UPMC (PA) says that the information of 27,000 of its employees was exposed in a February breach and the hackers have filed fraudulent tax returns for 788 of them so far. A lawyer seeking class action status of his lawsuit asks the obvious question: why did the breach involve only 27,000 of UPMC’s 62,000 employees? The attorney points out that UPMC first claimed that only 20 employees were affected, then 322, and now 27,000, obviously concluding that all employees may be at risk despite the announcement. The tax scam is a smart one since the IRS, like HHS, pays first and asks questions later.
From Down Boy: “Re: athenahealth. Down Friday – all sites, communications, interfaces, etc. Confirmed with hospitals and practices in CA, MO, SD, NH, and ME.” Unverified.
From Locked Box: “Re: athenahealth. Their ‘More Disruption Please’ program was supposed to be a collection of companies offering easily integrated products that would give athena customers functionality the company doesn’t offer, which would support innovation by giving those companies access to customers. In return, the companies would offer a discount to their customers, lowering the barrier to innovation. Now athenahealth has changed the program to a revenue share model, which is a 20 percent tax on interoperability for us and our customers, which is why we joined. We are leaving the MDP program.”
From Excelsior: “Re: JASON report. HHS’s report is similar to the 2010 PCAST report, including calls to represent health information as ‘atomic data with associated metadata.’ Two people involved in the PCAST report were also involved in the JASON report: Craig Mundie and Sean Nolan, both of Microsoft.” The report says “the entire health data infrastructure will be crippled” without better interoperability and recommends that EHR information be stored using common mark-up language and that EHR vendors should open up their systems via APIs that allow third parties to build on them with new applications. EHR vendors aren’t likely to embrace this concept enthusiastically given that the report recommends architecture that can “provide a migration pathway from legacy EHR systems,” but of course their EHR customers would need to apply pressure on their vendors to make it happen anyway since government reports have zero bottom line impact. Other findings:
From Guillermo del Grande: “Re: consultants. Here’s a list of ‘Things Consultants Wish Their Customers Knew.’”
HIStalk Announcements and Requests
The White House is most responsible for the ACA-related failures such as Healthcare.gov that led HHS Secretary Kathleen Sebelius to resign, according to 47 percent of poll respondents. New poll to your right: do you feel better or worse about HHS after its release of Medicare physician payment information? I felt worse: the lawsuit-mandated release of the data reminded that like pretty much all federal programs, taxpayers should be appalled at how their money is being spent, the cost of the self-protecting bureaucracy required to spend it, and the remarkably breezy oversight that expensive bureaucracy provides in return. Not to mention that Medicare payment rules are so convoluted that even they can’t figure out when they (meaning we) are being defrauded. HHS is like the IRS in that regard and I don’t trust either of them to enforce politics-embedded rules that nobody understands.
Listening: new from Atlanta-based melodic hard rockers Manchester Orchestra.
May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.
Acquisitions, Funding, Business, and Stock
From the athenahealth earnings call:
Here’s a one-year view of ATHN’s share price (blue) vs. the Nasdaq (red).
Healthbox, which runs medical accelerator programs, raises $7 million in expansion funds. One of its investors is Intermountain Healthcare. The company also announces that it will launch Healthbox Solutions to showcase healthcare IT products to hospitals.
Government and Politics
A ProPublica analysis of the CMS physician payments database finds that doctors previously charged with fraud and Medicare overbilling continue to make big money from the program. Medicare paid a psychiatrist who was arrested and barred from the Medicaid program in 2011 $862,000 in 2012. Sen. Chuck Grassley (R-IA) said Medicare and Medicaid programs need to communicate since, “The new transparency makes it harder to ignore when doctors who harm patients or defraud taxpayers in one program face no consequences in the other program” (how about a little bit of interoperability push there?) A doctor who was convicted of paying patients via his charity to use his pain clinic was paid $500,000 in 2012 for treating 80 patients despite his pending 50-month prison sentence and $3.5 million fine, but his lawyer claims his conduct didn’t cost Medicare anything because somebody would have treated the patients even if it wasn’t him. A Michigan oncologist charged with misdiagnosing patients with cancer so he could bill them for unnecessary treatments was paid $10 million by Medicare in 2012. Pay-and-chase is working really well for criminals.
Innovation and Research
The consumer wearables fad seems to be over as Nike fires 55 of the 70 members of its FuelBand team and cancels the planned fall release of a new model. Nike says it wants to focus on software, not hardware. Most likely they realized that (a) high-tech versions of a $5 pedometer not only don’t usually motivate anyone except those who are already motivated, and (b) spending money to bring out new hardware versions is risky now that the competitive field has opened up. FeulBands may die off just as quickly as those once-ubiquitous yellow Livestrong wristbands that people couldn’t trash fast enough once the headlines forced them to belatedly realized what a scumbag Lance Armstrong is. There’s a Nike connection there too – they used to make Livestrong-branded products until Lance finally admitted that he’s a cheater and a liar.
John Gomez from Sensato provides suggestions on dealing with the Heartbleed SSL vulnerability, warning that hospitals “have an obligation to deal with it because it is a serious threat to privacy.” Even Healthcare.gov is telling users to change their passwords. John’s suggestions:
T. J. Samson Community Hospital (KY) announces that 49 employees will be laid off and all employees will temporarily have their pay reduced due to effects of the Affordable Care Act and “the costly rollout of an inadequate software program.” That system is Siemens Soarian, which the hospital purchased in February 2012. Interim CEO Henry Royse says that Soarian “is still costing the hospital tens of millions of dollars in unrecoverable bad debt, consultant fees, and lost productivity” a year after it went live. He specifically says the implementation was rushed, Soarian can’t connect to its practice management systems, it can’t produce needed operational reports, and the hospital has been unable to send bills for 60-90 days at times. The hospital implemented Soarian to earn Meaningful Use payments.
Fast Company profiles SharePractice, which it describes as “a Yelp for medical treatments” in allowing physicians to review the success peers have had with specific treatments. The company calls its iPhone app “experience-based medicine.” The founder is a Naturopathic Doctor who works for San Francisco-based Care Practice, opened “like one would open a neighborhood restaurant with a focus on patient experience and developing a compelling identity and brand in a tough urban marketplace with fewer and fewer doctors.”
The outpatient clinics of Salem Health (OR) will begin their pilot with OpenNotes on Monday.
The CEO and CTO of Mississippi-based Samarion Solutions, which sold long-term care IT systems, are indicted for defrauding investors.
A study finds that US healthcare isn’t expensive because we use so much of it – the problem is that we pay the highest prices in the world for drugs and hospital procedures. As patients, it’s not altogether our fault that US healthcare is so expensive and produces unimpressive results for the impressive outlays. A day in the hospital costs less than $500 in Spain, $1,300 in Australia, and $4,300 here (and $13,000 for hospitals in the 95th percentile.)
A New York Post article names the highest-paid doctors in New York City, with two from Mount Sinai Hospital’s medical school topping the list: a urologist paid $7.6 million and a spine surgeon who made $6.9 million. The medical director of Consumer Reports Health summarized, “Whenever I see compensation data in health care, I’m stunned and nauseated. I’m embarrassed for the profession.”
In England, a review of a woman’s death after inpatient surgery finds that she was screaming and vomiting in her room afterward, even begging her children to call an ambulance to remove her from the hospital. Her doctor did not respond, the investigation found, because he was in the hall outside her room playing a video game.
Nuance is now officially in the medical image and document sharing business with their new acquisition. It’s not the first and won’t be the last as here’s another that opened last year. Features of course may not be identical but the main show here is to share medical images to avoid having duplicates done again for one and secondly the ability of physicians to share with each other as well as hospitals.
As I read here the platform will integrate with current medical records systems and images are stored in the cloud, where else:) Many medical records companies already have a document sharing module but this now incorporates the cloud and imaging which is a bit more complex. As I read through here there’s a dicom viewer built in so no separate software for that for those MRI and CAT scan images.
You need to become a member and I don’t know what the pricing is as I didn’t go that far. In addition PHRs have been in the image sharing business for a while with HealthVault as one example that has a built in Dicom viewer. That viewer comes in handy. You can read the links about the PHR aspect below.
The big plus here is for the built in capability for physicians to be able to have the information within a medical record as when else are you wanting to review medical images, when you are looking at the patient records. BD
Nuance Communications has announced today the immediate availability of Nuance PowerShare™ Network, the industry’s largest cloud-based network for securely connecting physicians, patients, and others to share medical images and reports as simply as people exchange information using social networks.
“This nationwide network, one that is fully integrated into the EHR workflow and already connected to approximately half of all clinicians producing diagnostic imaging information, is a ground breaking solution that delivers immediate benefits at an unprecedented scale to our healthcare system.”
