One thing’s for sure about patient portals: They’re a hot commodity.
What’s less clear is how much good they’re doing for health care.
The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.
Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.
But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.
In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”
Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.
Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.
Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.
The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.
When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.
The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.
Identity and the Leader
I vividly recall, at age 17, jumping off the bus at the in-processing station of Ft. Dix, New Jersey, where a drill sergeant greeted me—screaming. By the third day, I was wearing a uniform, had a shaved head, and was organized into a squad and a platoon.
The drill sergeant shouted, “Look to your left, look to your right, and now look down at yourself. In nine weeks, one of you will not be here, because you do not have what it takes to be a United States warrior!” Gulp. He scared the crap out of me.
But looking around myself, I determined I was better than at least one or two of my fellow trainees. Yep, I would be OK.
A couple of weeks after I graduated as Private Marx, I entered freshman orientation at Colorado State University as a poster child for insecurity. I have no recollection of who spoke that day, but I do remember him saying that 80,000+ students had graduated in the past 100 years. I pondered the odds and decided that surely there were other bozos who made it, so I, too could succeed.
Since childhood, the comparison method had been a pervasive mindset. My identity had been in what I was rather than who I was. And I had based my success on what I could create rather than why I had been created. I floundered under that junior-high mentality of “I am significant because you are less significant.”
This warped attitude gave me a false confidence in the workplace. I compared myself to my peers and to those above me. Sometimes I would try to learn from others who were stronger and smarter than I, but more often than not I would pounce on their weaknesses to climb over them and up the career ladder. Sure, my skills and talents have helped boost my success, but I was also counterfeiting my identity and confidence based on others’ deficiencies and weaknesses.
Leaving that mindset behind, I’ve been searching for the real me and trying to live as the genuine Ed—insecurity surrendering to conviction.
After qualifying for the USA national championship Duathlon (run-bike-run) as an average athlete, I had just hoped to finish the darned race. Qualifying for a spot on Team USA was not only about to become a dream come true, but also a test of my desire to be the genuine Ed.
At first, I suffered second thoughts based on my insecurities. The odds for success were not in my favor. In fact, competing at this elite level, I would likely end up embarrassing myself. But there I was already comparing myself again. Yet this was my only shot to compete with the gifted.
When I arrived in Tucson and began the registration process, I started doing what most athletes do—comparing myself to others. That guy has less body fat. Another athlete was clean-shaven all over. The guy next to him had a $10,000 bike. The woman in the corner was sponsored … And pretty soon I stood there mentally defeated with the race a mere two days away. I was still basing my success on how I compared to others, not on who I was.
Damn that warped thinking! I stopped it and chose to walk in the opposite spirit. I decided that what I had—a strong heart, a decent bike, and an OK albeit hairy body—was sufficient. I chose to look forward and not to my right or left. The outcome wasn’t in my hands anyway. As an athlete, what mattered was, how will my stats in this performance compare to my stats in the previous races? Was I improving? Forget the guy racing next to me. If I was meant to represent Team USA at the 2014 World Championships, then that would happen.
Identity is a tricky thing. What is it? How is it formed? How does it impact who we are and our performance? Most of the time, I base my identity on how I believe I compare to others. I suspect most of us are mis-wired to think this way.
I don’t claim to have it figured out; I already proved that. My true identity is squaring who I was made to be and living congruent with this truth. I’m still working on it, but as I approach 50, I’m finally getting close. If these ideas help nudge you in the right direction, I will have accomplished my goal for this post.
Some self-reflection ideas:
Who are you really? And are you happy with you?
To view my full reflections in depth, leave a comment with a request and I’ll send you “Identity and the Leader” Part 2.
Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.
Hearst Corporation acquires an 85 percent stake in Homecare Homebase, the #1 KLAS rated home health and hospice software vendor.
Martin Health System (FL) will deploy a new biometric patient identification solution from RightPatient that uses iris scanning to positively identify patients. MHS executives expect that the new system will help stop patient identity fraud, eliminate the creation of duplicate medical records, and reduce billing errors.
KLAS forms an imaging advisory board to lead a new project focused on imaging-based research.
Adventist (CA) will go live with Cerner across 50 clinics this week, completing a network-wide install.
