converted and moved to a new EHR, you realize just how complex it really is.

During a recent conversion of legacy data over to a new EHR, we came across this entry in the Medication List:  Raised toilet seat, daily.

Uh, come again??

How about this one?  “Dignity Plus XXL [adult diapers]; take one by mouth daily.”  What does the patient have, potty mouth?

Now, while we may snicker at the visual, it’s really no joke. These are actual entries encountered in source systems during clinical data migration projects. Some entries are comical; some are just odd; and some are downright frightening. But all of them are a conversion nightmare when you are migrating data.

Patient clinical data is unlike any other kind of data, for many reasons. It’s massive. It requires near-perfect accuracy. It’s also extremely complex, especially when you are not just migrating, but also converting from one system “language” to another.

Automated conversion is a common choice for healthcare organizations when moving data from legacy systems to newly adopted EHRs. It can be a great choice for some of the data, but not all. If your source says “hypertension, uncontrolled,” but your target system only has “uncontrolled hypertension,” that’s a simple enough inconsistency to overcome, but how would you predict every non-standard or incorrect entry you will encounter?

Here are some more actual examples. If you’re considering automated conversion, consider how your software would tangle up over these:

346.71D  Chm gr wo ara w nt wo st ???
levothyroxine 100 mg Should be mcg. Yikes!
Proventil Target system has 20 choices
NKDA (vomiting) NKDA= no known drug allergies.
Having no allergies causes vomiting?
Massage Therapy, take one by mouth twice weekly ???
Tylenol suppositories; take 1 by mouth daily Maybe not life-threatening, but certainly unpleasant
(Pelizaeus-Merzbacher disease)
Should have been PMDD
(premenstrual dysphoric disorder)
Allergy:  Reglan 5 mg Is patient allergic only to that dosage, or should this have been in the med list?
Confusing allergies and meds can be deadly.
Height 60 Centimeters or inches? Convert carefully!


These just scratch the surface of the myriad complexities, entry errors, and inconsistencies that exist in medical records across the industry. No matter how diligent your staff is, I guarantee your charts contain entries like these!

When an automated conversion program encounters data it can’t convert, it falls out as an “exception.” If the exception can’t be resolved, the data is simply left behind. Even with admirable effort, almost no one in the industry can capture more than 80% of the data. Some report as low as 50%.

How safe would you feel if your doctor didn’t know about 20% of your allergies? What if one of those left behind was the one that could kill you? What if a medication left behind was one you absolutely shouldn’t take with a new medication your doctor prescribed? Consider the woman whose aneurysm history was omitted during a conversion to a new EHR, so her specialist was unaware of it. She later died during a procedure when her aneurysm burst. I would say her family considered that data left behind pretty important, as did the treating physician, who could be found liable.

Liable, you say?

That’s right. The specialist could be found liable for the information in the legacy record because it was available….even if it was archived in an old EHR or paper chart.

You can begin to see the enormity of the problem and the potentially dangerous ramifications. Certainly every patient deserves an accurate record, and healthcare providers’ effectiveness, if not their very livelihood, depends on it. But maintaining the integrity of the data, especially during an EHR conversion, is no trivial task. Unfortunately, too many healthcare organizations underestimate it, and clearly it deserves more attention.

There is good news, however. With a well-planned conversion, using a system that combines robust technology with human expertise, it is possible to achieve 100% data capture with 99.8% accuracy. We’ve done it with well over a million patient chartsIt isn’t easy, but the results are worth it. Patients and doctors deserve no less.

Lisa Pike is the CEO of Versio, a healthcare technology company specializing in legacy data migration, with a proven track record of 100% data capture and 99.8% quality. We call it “No Data Left Behind.” For more information on Versio’s services or to schedule an introductory conversation, please visit us at www.MyVersio.com or email sales@myversio.com.

This post is part of the ‘Think Further’ series, sponsored by Fred Alger Management, Inc. Follow the link for more #ThinkFurther content. It is human nature to think about the future, and to predict great advances. Fifty years from now...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg

I have posted a number of notes about Epic's attitude toward interoperability (see: More on Epic's (Non)-Interoperability and the Recent NYT Puff PieceJudith Faulkner, EMR Interoperability, and Washington IT PoliticsSharing Medical Records across Hospitals with Epic's Care Everywhere). In general, I believe that Epic loves to encourage information sharing across its own hospital clients but makes it more difficult and expensive in relation to data sharing outside of its family circle. I further believe that the company is seeking to establish its own software as the de facto standard of interoperability, particularly in the larger and more complex hospitals. A recent article discusses how the company is now turning to a Washington lobbying firm to convince Congress that its goals are noble (see: Epic retains lobbyist to improve image on Capitol Hill). Below is an excerpt from the article:

Electronic health-record giant Epic Systems Corp. has hired a lobbying firm for the first time to counter a perception on Capitol Hill that its EHR systems aren't interoperable with other vendors' technology. The Verona, Wis.-based company retained lobbyists Card & Associates in August, according to the federal Lobbying Disclosure Act database. Epic says in the registration that it's making the move to “educate members of Congress on the interoperability of Epic's healthcare information technology.” The move is out of character for Epic, which has a reputation for doing its own thing and staying out of the D.C. fray, sources with knowledge of the lobbying business and health IT said. But the company is now finding itself fighting a perception that its technology is out of step with the drive toward interoperability. Meanwhile, Epic has teamed with IBM to compete with several other heavyweights for a multibillion-dollar contract to modernize the U.S. Defense Department's clinical technology systems (see: Epic Partners with IBM for Military EHR Proposal; This May Be a Problem). Bradford Card, the CEO of Card & Associates, said in an interview that Epic has been the “subject of misinformation.” His firm, Card said, will work to set the record straight....In a July hearing, Rep. Phil Gingrey...had sharp words for the company, citing a RAND Corp. report claiming Epic's systems were “closed records.” 