“The challenge of sharing images with interpretive reports is something we’ve heard about consistently from our customers and EHR partners, and we know Nuance PowerShare Network will overcome this major obstacle, helping physicians treat patients more efficiently and effectively,” said Peter Durlach, senior vice president of marketing and strategy, Nuance Communications. “This nationwide network, one that is fully integrated into the EHR workflow and already connected to approximately half of all clinicians producing diagnostic imaging information, is a ground breaking solution that delivers immediate benefits at an unprecedented scale to our healthcare system.”
You’ve no doubt hear about the kickback scandal involving CareFusion and Charles R. Denham, MD, founder of the Texas Medical Institute of Technology (TMIT). I wrote a piece about it in the context of Meaningful Use for Healthcare IT News this month, since Denham co-chaired the steering committee of the National Quality Forum’s Safe Practices for Better Healthcare program during the time CareFusion allegedly paid Denham $11.6 million to promote its products.
CMS, of course, has, to date, based Meaningful Use quality measures on NQF recommendations.
Denham has become a pariah of sorts in patient-safety circles since the U.S. Department of Justice announced a $40.1 million settlement with CareFusion in January. Yet, believe it or not, TMIT is still in business. The organization’s Web site is functional; in fact, the “about” page prominently features a video with Denham. And the TMIT Twitter account is activem, promoting a webinar as recently as yesterday.
The TMIT High Performance webinar with Perry Bechtle begins in 15 minutes! Join now! http://t.co/rvuNDRI8td Password: Webinar1
— TMIT (@TMIT1) April 17, 2014
Perry Bechtle, D.O., is a neuroanesthesiologist at Mayo Clinic in Jacksonville, Fla., and a former U.S. Navy flight surgeon. I want to believe that his credentials are impeccable, but it’s hard to take TMIT seriously these days in the absence of a major house-cleaning. Interestingly, the last academic article Denham wrote before the scandal broke was in the December 2013 issue of the Journal of Patient Safety. It’s entitled, “Safe Use of Electronic Health Records and Health Information Technology Systems: Trust But Verify,” and co-authors include heavyweights such as David Classen, M.D., and David Bates, M.D.
How are we supposed to trust an organization that itself was wrapped up in such a serious breach of trust?
In a recent note, a guest blogger, Nial Toner, raised the issue of what I will call distracted diagnostics for the purpose of this discussion (see: Cloud Computing in Digital Pathology: Addressing Some Pressing Needs). Here is a paragraph from his note making reference to the fact that some pathologists working on digital cases away from their normal office might feel stressed or unfocused:
Some pathologists may be skeptical about working from many different locations and believe that system settings may affect how they deal with their daily case workload. The key argument here is that the pathologist working in his or her office environment is more likely to stay focused and therefore make more accurate diagnoses.
This is a very interesting point. We all understand the hazards of distracted driving and have seen cars weaving about with the driver holding a cell phone to his or her ear. Many states have outlawed the practice as unsafe. By the way, I purposely chose the term distracted diagnostics because the issue is even more relevant for the radiologist than the pathologist, digital images being more widely available in radiology.
I am thinking about a pathologist or radiologist interpreting images in a home office, perhaps alternating between household tasks and professional work. Increasingly common may even be the scenario of the review of a surgical pathology case or a radiology study with a cell phone, ducking out of a restaurant or party. Distraction has always been one of the known challenges of telecommuting.
On the other hand, it may be relevant here to ask whether the notion of distracted diagnostics is a red herring? Clinicians take cell phone calls all of the time wherever they are located. They frequently provide critical clinical advice with their hand over one ear to block out ambient noise in a restaurant. No one considers this a problem. In fact, we consider it appropriate and necessary.
I found a reference to distracted doctoring on the web site of a malpractice lawyer. Here, cell phones and browsing social media sites were highlighted as common distractions for physicians and other health professionals in hospital settings (see: Find out how a Tennessee medical malpractice lawyer can help). Here is a quote from the web page:
Doctors are without question busy during their day. Certain distractions are unavoidable due to the nature of their work. Other distractions are unnecessary in an operating room or examining room:
Distracted doctoring is more common than people might think. In fact, the ECRI Institute, an organization that researches ways to improve safety and quality of patient care, listed “caregiver distractions from smartphones and other mobile devices” as No. 9 on a top 10 list of health technology hazards for 2013. Stories have surfaced of doctors wearing headsets and making a personal phone call during a procedure.
I don't know whether distracted diagnostics is really a problem. It might be worth a study, perhaps starting with digital radiology.
I’ve regularly seen the divide (sometimes really wide) between the programmer and technical people in an organization and the healthcare professionals. For example, a healthcare IT company recently emailed me about an issue they had with their main developer. They asked the insightful question, “Is it possible to find quality developers who are not, shall we say, “difficult”?”
There’s no simple answer to this question, but let me first suggest that this divide isn’t something that just happens between tech people and non-tech people. I’m sure many doctors feel the same way when dealing with other people who try and do their job. It turns out, people are hard to work with in general.
That disclaimer aside, tech people do like to think they’re in a tribe of their own. Check out this video which definitely comes from a programmer perspective and illustrates the divide that often exists.
Just the fact that the programmer feels like they’re considered a “code monkey” describes a major part of the issue. Much like I wrote about today on EMR and EHR, one of the keys is making a human connection as opposed to treating a programmer like a code monkey that’s just there to do your bidding. While there are exceptions, most people respond to someone who deeply cares about the individual and works to understand their needs as much as the project’s needs or their own needs.
The reason I think there’s usually a big divide between the healthcare people and the tech people is that it’s a real challenge for these two groups to connect. The healthcare people don’t want to talk about Battlestar Gallactica and Game of Thrones and the tech people don’t want to talk about Dancing with the Stars and The Voice. Yet, this is what needs to happen to build trust between the two different groups. It’s a rare breed that enjoys both.
If all of this fails, then try the nuclear option. Bring donuts. Most people can relate to donuts.
The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.
If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.
This question this time: What brand/model of mobile device do you use most often and what do you like most and least about it?
Interestingly enough, I did not end up with an iPhone by my sheer choice, but it was rather imposed on me by Allscripts of all people. They bought my initial e-prescribing "I scribe" which I had on a Palm for free and when Allscripts bought them they, did away with the Palm. In order to preserve my data, I had no choice but to get an iPhone and there you have it: there is no such thing as "free" and consumer choice, is it really? Mr H touched on this on one of his posts: the fact that it looks unprofessional to respond to emails from the iPhone (folks do not correct spelling, grammar, and at times it looks like mutilating the English language) but I admit I am guilty of doing it myself because on the other hand, what is the sense of the whole mobility trend? I cannot always wait for access to a desktop to respond to my emails, but I promise to correct the spelling.
Charles Corfield is president and CEO of nVoq of Boulder, CO.
Tell me about yourself and the company.
I started off life as a mathematician. The company that we’re talking about today is nVoq, which is based in Boulder, Colorado. It is a tech company. It does voice-assisted workflow, or voice-automated workflows.
Did you find that you had an aptitude for entrepreneurship that you didn’t expect, or is it truly related to your mathematical training?
If I may quote someone, when I was a teenager, I had the good fortune to observe a couple of entrepreneurs in action in the UK. John McNulty was his name, one of those entrepreneurs, who said, “The reason most people become entrepreneurs is because they’re fundamentally unemployable, so they have no choice.” [laughs]
If you’re one of these people who is a constructive troublemaker, that you’re always poking at things and asking questions, then entrepreneurship is a fairly natural thing to do, even if by personality traits you may not be the most obvious candidate for it.
For example, mathematicians are notorious for being somewhat shy, retiring, and socially awkward. I certainly plead guilty to being something of a social retard myself. The joke used to be that you can tell an extrovert mathematician because he or she stares at your shoelaces instead of his or her own. [laughs]
What you figure out as a mathematician is that there’s a pattern to all these things. Go learn the pattern and go figure it out. It’s really actually not that strange for a mathematician to become an entrepreneur.
What characteristics about yourself, other than being rebellious, would you say have been important in your career as an innovator, investor and now running nVoq?
At least willing to ask awkward questions, if you can characterize rebelliousness somewhat more charitably.
Two attributes which I think are key in this are, one, the willingness to sink your teeth into something and just stick at it. One of the things that I have observed over the years as I applied my trade in technology is that many people have folded their hands far too early. They’ve just sort of given up. Somehow they didn’t in the end have the courage of their convictions.