Medical researchers are turning to new ways to fund their work in light of cuts at the NIH due to the sequester and chronic cost-cutting by the agency. I recently blogged about a project at the University of Michigan called MCubed in which individuals outside of the University are encouraged to fund seed projects at the University to the tune of $75,000 (see: Fund Your Own Seed Research Project at the University of Michigan). For MCubed, the funders must have a research question in mind to ask and then are able to tap into the UM faculty resources to get answers. Another approach is being tried at the University of Minnesota by a surgeon/researcher; he is pursuing crowdfunding to support his cancer treatment research (see: Impatient with NIH, cancer researcher turns to crowdfunding), Below is an excerpt that provides more details about this approach:
Dr. Daniel Saltzman says he can prove that bacteria that ordinarily cause food poisoning in people can be modified for use as guided missiles to deliver cancer-killing payloads into tumors. But he needs $500,000 for some preliminary work, and despite his project’s potential, he’s not holding his breath for funding from the National Institutes of Health (NIH), the nation’s leading source of biomedical research grants. So Saltzman has teamed up with an entrepreneur in the television industry and Twin Cities advertising and public relations professionals to make an unusual direct appeal to the public. In the process, he’s helping to bring so-called crowdsourcing to the field of medical research....To convince people of his work’s promise, Saltzman and his partner have built a website branding his research “Project Stealth,” created an eye-catching plush toy to represent the salmonella bacterium, made a video featuring Saltzman and a golden retriever named Buddy, and turned to private fundraising events and crowdfunding avenues like Razoo.com. Saltzman, who has raised about $32,000 since launching Project Stealth in mid-October, acknowledges that the approach is unusual. But he says that, with federal research funds getting tighter every year, he had little choice....
Over the past decade, inflation has eroded more than 20 percent of the buying power of NIH grants for scientists studying genomics, neurology, cancer, heart disease and countless other health issues. With so many competing projects, NIH has reduced the percentage of requests it has funded. Such novel fundraising methods raise concerns because they don’t go through the conventional peer-review process, said Arthur Caplan, a medical ethicist at New York University’s Langone Medical Center. And when they rely on celebrities, as some do, they can draw money for reasons other than scientific merit, he said....Caplan’s only concern was why the project hadn’t drawn NIH or foundation funding given its promising results in animals.....The idea of crowdfunding Saltzmans’ work came from Max Duckler, a semiretired entrepreneur who in 1993 founded CaptionMax, a closed-captioning service for television. Duckler has a degree in biology and a lifelong fascination with medicine. He attended a fundraiser where he bid to spend a day with a surgeon. He won, shadowed Saltzman on six surgeries, and learned about the cancer research. Duckler said he was disturbed to find that Saltzman and his lab workers were worried whether they could afford to spend $600 to buy special research mice.
We are obviously moving from a highly controlled, peer-reviewed research funding environment to one that differs in many respects. On the one hand, I applaud the efforts of individuals like Dr. Saltzman who seems to have a flair for marketing and promotion of his research. However, does the lack of NIH funding suggest a lack of merit for the research? Not necessarily because NIH funds are diminishing, as noted above, and it's often difficult for younger researchers to get a toehold in the NIH funding hierarchy. It's to Dr. Saltzman's credit that he has gotten the attention of an entrepreneur named Max Duckler who is working on Saltzman's behalf. Although the NIH peer-review system is tried and true, it tends to favor accepted research hypotheses and researchers with well-known mentors. Medical researchers have always been required to be entrepreneurial in the sense that they have to continuously hustle for funding. Some of these new funding approaches can only stimulate this entrepreneurship. Hopefully, all of this will result in better research outcomes.
We all know that October 1, 2014 is the date when ICD-10 will go live in the US (if you didn’t know that shame on you, but you know now). There have been plenty of rumblings that ICD-10 is going to be delayed…again. In fact, I even hypothesized that the Healthcare.gov debacle could prompt HHS to delay ICD-10 again.
While I think that there are plenty of reasons why they could choose to delay ICD-10, I now think that there’s no way HHS is going to delay ICD-10 (meaningful use may be another story). There’s so much momentum behind ICD-10 and with the previous delays, I think HHS will go forward with ICD-10 regardless of whatever reasons people come up with for delay.