It's refreshing that Epic has hired a lobbyist, Bradford Card, to present the "truth" to our politicians in Washington about the company's enthusiasm for interoperability of medical records. As we all know, it's only through the efforts of such lobbying firms that the truth gains traction in Washington. However, one might well ask the following question: why only now does Epic feel a need to clarify its position of interoperability for our elected officials after a number of years of what would seem to be total indifference to its reputation in Washington? Take note in the above excerpt that the author threw into the article the fact that Epic has recently decided to partner with IBM to bid on a huge military EHR contract.

I personally think that there is a connection between this new partnership with IBM, the military EHR contract up for grabs, and this new Epic recent enthusiasm for public relations. Here's a quote from an IBM executive regarding this military contract: we don’t bid on everything, but when we do, we want to change the world (see: Epic Partners with IBM for Military EHR Proposal; This May Be a Problem)IBM has always presented itself as a white knight, solving technology challenges for appropriate compensation. I think that some of this IBM culture is rubbing off on Epic executives and persuading them that what politicians think about Epic outside of Wisconsin may be relevant for the future of the company. 


The Fred Alger Management team reached out to me recently asking what innovative changes I thought the medical and healthcare industry will be going through over the next 50 years. It was for their innovative “Think Further” series:

As Yogi Berra famously quipped “It’s tough to make predictions, especially about the future” but Alger’s “Future of Medicine” question is an interesting approach to generating ideas so I thought I’d give it a shot.

For the first 50 years in computing we’ve been busy digitizing the areas of human activity such as:

  • Administration (letters and memos are rarely done by hand)
  • Engineering (computations and drawings have been done on machines for a while)
  • Finance & accounting (spreadsheets and software drive most financial tasks)
  • News & press (social media, online news)
  • Literature (e-books, publications)
  • Retail (online stores)

There are many more examples of digitization plus even more examples of how mobile, social, and Internet have changed the world for the better. While the innovations I’ve cited above have brought enormous benefits to humanity, the next 50 years when we digitize biology through genomics, digitize chemistry through early detection systems, and digitize physics through better simulations we’re going to live in a world that might soon look even more like science fiction than it does today. Here’s how:

  • We already have “Dr. Google” through search engines but the coming decades will make medical knowledge, especially differential diagnoses, even better and more accessible to the average patient.
  • In the next decade we’re going to have the first versions of Star Trek’s “Medical Tricorder” and “Biobeds” which will focus on improved digital diagnostics by using digital medical education and improved mobile sensors to teach our devices how to read biomarkers in blood or other human biological specimen and identify disease or other ailments.
  • Over the following decades we’ll use those better diagnostics to create significantly better therapeutics such as personalized drugs. The better our diagnostics get on a personal (patient-specific) basis, the better our personalized therapies will get.
  • Within next couple of decades we’ll be able to use the advanced diagnostics capabilities of genetics and proteomics to create personal simulators of our body so that drugs and their side effects can be tested on a digital version of ourselves instead of running clinical trials in live settings.
  • As computing power increases and digital biological specimens become easier to obtain, we can imagine a world in which computers can run biological research that only humans can do today. And do it more safely and quickly than is possible this decade.
  • We can even imagine a world in which we can detect and correct diseases by touching our smartphones or smartwatches.

Just as we couldn’t imagine 20 years ago that a device we hold in our hands could guide us using GPS systems, there are things we’ll get through digital biology, digital chemistry, and digital physics that would be unimaginable today.

Our biggest struggles with future innovations won’t be around technology – that part will be solved quickly because of a huge pool of talented entrepreneurs and engineers. The biggest risk to our next generation technologies will really be around regulatory, privacy, and security. We already don’t know how to handle mobile medical devices from a regulatory perspective. We barely know how to manage privacy and security with the small amounts of personalized health records and diagnostic data we have now.

This article is part of the ‘Think Further’ series, sponsored by Fred Alger Management, Inc. For more ‘Think Further’ content and videos, visit thinkfurtheralger.com.


20 Questions for Health IT 19

Question number 19 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Vince Kuraitis, principal, Better Health Technologies, LLC:

The migration from “Hoarding” to “Sharing” patient health information — necessary, but is it sufficient?

Conventional wisdom suggests that the U.S. health system is going through a lengthy and painful two-phase process of migrating from ‘hoarding’ patient information to ‘sharing’ patient info. While correct, I don’t think this vision goes far enough. I envision a third phase – “applying” patient information.

Let me explain. ‘sharing’ implies simply making information available. It doesn’t necessarily imply that patients or providers actually want or have to do anything with the information. It also implies fairly neutral expectations on the part of the party that shares the information: ‘OK, I’m now sharing information…use it as you see fit.’

As payment models migrate from volume to value, care providers and patients each have more skin in the game: providers increasingly will be at-risk financially, and patients are being subjected to higher co-payments, deductibles and other out-of-pocket payments. This concurrent health system transformation is what triggers Phase 3 of ‘applying’ patient health information. Expectations around patient information shared with providers and patients will increase. ‘I’m sharing information with you. I expect you to act on this information. The patient has a team care plan and we each have a role. Do your part.’

The implications here are huge. If you’re proactive, you can already be building operational and business models anticipating Phase 3. Discuss.

Categories: News and Views , All

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