That brings me to the second point, which is, mathematicians can often have insights into the way things work and see things which are not always easy for other people to see. If you have the good fortune to have the right insights, then that’s probably more important than having a big VC backing you. In other words, good insights can make up for a shortage of dollars.
You were an investor in BeVocal that was sold to Nuance a few years back for a pretty good chunk of change. That became Siri, right?
That I could not comment on. [laughs]
I wondered if I’d get a “yes” out of you on that.
I think I shall refer you to Nuance to comment on matters of Siri or otherwise. [laughs]
How did you get involved with speech recognition?
The story behind it was that I met up with several would-be entrepreneurs in Silicon Valley who wanted to do something with speech recognition. They were not ready for prime time as far the VC community there was concerned.
However, I liked what I saw, and so I worked with them in formulating the business. I invested in at as well, as did eventually a number of VCs once they got to a stage where they were a candidate for taking funding from the VC.
It was an interesting model, because before we had the term "cloud," they were actually doing a cloud-based IVR. This was also one of the not very common times when you could do a gain share model and control enough of the levers to make it work.
In that environment, it was well known in the industry what percentage of your incoming phone calls to customer care you could automate, or not as the case may be. If you couldn’t automate it, it had to go to an agent and that’s really what drove your expense. The approach at BeVocal was that we would use a judicious amount of speech recognition to increase the — as some people call it — call deflection, meaning deflection away from an agent, or call automation or containment within the IVR.
The deal we would make with the customer is that for every percentage point we can increase that automation, you pay us X cents per minute. That turned into a very good business model. The reason that type of model is not very common is because often technology companies can’t control enough of the levers to influence the outcome in their favor. Gain share models are often very good for the client and lousy for the technology company.
Nuance is probably the name people people think of most often when they hear the term speech recognition. How are NVoq’s offerings different and how do you compete against Nuance?
We take a different approach. As you said, Nuance is the brand name or the 800-pound gorilla that is known in healthcare. Their primary offerings are back-end transcription as they have absorbed transcription companies and put that on to their back-end speech recognition. Then the front-end product, hich is more widely known, the medical version of Dragon. That is a desktop product. It’s what is called a fat client. All the functionality has to be installed either on the enterprise server or the user’s desktop.
Our observation is that by taking a different approach, which is to supply functionality out in the cloud, we are able to meet the needs of people who are more cost conscious and need a very simple and portable access to speech recognition. By simple, meaning it’s very easy for them to learn what they need to learn. By portable, it respects the fact that they are working in multiple locations. They’re going from offices to clinics to hospitals and so on and they really need just one account that can follow them around.
The cloud, as long as they have Internet connectivity, allows them to hook up to their account wherever they are. Then from a user experience point of view, what we have focused on is to make that process upon boarding the user — that is, training them up from ground zero — very simple for the user. The process of supporting that user in their daily use is to make that very simple as well.
Let me give you a for instance. Because the functionality is in the cloud, we or the reseller can see exactly what the user is doing during the early days and can make judicious interventions to true things up for that user: introduce vocabulary items or tweak the system in a way that meets the user’s actual usage. What is nice for the user is that the system seems to be proactively addressing their needs without them having to pick up a phone and ask for help.
This brings us to, I think, one of the big opportunities of using speech recognition in the healthcare space, which is to get a higher adoption rate. Nuance has in effect set the standard, so you will see roughly 50 percent of people who have started on Dragon end up abandoning it. Not because Dragon is a bad product. Dragon is a perfectly good speech recognition product. The issue is that when they need support, it’s not convenient to get it.
We make a very strong push in that direction of delivering good customer service and timely customer service that makes the difference for these users. Because to be blunt, they’re all far too busy to pick up manuals on speech recognition or wade their way through indexes trying to figure out, what did I get wrong? Why isn’t this working for me? Far better that before they even realize they’re having issues, someone can intervene behind the scenes and make the system do what it needs to do.
How do you see the market for voice-operated commands in healthcare or the use of speech recognition by non-physician clinicians for something other than dictation?
If you consider the numbers, there are 800,000 physicians, plus or minus, in America. But the total number of people working provider side in healthcare is closer to 16 million. There is clearly a large, unserved market or potential market of people who need something which can speak to their needs, speak to their workflows, if you will. It’s simple. It’s affordable. It can automate their rote tasks.
Providing a solution for these people is something we are very interested in and are already doing. We look at it as being ultimately that we should see millions of people who are working on the provider side who are able to benefit from driving the EHR or whatever application they’re using for scheduling or some other type of documentation where they can use voice where appropriate.
I don’t mean to ask too many Nuance questions, but companies that have been successful in anything vaguely related to speech recognition usually end up being bought by Nuance. Is that a concern of clients or an interest that you have?
Well, the future’s always very hard to predict, isn’t it? So I shall defer on that one. We’ll stay focused on providing a very attractive user experience and also financial experience for the users. Where that takes us in the future, who’s to know? [laughs] We’re not courting Nuance, nor are they courting us.
Talking about those potential non-physician users, how do they find you or how do you make your presence known in ways for something the average hospital hasn’t thought of?
There’s nothing like word of mouth that you make something easy for someone who had no idea it’s possible. The fact is that Nuance has invested heavily in creating awareness of speech recognition. So people have thought about potential applications, but they may not be able to implement those applications using what’s available from Nuance.
As much as anything, that’s just a fact of life. It’s very hard for one company to cover all possible eventualities. We focus on the ones which are probably not in their sweet spots. But we are in a sense down market from where they are pushing with natural language recognition, the coding engines and what have you. We are much more focused on bread and butter and workflow, and in a sense, a more mass market offering.
I don’t know how you distribute your product or who your customers are, but who’s doing something really interesting with it that would be a notable name?
First of all, how people are getting their hands on the product. The approach we take is it’s channel based. We will work people in the reseller community who, over the years, they know a lot about end users in their neck of the woods. They know where to go hunt, so to speak.
I think in respect to people whether or not they want their names used, we do have end users who are some well-known names and who certainly appreciate the fact that there is an vendor out there who is taking an attractive approach both for support and also financially. Budgets are under pressure and it’s a very low-risk way for them to use speech in their applications, because for example, we are a subscription base, which means the financial risk is fairly low. If you really don’t like the product or it doesn’t work for you, well, stop paying. [laughs] It’s a monthly subscription, as simple as that. On the other hand, if it works for you, the fact that it’s now a monthly expense rather than a large capital outlay is for a number of users a very attractive proposition.
Other than BeVocal, one of the other big successes you had business-wise was Frame Technology. You sold that to Adobe for $500 million a while back. You’ve had a lot of success in creating and selling these companies. What kinds of investments would you be looking for today in healthcare?
Everything around workflow. There’s opportunity here to look at a script we have seen before, which is with the ERP software or database software that took place in the enterprise world. You had companies like Oracle and SAP and Powersoft and others rising out of that technology wave, if you will.
The big databases are in a sense the equivalent of the big EHR systems going in. Now that we are probably most of the way through adoption of EHR, that big data repository is now in place into the hospitals or clinics. The opportunity is now for a second generation of applications to come along which can ride on top of the big iron EMR and they can then address particular types of workflow.
I think we will see a wave of companies emerging in the next five years who build on top of the EHR and go and address some of these point workflows that are hard for the big manufacturers to address because they already have their hands full with Meaningful Use and a list a mile long from their clients about the other things they need.
What are you priorities or strategies for the company for the next few years?
It’s really all about customer service. We are in the business of productivity, taking cycles out of people’s workflow. Anywhere where we see inefficiencies that we can address, we go after that.
The thesis in high tech is that it’s really an arbitrage game if you will, because you’re always taking an existing process and re-implementing it, leveraging technology to lower the cost point of that process. The difference you’ve opened up between what it costs today versus what it will cost once you put in the technology – that’s the arbitrage that you can then take your cut of and run a business on. So for us, it’s all about productivity.
Do you have any final thoughts?
For anyone reading this interview, if you would like a very friendly and approachable and high-impact customer service approach to using voice recognition in a workflow, come give us a call. I’m sure we can make you happy.
The company is so large anymore with so many subsidiaries I guess keeping on top of business analytics, contracts and policies is getting to be a chore. This is not a huge lawsuit here but the complaint is for false advertising basically with showing commercials for Secure Horizons promising competitive service and this patient found out there were no urgent care centers in network in California. A higher co-pay of $50.00 instead of $30.00 applies.
United pulled out of California with individual policies at the end of 2013 and basically what’s left here is employer insurance along with Medicare Advantage and of course Tri-Care. Maybe they are going to build urgent care centers here too like they are doing elsewhere?