Is your organization ready for ICD-10? What do you think about the possibilities of a delay? I’m interested to know your views in the comments, but for those too shy to comment I’ve embedded a poll below where you can rate delay or not on a scale from 1 to 5.
In a more complex question to answer, I’m also interested to know if readers think their IT and EHR vendors will be ready for ICD-10. Vote in the poll below.
Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.
Hearst Corporation will acquire 85 percent of Homecare Homebase, the #1 KLAS-ranked software provider for the homecare and hospice market. Hearst’s other healthcare IT companies include First Databank, Map of Medicine, and Zynx Health.
From N2InformaticsRN: “Re: CAP Consulting. The College of American Pathologists is dissolving CAP Consulting, its informatics consulting practice. This is the group that was doing exceptional work in terminology and standards with a deep understanding of the information needs and challenges faced by providers across the health care delivery and laboratory spectrum. More recently they developed an effective framework to assess and tackle health information management. The team has unique skill sets and helped us ensure ontological correctness by developing a terminology roadmap. It will be interesting to see who picks these folks up or whether they form a consulting group on their own.” Unverified. We have a call scheduled for Wednesday with CAP Consulting to learn more.
Welcome to new HIStalk Platinum Sponsor Physician Technology Partners. The physician-owned and led consulting company offers provider-to-provider services that make Epic-using physicians more productive. Its physician champions hold ASAP and EpicCare Ambulatory certifications. PTP’s six-phase approach to building to optimize for quicker ROI includes strategic planning, implementation, build and validation, training, go-live support, and optimization. They’ve done it for customers that include Ohio State, UCSF, Sutter, Exempla, Texas Children’s, Providence, University of Miami, and a bunch more names you would know. PTP’s expertise also includes making Dragon speech recognition work optimally in an Epic environment. Thanks to Physician Technology Partners for supporting HIStalk.
I have an interesting challenge with HIStalkapalooza. Jonathan Bush has a conflict and, for the first time since the inaugural HIStalkapalooza in 2008, we may need to find someone else to present the HISsies awards (travesty, I know.) I need someone who has commanding stage presence, a wicked sense of humor, and a cynical view of healthcare IT (extra points for being able to swig large-format bottles of high-gravity beer while uttering a non-stop stream of one-liners during the otherwise august proceedings.) Let me know if you’ve seen anyone who can approximate JB’s on-stage magic since otherwise Inga’s going to have to get up there and she will be terrified.
Post-acute care software provider Brightree acquires MedAct LLC, a developer of home medical equipment and DME software solutions.
Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.
Shareable Ink closes $10.7 million in Series C financing and names former Allscripts CEO Glen Tullman to its board.
Lexmark will consolidate four acquired businesses — Pacsgear, Saperion, Twistage, and Acuo Technologies — under its Perceptive Software subsidiary.
AnMed Health (SC) will implement technology from Iatric Systems to integrate multiple hospital and departmental systems.
The Metropolitan Chicago Healthcare Council selects HIE technology from Sandlot Solutions.
Children’s National Medical Center (DC) will deploy Streamline Health’s OpportunityAnyWare business analytics software suite.
Kristina Greene (Proxicom) joins Lucca Consulting Group as RVP.
Acusis names Richard Simonetti (Horiba Medical) VP of strategic business solutions.
Kareo hires Amyra Rand (HireRight) as VP of sales.
Perigen appoints Chip Long (Merge Healthcare) SVP of growth and development.
RCM service provider MedData appoints Paul Holland (QuadraMed) VP of sales and Carl Naso (Aleris International) corporate controller.
Stephen Bernard (Accretive Health) joins Connance as VP of professional services.
Valence Health names Nathan Gunn, MD (Verisk Health) VP of population health and Dan Blake (AirStrip Technologies) SVP of software product development.
KLAS names six members to its first-ever imaging advisory board: Mark Christensen (Intermountain Healthcare), Karen McGraner (Exempla St. Joseph Hospital Denver), Eugene V. Pomerantsev (Massachusetts General Hospital), Peter S. Rahko (University of Wisconsin Hospital), Pablo Ros (University Hospitals HS Cleveland), and Brian Wetzel (Our Lady of Lourdes Memorial Hospital Binghamton.)
Announcements and Implementations
Pro-Laudo, a teleradiology practice in Brazil, implements eRAD PACS with integrated reporting and speech recognition.