Part of the case here is to also stop representing that plan participants can receive urgent care for #30.00. BD
As a result, plan beneficiaries have no choice but to incur $50 co-payments for each urgent care clinic visit they need as out-of-network claims, instead of the $30 they would pay for an in-network visit, according to the complaint.
Eventually, a United Healthcare supervisor informed him that the plan’s network included no urgent care clinics in the state at all and he was forced to pay a $50 dollar co-pay when he later needed urgent care at the recommended clinic, the complaint alleges.
Nuance announces that it has acquired image sharing vendor Accelarad and will immediately begin marketing a cloud-based document and image sharing platform called the Nuance PowerShare Network. Financial details were not disclosed.
Athenahealth reports Q1 earnings: revenue was up 30 percent at $163 million, but missed analyst estimates of $170 million, EPS $0.12 vs. $0.38.
In Australia, Epic wins a $48 million deal at Melbourne’s Royal Children’s Hospital, concluding a vendor search that reportedly included all major US vendors as well as representation from local Australian vendors.
San Francisco, Calif.-based One Medical Group, a startup building technology-laden primary care offices across the nation, raises a $40 million investment round to continue its expansion.
Here’s a few words today that coincides with a post I made a few days ago relative to the PHR starter kit in a box coming to retail markets soon from MMRGlobal aka MyMedicalRecords.com. The site needed an update to allow consumers to take advantage of ordering the starter kit on line. In addition there are some new pricing break downs as well so you don’t have to pay more for what you may not need.
In addition soon to come will be the ability to share legal documents as well. Unfortunately with healthcare in the state that it is in today leads to legal documents arising out of disputed care scenarios and if you happen to be in a dispute of any source you will be able to share documents with both doctors and lawyers from the same site, such a deal!
I looked around a bit and signed on as if I didn’t have an account to begin with. I do have an account and frankly I have more files on my dog than me but both of us are in there with our records:) I went to the “best deal’ link and this is what comes up.
If you are only needing storage and access for 2 people the cost if half of what it used to be and the same for more up to 10 family members. Its probably worth a mention here too that the laws have changed a bit and now consumers will be able to get their own copies of their lab reports now and a PHR is good place to store them for sure.
The new rule says they need to be available within 30 days and I’m sure most are going to do it via the web versus mailing on paper. I just read the other day where Quest Diagnostics is ready with their system to provide consumers copies of their labs. Labs have until October to comply so there might be some labs out there still working on their access programs.
I do have to say this has been interesting following the company for the last year too with many turn of events relative to the various licensing and patent settlements. CEO Bob Lorsch does use his own PHR program too and wrote about it not too long ago. BD
From Worth HIT: “Re: tradeshow blooper. At HIMSS Middle East, 3M’s booth described a new service offering, ‘Coding and Groping Quality.’ Go to love the high-tech fix … white tape.” The sign is full of inconsistencies: “groping” and “intelligence” are the only words not capitalized, “ICD-10” also appears as “ICD10,” some random commas found their way onto the page, and some lines end with periods while others don’t. You’re gonna need a bigger roll of tape.
From Pure Power: “Re: your 2009 thoughts about EHR data. Worth looking at again.” Well, here you go then, as I was referring five years ago to a research study about using EHR data in nephrology:
I don’t have access to the full text of the article, but I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the “pain” part), the benefit will be incredible. This article apparently deals with having nephrologists automatically consulted when the EHR finds problems. There are other benefits. You could do society-improving medical research by just slicing and dicing data from millions of patients, at least the parts of it that aren’t just clinical-sounding billing events that are useless or even misleading. You could find candidates for research trials. Patients could be followed over many years, even as they move around and use the services of a variety of providers. And for individual patients, there could be great value in putting research findings into the hands of front line doctors. Not to mention giving patients a platform whereby they can participate in their own care and add non-episodic information related to lifestyle, personal health assessment, etc. Clinical systems will not save time, as clinicians know – they exist to create data whose value mostly accrues to someone else. My advice to providers: much of your future income may be based on the data you create and the ownership in it you retain. Don’t be like the Native Americans and let greedy outsiders buy your land for trinkets.
HIStalk Announcements and Requests
A few highlights from HIStalk Practice this week include: US physicians produced $1.6 trillion in direct and indirect economic advantage in 2012. Steven Posnack creates a fun proof of concept graph that matches Medicare payment data with MU incentive payments. Boston doctors prescribe bike riding. AAFP’s president points out the disparity in compensation between family practice physicians and specialists, as evidenced by the recent release of Medicare payment data. CMS offers guidance on the Attestation Batch Upload option. A urology practice employee sends details on 1,114 patients to a competing practice to help the competitor solicit business. Thanks for reading.
This week on HIStalk Connect: Nuance acquires image-sharing vendor Accelarad, which will power a new cloud-based image and report exchange platform that integrates with its existing transcription product lines. In England, the NHS kicks-off a campaign to use telehealth and mHealth apps to reduce ED visits. The Mayo Clinic is funding a medical research assistant app designed to help consumers responsibly look up their symptoms and conditions. Dr. Travis recounts past mistakes the health IT industry has made with EHR data exchange and questions whether the same mistakes are being made with newer payment and care delivery models.
May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.
Acquisitions, Funding, Business, and Stock
Athenahealth announces Q1 results: revenue up 30 percent, adjusted EPS $0.12 vs. $0.38, missing analyst estimates for both.
Liaison Technologies raises $15 million in funding.
HCA subsidiary Health Insight Capital makes an equity investment in Intelligent InSites.
One Medical Group, a 27-location practice that heavily promotes its use of healthcare IT in providing care, raises $40 million in growth capital, bringing its total to $117 million.
Great Point Partners makes a “significant investment” in Orange Health Solutions to finance the acquisition of MZI Healthcare, developers of EZ-Cap and other technologies for ACOs and IPAs.
CareCloud reports that it added 170 clients in Q1.
Australia’s Royal Children’s Hospital in Melbourne awards Epic a $48 million contract.
Sisters of Charity of Leavenworth Health System (CO) selects Allscripts EPSi as its financial decision support system.
University Health System (TX) will deploy PeraHealth’s PeraTrend real-time patient status system, which calculates a score of acuity called the Rothman Index.
Crain’s Cleveland Business names Cleveland Clinic CIO Martin Harris, MD as its CIO of the year.
Healthcare data analytics firm GNS Healthcare hires Mark Pottle (N-of-One/Optum Insight) as CFO.
Aventura names Bill Bakken (Nordic Consulting) COO.
NaviNet promotes Sean Bridges to CFO, Sridhar Natarajan to VP of software development, and Thomas Smolinsky to VP/CISO.
Announcements and Implementations
Steward Health Care System launches the StewardCONNECT patient portal based on Get Real Health’s InstantPHR patient engagement platform.
Park Nicollet Health Services (MN) will implement StrataJazz from Strata Decision Technology for cost accounting, contract modeling, long-range financial planning, and rolling forecasting.
The Patient-Centered Outcomes Research Institute (PCORI) provides an update on its $100 million initiative to develop the National Patient-Centered Clinical Research Network that was originally announced in December. PCORI’s executive director Joe Selby, MD outlines details on governance, data security, privacy, and interoperability as participants work to build a database of 26 to 30 million EHR records in support of retrospective clinical research.
The 25-bed Dan C. Trigg Memorial Hospital (NM), which is owned by Presbyterian Healthcare Services, implements Epic.
The Whitman-Walker Clinic (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.
Cincinnati’s fire department rolls out Tempus Pro, a real-time vital signs monitoring system developed for battlefield use that allows hospital-based physicians to monitor patients being transported by ambulance.
Mayo Clinic and startup Better announce a $50 per month membership-based app that includes a symptom checker, health information, and access to a personal health assistant.
Government and Politics
The HHS’s OIG warns that some state Medicaid agencies may be putting patient health information at risk by outsourcing administrative functions offshore.
Innovation and Research
A VA survey of 18,000 randomly chosen users of its My HealtheVet system finds that a third of them use Blue Button, with three-quarters of those saying its main value is collecting their information in one place. Barriers to adoption were identified as low awareness and usability issues.
HIMSS Analytics says that healthcare IT systems with the highest growth potential are bed management, ERP, and financial modeling.
TechCrunch profiles One Medical Group, which has raised $117 million (the latest funding announcement is above) in funding to create a new kind of technology-powered medical practice, with its custom-developed EHR and portal offering appointment scheduling, refills, lab results, and access to a patient’s records from any of its 27 locations. Patients pay $149 per year for access and can use their health insurance.
It’s not exactly health IT related, but appalling: Yahoo fires its COO of only 15 months after he fails to improve the company’s advertising revenue. He didn’t get a bonus because he didn’t make his numbers, but he still walked out with a severance check of $58 million.
The Bloomberg School of Public Health at Johns Hopkins University tweets that it has exceed 1 million enrollments in its free Coursera courses. Starting soon: Community Change in Public Health, Mathematical Biostatistics Boot Camp 2, The Data Scientist’s Toolbox, Getting and Cleaning Data, Exploratory Data Analysis, and The Science of Safety in Healthcare.
BIDMC CIO John Halamka, MD offers common sense HIPAA-related tips to hospitals using patient data for fundraising:
Interesting facts from an article on clinicians who use social media in the OR:
UNC Healthcare (NC) reduces patient volumes as it adjusts to its April 4 Epic go-live.
A seventh grader undergoing cancer treatment “attends” classes in his school more than 1,100 miles away from Children’s Hospital of Philadelphia by using VGo, an audiovisual-equipped robot he can steer down the school hallway and into classrooms as he says hello to classmates. The same VGo robot is used by hospitals for patient monitoring and telemedicine.
Weird News Andy calls this story “Doc on the Run.” An Arkansas gynecologist allegedly takes smartphone pictures of his patients without their consent while they are in the stirrups. Police investigating a patient’s complaint find her photos on the doctor’s phone, but don’t initially find him (and thus WNA’s headline). Since then, however, he has been arrested and charged with video voyeurism.
Highlights from the Atlanta iHT2 Health IT Summit
By Jennifer Dennard
This was my third year in a row attending the Health IT Summit in Atlanta. It continues to be a great experience.
The conference, hosted by the Institute for Health Technology Transformation (iHT2), was held at Georgia Tech’s Academy of Medicine. It was an intimate gathering of providers, government healthcare reps, and vendors, with a few lab and pharma folks thrown in for good measure.
The topics of discussion both on stage and during networking breaks have moved over the last two years from Meaningful Use and EMRs to accountable care and patient engagement. Providers are concerned with:
Mary Jane Neff, senior director of regional IS; Katheryn Markham, VP of IS planning; Lynda Anderson, senior director of regional IS, all of Kindred Healthcare.
Thea-Marie Pascal, certified Epic clinical documentation application coordinator; Susan Still, RN, Epic ASAP lead application coordinator; Makeba Lippitt, certified Epic clinical documentation application coordinator, all of Piedmont Healthcare.
The panel on "Transforming Health Care Through HIE: Driving Interoperability" featured (from left to right) moderator Kimberly Bell, executive director, Georgia Health Information Technology Extension Center at Morehouse School of Medicine; panelists Eddy Brown, VP of business development, TeraMedica; Steve Sarros, VP/CIO, Baptist Health Care; and Sonya Christian, CIO, West Georgia Health.
The keynote presentations were solid, though a high bar was set a few years ago by Naomi Fried, chief innovation Officer at Boston Children’s Hospital (MA). My favorite session was the last, with West Georgia Health’s CIO, CFO and director of nursing all participating on the same panel, answering questions about workplace culture, Lean Six Sigma, and patient safety.
Ten companies exhibited, among them Merge Healthcare, TeraMedica, VMware, Information Management Consultants, and Jvion. Nicole Cirillo from LabCorp explained how patients can review their own lab results through its portal (Georgia is not a right-to-know state.) LabCorp now offers its own portal through which patients can, with guidance from their physicians, access results.
I had a run-in with one of our employed physicians yesterday. Some of these folks are really starting to wear me down. He’s been with us for a while, and unfortunately the EHR we purchased for our large multispecialty group many years ago does not have specific content for his specialty.
We knew this when we implemented him. We gave him the ability to use speech recognition to essentially dictate all of his office visit documentation except for orders, physical exam, and review of systems, which must be entered discretely. His staff enters other discrete data for patient history, allergies, etc.
Most of our other physicians (even those who do have content for their specialties) would kill for this arrangement. Still, it’s not enough for this guy, who demanded that I come to his office and personally shadow him to see how deficient the system is. I’m trying to win hearts and minds, so I agreed to go out. Rather than take the opportunity to show me how he sees patients and let me assess what his needs truly are, he preferred to spend the time we had standing in the hallway complaining about templates.
It turns out he has been using internal medicine templates to try to document his visits because he doesn’t like the dictation arrangements. He has the option to either dictate in the exam room with the patient present (many of our surgical consultants like this because it gives another opportunity for the patient and family to hear the diagnosis and plan of care one more time and ask questions), to release the patient to checkout and dictate in the exam room after the patient leaves, or to go to his administrative office to dictate. He has his own reasons why each of these is inadequate, but doesn’t have any suggestions for what he wants.
Of course, the internal medicine templates are completely overkill for what he’s trying to do. He has to weed through primary care clinical protocols and other information that’s not relevant to his specialty and feels frustrated. I reminded him that we didn’t train him to do this, that we recommended he use a specialty set that’s closer to his own instead, but he doesn’t like those either.
Most of our other specialists who don’t have content for their specialties are perfectly happy to dictate because it changed their workflow minimally from the paper world. Our primary care docs would love to be allowed to dictate as much as these guys can, but unfortunately for them, we need discrete data from more parts of the chart to meet payer incentive programs and other quality initiatives that we’re working on.
I’m not sure what he really wanted to get out of the visit other than to vent, which is fine, but it doesn’t change anything as far as documenting in the EHR. He wasn’t interested in any of the options I had to present and isn’t going to change his opinion. He doesn’t want a scribe. He doesn’t want to point and click. He doesn’t want to dictate. He doesn’t want a pen solution like Shareable Ink. His continued push-back (going on two years now) is an exercise in futility.
As I was driving back to my office, I got to thinking about that. This is a physician who deals regularly with patients who have life-altering injuries and conditions that cannot be fixed. His specialty is centered on helping people maximize the functionality they currently have and to compensate for what they have lost. He’s very good at what he does, yet he can’t see his EHR issues with the same perspective he uses when treating patients – helping them use what they have to the best of their abilities and not dwelling on what they don’t have or have never had.
We learn in medical school and residency to identify when interventions are futile. We call the code when there’s no hope of getting the patient back. We don’t perform surgeries when they’re not going to improve the patient’s condition. We understand that there are limits to technology and our ability to treat and cure. We’re pretty good at helping patients understand the options when they’re faced with a lack of good choices.
When it comes to limitations in information technology, however, we’re struggling mightily with the thought of applying those same concepts. The EHR of the future is going to look a lot different than what we have today – just like the laparascopic surgeries we do now are completely different from the open surgeries we did in the past. Maybe in the future we’ll beam your gallbladder out of your abdomen instead of having to cut you at all. But for the time being, we have to work with what we have as best as we can. We have to realize there are limits to everything. There’s no psychic module for EHR that’s going to document directly from your thoughts, at least not for now.
Fighting is good when it’s appropriate, but at some point, we have to realize when it’s futile and either accept our current situation or move on. I’m not sure what else to do with or for this physician since we’ve not been able to make him happy as long as we’ve been trying. I suspect there are other factors at play that have nothing to do with EHR, but they’re not within my realm to tackle. We’ll keep reinforcing his options, pair him up with peers that are successful, and encourage him. Until he’s ready to leave the group or retire, I’m not sure what else we can do.
Well, I guess there’s one more thing we could do – pastry therapy. I just dropped a little surprise at his office to thank him for his time yesterday. A girl can hope.
Dear Accelarad customer,You should have received an email from me on Monday of this week, when I provided our customers an early insight into the announcement that Accelarad is now a part of Nuance Communications. At this time, I wanted to provide you some additional information and invite you to learn more.
You can read the full press release here: (Nuance Unveils PowerShare – April 17,2014)As discussed, this new union brings together our cloud-based medical image sharing technology and Nuance’s PowerScribe radiology reporting and communication platform. The partnership will give you, our valued customer, access to Nuance’s expansive healthcare technology and professional services, while continuing to provide you with the proven software and solid relationships you have come to expect from Accelarad. With this partnership, Accelarad’s SeeMyRadiology solution has been rebranded to align with the Nuance diagnostic brand, and will be part of the Nuance PowerShare Network. To learn more about PowerShare | Image Sharing, sign up to join one of our webinars.
Most importantly, know that the products and people you have come to rely on will not change. Accelarad's leadership team and valued employees will be deeply involved in creating a smooth transition for our customers, and our focus remains on making sure you continue to receive the excellent service you deserve.
Thank you again for your support and confidence in us. We will keep you informed about any incremental changes along the way and are open to your feedback.
Willie Tillery, CEO, Accelarad
Rodney Hawkins, General Manager, Diagnostic Solutions, Nuance
Nuance PowerShare Network Unveiled for Cloud-Based Medical Imaging and Report ExchangeDefinitely an interesting constellation of services! I wonder where this might lead. Ironically, Rodney is also an old friend from the AMICAS days...