PeaceHealth Medical Group in Longview, WA goes live on Epic.
Hospitals and skilled nursing facilities in California’s Santa Clara county will deploy CareInSync’s Carebook platform to coordinate care transitions.
Cheyenne Regional Medical Center (WY) converts patient information and data from seven legacy systems into a single platform integrated with Epic using Hyland Software’s OnBase ECM solution.
More than 50 Adventist Health/Central Valley Network (CA) facilities go live this week on Cerner.
Martin Health System (FL) deploys the RightPatient iris biometrics patient identification system from M2SYS Healthcare Solutions.
Providence Health & Services (WA) opens a clinic without a waiting room in its first go-live of RTLS from Versus Technology.
UCLA Health System (CA) opens the Lockheed Marking UCLA TeleHealth Suite and Lockheed Martin Outpatient Recovery Suites for Wounded Warriors of Operation Mend, which were made possible by a $4 million gift from Lockheed Martin.
GE Healthcare launches Centricity 360, an online clinical collaboration tool that provides real-time sharing of data.
3M Health Information Systems releases 3M ChartScriptMD Software for Radiology, a reporting application that allows radiologists to create, sign, and distribute complete reports and communicate diagnostic findings from a single, integrated system.
Congratulations to Tampa General Hospital (FL), which VP/CMIO Richard Paula tells me has earned HIMSS EMRAM Level 7 with its $90 million Epic system.
Innovation and Research
Researchers from NORC at the University of Chicago will study how Cerner employees respond to cost transparency tools from Change Healthcare. The RWJF-funded study will assess the impact of price, quality, and engagement approaches on consumer choice of healthcare.
Researchers at the University of Pittsburgh create a publicly searchable digital database of infectious diseases cases dating back 125 years.
The Leapfrog Group publishes its annual list of top hospitals based on quality of care.
Carolinas HealthCare System launches analytics capabilities that integrate data for evidenced-based health management, individualized patient care, and predictive modeling. The health system’s in-house analytics group built the data analytics models and are using de-identified clinical and financial information from 10.5 million patient encounters. I interviewed SVP/CIO Craig RIchardville in September.
Happtique certifies 19 health and medical apps, which requires them to meet privacy, security, and operability standards and pass clinical content testing.
WEDI, EHNAC, and DirectTrust partner to promote and accelerate the adoption of a national accreditation program for information “trusted agent” service providers.
The New York Times highlights the insanity of US hospital charges, including pricing that is often arbitrary; wide variations in pricing for the same service across different facilities and regions; and, heavily inflated prices for routine supplies and services. For example, the average cost of treating a cut finger in an ER ranges from $790 in New England to $1,377 in the Pacific. Also noted: the hefty incomes of many executives in non-profit health systems, including 28 Sutter Medical Center officials who each make more than $1 million a year.
A tone-deaf boy in Denver suffers a concussion playing lacrosse, recovers, and develops the ability to play 13 instruments. His physician theorizes that the musical talent was “latent in his brain and somehow was uncovered by his brain rewiring after the injury.” Sort of gives new meaning to the term, “one-hit wonder.”
Crain’s Chicago Business points out that despite the hoopla around the 34 hospitals MetroChicago HIE has announced as members, it has failed so far to sign at least three of the biggest ones: Northwestern, University of Chicago Medicine, and NorthShore.
Weird News Andy finds himself thankful for piercings after reading this story, which describes a joystick-like device implanted as tongue piercing that allows paralyzed people drive their wheelchairs by flicking their tongues.
WNA may have a new competitor, as a reader provided this toothsome morsel of prose. A Swedish prisoner escapes two days before his scheduled release to have a tooth fixed, having been denied service by the prison dentist. He has the tooth removed and then returns to his cell. The prison gives him an oral warning and extends his stay by 24 hours to make up his time.
Based on my observations of RSNA 2013’s multitude of imaging informatics products, radiology (and other image-generating “ology” or department) PACS continue to be “deconstructed”.
For example, the “A” in PACS (for Archiving) remains the focus of many Vendor Neutral Archive (VNA) system products. No noteworthy independent (of PACS vendors) VNA products are being introduced this year, and most of the PACS vendor VNA products are trying to catch up to the independents by highlighting new functionality. This year’s newer focus centers on enterprise viewers, which consolidate provider organizations’ large number of disparate clinical system viewers, such as those of the multi-modality PACS (DICOM), Enterprise Content Management (non-DICOM), and even EHR system viewers.