Industry’s Largest Medical Imaging Network Helps Providers and Patients Coordinate Care and Share Information Across Distances and Disparate Healthcare Systems
BURLINGTON, Mass., – April 17, 2014 – Nuance Communications, Inc. (NASDAQ: NUAN) announced today the immediate availability of Nuance PowerShare™ Network, the industry’s largest cloud-based network for securely connecting physicians, patients, government agencies, specialty medical societies and others to share essential medical images and reports as simply as people exchange information using social networks. Nuance PowerShare Network promotes informed and connected physicians and patients who can instantly view, share and collaborate while addressing patients’ healthcare needs.
“Organizations are being tasked to communicate efficiently both in and out of their networks to provide clinical insight to physicians beyond one person or office to a much broader team involved in the continuum of care,” said Keith Dreyer, DO, PhD, FACR, vice chairman of radiology at Massachusetts General Hospital and Chair of the American College of Radiology (ACR) IT and Informatics Committee. “Nuance PowerShare Network addresses the information sharing challenge physicians face today with a network that supports things we’ve dreamed of doing for years,” he adds.
Fully Connected Patients & Providers
Nuance PowerShare Network is already used by more than 1,900 provider organizations for sharing images via the cloud using open standards. Made possible through the acquisition of Accelarad, this medical imaging exchange eliminates the costly and insecure process of managing images on CDs and removes silos of information in healthcare that inhibit providers from optimizing the efficiency and quality of care they provide. Anyone can join the network regardless of IT systems in place to instantly view and manage images needed to consult, diagnose or treat patients, enabling clinicians to more seamlessly evaluate and deliver care for patients who transition between facilities or care settings.
Nuance is already used by more than 500,000 clinicians and is a critical component within the radiology workflow and a trusted partner for 1,600+ provider organizations that rely on Nuance PowerScribe for radiology reporting and communications. Healthcare organizations that use Nuance PowerScribe, a group that produces more that 50 percent of all radiology reports in the U.S., can immediately leverage their existing investment and begin sharing radiology reports along with images, such as X-rays, MRIs, CT scans, EKGs, wound care images, dermatology images or any other type of image. This simplifies secure health information exchange between multiple providers, patients and disparate systems without costly and time-consuming interfaces, CD production or the need to install additional third-party systems.
“The challenge of sharing images with interpretive reports is something we’ve heard about consistently from our customers and EHR partners, and we know Nuance PowerShare Network will overcome this major obstacle, helping physicians treat patients more efficiently and effectively,” said Peter Durlach, senior vice president of marketing and strategy, Nuance Communications. “This nationwide network, one that is fully integrated into the EHR workflow and already connected to approximately half of all clinicians producing diagnostic imaging information, is a ground-breaking solution that delivers immediate benefits at an unprecedented scale to our healthcare system.”
“Integrated image and report sharing helps us deliver quality care and drive down costs especially when patients transfer from one facility to another. Whether at their desktop or on their mobile device, our physicians can see the study that was done along with the interpretive report, which provides the information they need to treat the patient and avoid duplicate testing,” says Deborah Gash, vice president and CIO, Saint. Luke’s Health System in Kansas City. “By integrating this with our EHR, PowerShare will enable physicians to manage inbound imaging through one point of access and login. Physicians in our 11 hospitals and 100-mile radius referral network see this cutting-edge technology as a way to deliver the highest level of patient care,” she adds.
To learn more about the PowerShare Network and the new image sharing solution, visit http://www.nuance.com/products/PowerShareNetwork to join one of our webinars. Connect with Nuance on social media through the healthcare blog, What’s next, as well as Twitter and Facebook.
By refusing to pay for readmissions within 30 days of discharge from a hospital, Medicare has sent a strong message across the healthcare industry: < 30 day readmissions should be avoided at all costs. As a result, providers and vendors are doing everything in their power to avoid < 30 day readmissions.
This seems like a simple way to reduce costs, right? Well, not quite…
The vast majority of costs of care delivery are fixed: capital expenditures, facilities and diagnostics, 24/7 staffing, administrative overhead, etc. In other words, it’s extremely expensive just to “keep the lights on.” There are some variable costs in healthcare delivery – such as medications and unnecessary tests – but the marginal costs of diagnostics and treatments are small relative to the enormous fixed costs of delivering care.
Thus, Medicare’s < 30 day readmission policy doesn’t really address the fundamental cost problem in healthcare. If costs were linearly bound by resource utilization, than reducing readmissions (and thus utilization) should lead to meaningful cost reduction. But given the reality of enormous fixed costs, it’s extremely difficult to move down the cost curve. To visualize:
Medicare’s < 30 day readmission policy is a bandaid – not a cure – to the underlying cost problem. The policy, however, reduces Medicare’s outlays to providers. Rather than reduce (or expand, depending on your point of view) the size of the pie, Medicare has simply dictated that it will keep a larger share of the metaphorical pie for itself. Medicare is simply squeezing providers. One could argue that providers are bloated and that Medicare needs to squeeze providers to drive down costs. But this is intrinsically a superficial strategy, not a strategy that addresses the underlying cost problems in healthcare delivery.
So how can we actually address the fixed-cost problem of healthcare? Please leave a comment. Input is welcome.
There are 6 doctors in her network that will take her plan, but she can’t get an appointment for what ever reason with any of them. Her prescriptions are denied. She had to get a Congressman to intervene to get some of her prescriptions and there are others in the same boat. Top cancer centers are now no longer on the list either so we have these new models that are being used with restrictive networks that are netting the same results, no care. Even within their own business intelligence, and here’s one example below where United goes out and bids and finds their restrictive networks they established didn’t allow for any doctors to see patients. This was a Medicare Advantage contract they bid and were awarded for a retiree plan. The county has to rescind it because they had restricted the network of available providers down to such a definitive list of criteria, that there were none left to keep in network, but as we are always told “this is a business decision”.
As I wrote in a recent post at the link below, in essence the “death panels” are not gone, they have taken a new shape and are now algorithmic formulas that show up and based on criteria used, care is denied, so now I guess we can say it’s a business decision made by the criteria of the algorithms that run on servers 24/7 making life impacting decisions about all of us. This is how modeling and math formulas work. I urge you to watch the 4 videos in the footer of this blog to get a better idea of how you get duped on some of this and how models work for profit. The information is a lot about the financial markets but you have the same thing with models with insurers and they too are hiring new Quants to create risk assessment models for profit.
This is what worried me way back when the law was created that the government would be “out foxed” by insurers as that’s what they do as we have years of denials due to pre-existing conditions that denied care and now with smaller networks they are using a new risk model for profit and people don’t get care. Whether you want to see how this works or not, this is it and how and why this happens. Government is outdone with for profit business models and this is what banks and insurers do all the time, work the models and we are not able to see exactly how it all computes as that’s proprietary computer code making the decisions as the formulas run on servers 24/7. Here’s the latest on United Healthcare kicking doctors out of network that see Medicare Advantage patients too, their business intelligence algorithmic formulas. Right in New York where this patient is located, here’s the scoop on doctors being dropped right and left by United Healthcare.
But if you happen to be the wife of banker, the company seemed to have no problem paying over $175,000 for a hammer toe procedure, so again what type of business intelligence are insurers using here. The money sent to that doctor sure would have been a welcome sight for this patient who has been denied.
The game just like what happens on Wall Street is fixed here too and thus I call this yet one more Attack of the Killer Algorithms. Here’s a former Wall Street Quant that now does a lot of work with the Occupy movement that did a video that explains how this works too, it’s all modeled. Killer Algorithms exist when math and formulas deny consumers access to care, money, etc. when the data is all wrong and/or flawed or just modeled for profit and my series shows every day events where this occurs and hurts consumers.
I also asked the question recently too on how long before we begin calling health insurance a “science” as that’s what we seem to do today is call everything that has become complex with extreme business models, a science. Again with all the talk about the markets today being “rigged”, well this too is rigged but in a different fashion but using the same mathematical types of models to do it.
I call this “The Grays” to where people are not able to tell the difference anymore on what is a virtual world value versus a real world value. The real world has people that are sick and need care and the virtual worlds and models make it appear that this risk factor doesn’t really exist if you will and we are given tons of statistics to drive you over to that type of belief. So every day now we get some story with jaws dropping accountings on “how can this happen”..it’s the math and the subsequent algorithmic business models that do it. You are sold one perception while in fact another real world crisis is taking place, so you get blinded. Check out the 100 bottles of beer videos clip here and you can see why it end up maybe being 80 or 200 and in this model the numbers of bottles is like one or two. In essence your care that you need is never going to be 100 bottles if you will, and this how it works today in the “modeled” business world. This is the #1 Quant in the world, Paul Wilmott sharing some words of wisdom and if you want to see the entire video, it’s #2 in the footer.
So we have this issue and then let’s take a look at the priorities of CMS these days too. Patient don’t have access to so many physicians and facilities who offer the care and help, so in view of all of this taking place, we have this oxymoron mentality of having to create 5 star ratings for hospitals. See the link below, so does this make any sense at all? Just one more case of “The Grays” at CMS I might say with some strange perceptions on what they think is relative today and this is not it, but as long as they believe it is, well not much gets done back over at the real worlds as this rating system they are working on is nothing more than some virtual values to dish out.
I should maybe say here too that these algorithms have no political ties either, it’s math for profit; however insurers will tend to go in the direction of lawmakers to where they can lobby and present a marketing type of situation to where they “think” they have the entire picture when in fact they don’t and are also hanging in “The Grays”…as that’s the plan, keep this complicated, just they do on Wall Street and you keep hearing that over and over in the last couple of weeks since the release of the book, “Flash Boys”..same principles for profit here.
I know how this works with profits and I’m not picking on insurers making a profit but does it have to be “that big” to where business models used are presenting this type of end result? I guess we are somewhat reach a crossroads here on where do ethics come into play with making money? From what is materializing in the news, it appears that money has the top billing for now at least. Below is a link written by a former Wall Street Quant who understand and share some of this with us and it’s important as she’s telling us to be a skeptic when we need to be and Cathy is also video #3 in the footer of this blog too, way back used to write models for Larry Summers and bonus points at the end for a couple of comments on her history there. I have a few more links and videos at the Algo Duping page too that discusses both how you get duped and the end result of bite of the Killer Algorithms as they occur. BD
"I've been vomiting. I lost 22 pounds. The pain is unbearable," said Margaret Figueroa, 49, on Wednesday. "My medication helps me function during the day."
Figueroa suffers from a disease known as Arnold Chiari Malformation and Syringomyelia. Even though the Obamacare plan she purchased assured her that she was covered, her insurance card was denied when she went to fill her prescriptions. Then she learned that none of her doctors accept her Obamacare plan. Figueroa says she cannot find a doctor who accepts her Obamacare plan; indeed, there are only six doctors in all of Staten Island who take her plan, none of whom she's been able to get appointments with.
Figueroa's congressman, Rep. Michael Grimm (R-NY), intervened to help her obtain some of her vital prescriptions. Grimm says he's already received calls from at least a dozen Staten Island residents facing the same problem with Obamacare's "narrow networks" – extreme restrictions to doctor and hospital access imposed by Obamacare.
Obamacare's narrow networks have also shut out access to top cancer centers. The Associated Press says just 4 of 19 nationally recognized comprehensive cancer centers offer Obamacare access through all insurance plans in their state Obamacare exchanges, and a McKinsey and Co. study revealed 38% of all Obamacare plans only allow patients to pick from just 30% of the largest 20 hospitals in their areas.
I admire those who can explain the complex simply. In researching the latest developments in neuroscience and technology, I discovered the brilliant Dr. Story Landis, a neurobiologist and the Director of the National Institute of Neurological Disorders and Stroke.
Dr. Landis is part of the leadership for the President’s new “BRAIN Initiative,” a Grand Challenge of the 21st Century, and provides an easy overview of the latest advances in neurotechnology in this video (starting at 5:05).
She presented at the Society of Neuroscience’s Annual Convention as part of a distinguished panel to discuss the new brain initiatives in the United States and in Europe for 2014.
The acronym, BRAIN, stands for Brain Research through Advancing Innovative Neurotechnologies.
According to the National Institutes of Health, “By accelerating the development and application of innovative technologies, researchers will be able to produce a revolutionary new dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space.”
The goal of the initiative is to develop tools for researchers to discover new ways to treat, cure, and even prevent brain disorders. Through these technologies, researchers will explore “how the brain enables the human body to record, process, utilize, store, and retrieve vast quantities of information, all at the speed of thought.”
Neuroscientists need a consistent map of brain anatomy, but there isn’t one yet. Why? According to the Kavli Foundation, one of the partners of the initiative, “In the fast-moving field of neuroscience, researchers constantly reorganize brain maps to reflect new knowledge. They also face a vocabulary problem. Sometimes, different research groups will use several words to describe a single location; other times, a single word may mean different things to different researchers. Nor do maps remain consistent when moving across species.”
A Connectome is a structural description of the brain first proposed by Olaf Sporns. The Human Connectome Project (HCP) is a consortium comprehensively mapping brain circuitry in 1,200 healthy adults using noninvasive neuroimaging, and making their datasets freely available to the scientific community. Get the HCP data here.
Four imaging modalities are used to acquire data with unprecedented resolution in space and time. Resting-state functional MRI (rfMRI) and diffusion imaging (dMRI) provide information about brain connectivity. Task-evoked fMRI reveals much about brain function. Structural MRI captures the shape of the highly convoluted cerebral cortex. Behavioral data provides the basis for relating brain circuits to individual differences in cognition, perception, and personality. In addition, 100 participants will be studied using magnetoencephalography and electroencephalography (MEG/EEG). – HumanConnectome.org
Brainbow is the process by which individual neurons in the brain can be distinguished from neighboring neurons using fluorescent proteins. The idea is to color-code the individual wires and nodes, and was developed at the Center for Brain Science at Harvard.
CLARITY (Clear, Lipid-exchanged, Anatomically Rigid, Imaging/immunostaining compatible, Tissue hYdrogel) is a method of making brain tissue transparent, and offers a three-dimensional view of neural networks. It was developed by Karl Deisseroth and colleagues at the Stanford University School of Medicine.
The ability for CLARITY imaging to reveal specific structures in such unobstructed detail has led to promising avenues of future applications including local circuit wiring (especially as it relates to the Connectome Project). Pictured is a mouse brain with CLARITY.
Optogenetics uses light to control neurons that have been genetically sensitized to light. Optogenetics is credited with providing new insights for Parkinson’s Disease, autism, Schizophrenia, drug abuse, anxiety and depression.
Also part of the leadership for the BRAIN initiative is neuroscientist William Newsome of Stanford University:
Most of us who have been in this field in the last few decades understand that there is a revolution going on right now, so these tools we’ve mentioned already did not exist 8 years ago, and some did not exist 6 months ago. The pace of technological change is so rapid right now that those of us who were traditional experimental scientists say, “Whoa, what does it even mean to be an experimental scientist in this day and age?” We have to totally rethink what experiments are even possible, and it opens up vistas that were unimaginable 10 years ago.
Dr. Newsome recently wrote about the Initiative in JAMA Neurology:
“Missing, however, has been an understanding of how the many millions of neurons associated with a perception, thought, decision, or movement are dynamically linked within circuits and networks. Even the simplest perceptual task involves the activity of millions of neurons distributed across many brain regions. How simple percepts arise from patterned neural activity and how the resulting percepts are linked to emotion, motivation, and action are deeply mysterious. In the past, answers to these questions seemed out of reach.”
To get a deeper understanding of the brain before and after disorders, neuroscientists from the University of California San Francisco have established a new “Brain Health Registry.” Their goal is to address one of the biggest obstacles to cures for brain disorders – the costs and time involved in clinical trials. To register your brain, participate in games, and help scientists, read more in the FAQs.
The average adult brain is about 1,300 to 1,400 grams or 3 pounds, and is about 5.9 inches or 15 centimeters long. It is often quoted that are 100 billion neurons in the human brain, but Dr. Suzana Herculan-Houzel of Brazil recently discovered there are 14 billion fewer. According to her research, the human brain has 86 billion neurons or nerve cells.
What is the impact of brain disorders in the U.S.?
According to the World Health Organization, brain disorders are a leading contributor to the global disease burden, and the fourth highest for Western developed countries. About 50 million people in the U.S. suffer from damage to the nervous system, and there are more than 600 neurological diseases.
Psychiatric Illness – About 1 in 4 American adults suffer from a diagnosable mental disorder in any given year, according to the NIMH.
Alzheimer’s – In 2014, there are 5.2 million people in the U.S. with Alzheimer’s Disease, according to the Alzhemier’s Association. With the growth of the Baby Boomer generation, it is expected that between 11 and 16 million will be affected by 2050.
Parkinson’s – The Parkinson’s Foundation estimates 1 million Americans live with Parkinson’s Disease.
Autism – One in 68 children in the U.S. are affected by Autism Spectrum Disorder, a 30% increase from two years ago.
The BRAIN Initiative involves a number of government agencies and private partners fostering a multi-disciplinary approach to research and technology. Specifically, it is a unique collaboration across disciplines involving the National Institutes of Health and the National Science Foundation. Learn more in this video with Dr. Tom Insel, Director of the NIMH, and Dr. Fleming Crim of the NSF, as they discuss exploring the connections between the life sciences and physical sciences in understanding the brain.
Through a Call to Action, the White House has asked to hear from companies, health systems, patient advocacy organizations, philanthropists, and developers about the unique activities and capabilities underway that could be leveraged to catalyze new breakthroughs in our understanding of the brain.
Do you have an idea? You have until May 1st to send your ideas to: email@example.com.
If you’ve ever traveled to a country that doesn’t speak your native tongue, you can appreciate the importance of basic communication. If you learn a second language to the degree that you’re adding nuance and colloquialisms, you’ve experienced how much easier it is to explain a point or to get answers you need. What if you’re expected to actually move to that foreign country under a strict timeline? The pressure is on to get up to speed. The same can be said for learning the detailed coding language of ICD-10.
The healthcare industry has been preparing in earnest to move from ICD-9 coding to the latest version of the international classification of diseases. People have been training, testing and updating information systems, essentially packing their bags to comply with the federal mandate to implement ICD-10 this October — but the trip was postponed. On April 1, President Barrack Obama signed into law a bill that includes an extension for converting to ICD-10 until at least Oct. 1, 2015. What does this mean for your ICD-10 travel plans?
Despite the unexpected delay, you’ll be living in ICD-10 country before you know it. With at least another year until the deadline, the timing is just right to start packing and hitting the books to learn the new codes and to prepare your systems. For those who have a head start, your time and focus has not gone to waste, so don’t throw your suitcases back into the closet. The planning, education and money involved in preparation for the ICD-10 transition doesn’t dissolve with the delay – you’ve collected valuable tools that will be put to use.
Although many people, including myself, are disappointed in the change, we need to continue making progress toward the conversion; learning and using ICD-10 will enable the United States to have more accurate, current and appropriate medical conversations with the rest of the world. Considering that it is almost four decades old, there is only so much communication that ICD-9 can handle; some categories are actually full as the number of new diagnoses continues to grow. ICD-9 uses three to five numeric characters for diagnosis coding, while ICD-10 uses three to seven alphanumeric characters. ICD-10 classifications will provide more specific information about medical conditions and procedures, allowing more depth and accuracy to conversations about a patient’s diagnosis and care.
Making the jump to ICD-10 fluency will be beneficial, albeit challenging. In order to study, understand and use ICD-10, healthcare organizations need to establish a learning system for their teams. The Breakaway Group, A Xerox Company, provides training for caregivers and coders that eases learning challenges, such as the expanded clinical documentation and new code set for ICD-10. Simply put, there are people can help with your entire ICD-10 travel itinerary, from creating a checklist of needs to planning a successful route.
ICD-10 is the international standard, so the journey from ICD-9 codes to ICD-10 codes will happen. Do not throw away your ICD-10 coding manuals and education materials just yet. All of these items will come in handy to reach the final destination: ICD-10.
Xerox is a sponsor of the Breakaway Thinking series of blog posts.
This is a guest blog by Nial Toner of PathXL, a vendor of cloud-based digital pathology systems. I asked him to discuss the benefits of cloud computing in digital pathology and barriers to its deployment. There will be some emphasis placed on digital pathology at the upcoming Pathology Informatics Summit 2014 (see: Digital Pathology Well Represented at Pathology Informatics Summit 2014)--BAF
In digital pathology, cloud computing can help to deliver cost effective healthcare and also help to manage the growing amount of data that is generated by the technology. Cloud computing provides many benefits but also some drawbacks. The benefits of cloud computing in digital pathology are the following:
Despite these benefits, some reservations and barriers to using cloud technology in digital pathology persist and include:
While the benefits are substantial, cloud computing has yet to make any major inroads in pathology. Despite this, cloud computing in support of digital pathology is increasingly being used for medical education and in research settings. The future for cloud technology does look bright and the value of cloud computing for the healthcare industry has been predicted to reach $5.4 billion by 2017. We are all increasingly adapting to a mobile world and digital pathology will make a major contribution to this goal.
A post-stroke rehabilitation system integrating robotics, VR and high-resolution EEG imaging.
IEEE Trans Neural Syst Rehabil Eng. 2013 Sep;21(5):849-59
Authors: Steinisch M, Tana MG, Comani S
We propose a system for the neuro-motor rehabilitation of upper limbs in stroke survivors. The system is composed of a passive robotic device (Trackhold) for kinematic tracking and gravity compensation, five dedicated virtual reality (VR) applications for training of distinct movement patterns, and high-resolution EEG for synchronous monitoring of cortical activity. In contrast to active devices, the Trackhold omits actuators for increased patient safety and acceptance levels, and for reduced complexity and costs. VR applications present all relevant information for task execution as easy-to-understand graphics that do not need any written or verbal instructions. High-resolution electroencephalography (HR-EEG) is synchronized with kinematic data acquisition, allowing for the epoching of EEG signals on the basis of movement-related temporal events. Two healthy volunteers participated in a feasibility study and performed a protocol suggested for the rehabilitation of post-stroke patients. Kinematic data were analyzed by means of in-house code. Open source packages (EEGLAB, SPM, and GMAC) and in-house code were used to process the neurological data. Results from kinematic and EEG data analysis are in line with knowledge from currently available literature and theoretical predictions, and demonstrate the feasibility and potential usefulness of the proposed rehabilitation system to monitor neuro-motor recovery.
Brain-computer interfaces: a powerful tool for scientific inquiry.
Curr Opin Neurobiol. 2014 Apr;25C:70-75
Authors: Wander JD, Rao RP
Abstract. Brain-computer interfaces (BCIs) are devices that record from the nervous system, provide input directly to the nervous system, or do both. Sensory BCIs such as cochlear implants have already had notable clinical success and motor BCIs have shown great promise for helping patients with severe motor deficits. Clinical and engineering outcomes aside, BCIs can also be tremendously powerful tools for scientific inquiry into the workings of the nervous system. They allow researchers to inject and record information at various stages of the system, permitting investigation of the brain in vivo and facilitating the reverse engineering of brain function. Most notably, BCIs are emerging as a novel experimental tool for investigating the tremendous adaptive capacity of the nervous system.
Android Wear will show you info from the wide variety of Android apps, such as messages, social apps, chats, notifications, health and fitness, music playlists, and videos.
It will also enable Google Now functions — say “OK, Google” for flight times, sending a text, weather, view email, get directions, travel time, making a reservation, etc..
Google says it’s working with several other consumer-electronics manufacturers, including Asus, HTC, and Samsung; chip makers Broadcom, Imagination, Intel, Mediatek and Qualcomm; and fashion brands like the Fossil Group to offer watches powered by Android Wear later this year.
If you’re a developer, there’s a new section on developer.android.com/wear focused on wearables. Starting today, you can download a Developer Preview so you can tailor your existing app notifications for watches powered by Android Wear.
A Hybrid Brain Computer Interface System Based on the Neurophysiological Protocol and Brain-actuated Switch for Wheelchair Control.
J Neurosci Methods. 2014 Apr 5;
Authors: Cao L, Li J, Ji H, Jiang C
BACKGROUND: Brain Computer Interfaces (BCIs) are developed to translate brain waves into machine instructions for external devices control. Recently, hybrid BCI systems are proposed for the multi-degree control of a real wheelchair to improve the systematical efficiency of traditional BCIs. However, it is difficult for existing hybrid BCIs to implement the multi-dimensional control in one command cycle.
NEW METHOD: This paper proposes a novel hybrid BCI system that combines motor imagery (MI)-based bio-signals and steady-state visual evoked potentials (SSVEPs) to control the speed and direction of a real wheelchair synchronously. Furthermore, a hybrid modalities-based switch is firstly designed to turn on/off the control system of the wheelchair.
RESULTS: Two experiments were performed to assess the proposed BCI system. One was implemented for training and the other one conducted a wheelchair control task in the real environment. All subjects completed these tasks successfully and no collisions occurred in the real wheelchair control experiment.
COMPARISON WITH EXISTING METHOD(S): The protocol of our BCI gave much more control commands than those of previous MI and SSVEP-based BCIs. Comparing with other BCI wheelchair systems, the superiority reflected by the index of path length optimality ratio validated the high efficiency of our control strategy.
CONCLUSIONS: The results validated the efficiency of our hybrid BCI system to control the direction and speed of a real wheelchair as well as the reliability of hybrid signals-based switch control.