Also moving to the enterprise level are the image share / image exchange capabilities, which include the taking-along of key clinical content down/uploaded from/into the EHR. An impressive Johns Hopkins Medicine work-in-progress at IHE’s Image Sharing Demonstration included Face Time/Skype-like (yet HIPAA secure) video conferencing for consultations and/or second opinions. The remote providers collaborated on diagnostic-quality views of DICOM images with side-by-side, structured EHR data and unstructured text reports – all in one view at the click of a button.
In summary, traditional PACS functionality continues to be siphoned off into other, more robust and often enterprise components, leaving traditional PACS as the important workflow engines for the modalities.
“Happy dreams, Mama.”
That’s the last thing my daughter says to me before bedtime. I like it because it seems more tangible and emotional than the standard, “Sweet dreams.” Also, it ensures I’m not kept awake because I have this classic Eurythmics song stuck in my head.
Eighties music aside, it seems many Americans aren’t dreaming much these days. According to the Centers for Disease Control and Prevention, 50 to 70 million Americans have a sleep or wakefulness disorder.
Factors that contribute to sleep disturbances include medication, illness, and stress. So do two things common to the health care industry – shift work (particularly night shift) and technology. Both are messing with our circadian rhythms.
Circadian rhythms are basically a human being’s internal clock. They run on a 24-hour cycle and tell us when it’s time to wake, sleep and release particular hormones like cortisol and melatonin.
The circadian biological clock is controlled by a group of cells in the hypothalamus that respond to light and dark signals. When light travels to this group of cells, it’s signalling the body that it’s time to be awake. The other parts of the brain that control hormones, body temperature and other functions that play a role in making us feel sleepy or awake also kick in.
This is the perfect set-up for the day shift. When they get up in the morning to go to work, they are exposed to light and the brain sends signals to raise body temperature and produce hormones like cortisol. Unfortunately, the bright sunshiny day also greets the soon-to-be clocking out night shift. Even though they’ve been up all night, their body is jolted by the same shot of sunshine as the day shift. But here it is detrimental to their sleep habits. It’s telling them, “Get up! Get moving! It’s time to start the day,” when what they really need is sleep.
Light from technology is affecting users in the same way natural light affects night shift workers. The blue light emitted from your tablet as you play Angry Birds before bed is particularly powerful in suppressing melatonin production — the hormone needed to induce sleep. The blue light that most of our devices emit works on melatonin in the same way. Again our bodies are being told, “Get up! Get moving! It’s time to start the day!” even though it’s 11pm.
Sleep disturbances and sleep disorders can have serious impact on people’s health. According to research, working the night shift is going to kill us. A 2003 review lists peptic ulcers, cardiovascular disease, cancer, and diabetes as hazards of working nights. Shift work has also been linked to obesity and depression.
Some suggestions to help mitigate sleep disturbances are:
Installing blackout curtains and wearing amber colored glasses when the sun sets can also help night shift workers.
There’s also some technology out there that claims to help with sleep disruption.
If none of that technology works for you, you can always try the old fashioned remedies eliminating screen time two hours before bed, restorative yoga poses such as legs up on the wall, and meditation or relaxation.
What are your tips for working the night shift and/or breaking through insomnia?
After ignoring IT department recommendations to upgrade aging infrastructure components, Bryant Community Healthcare in Ontario is paying the price. A power surge that resulted in a system-wide network crash and three days of unplanned downtime prompted hospital leadership to green light a new virtualized server environment that has eliminated unplanned downtime.
CMS releases a Healthcare.gov progress report outlining the improvements made. A new analytics platform has been installed that is allowing developers to monitor site performance in real time from a centralized war room where decisions are being made on which improvements to tackle next.
In North Carolina, Forsyth Technical Community College is launching a free "back-to-work" program that will build up a local supply of hard-to-find talent by training unemployed residents on key skills. One of the three career options students can chose from is an electronic health records specialist. The program will pay for registration fees, books and other incurred costs.
I’m so excited. Things are coming together for a really big announcement next Monday. I’m really excited about what we’ve put together and I think many readers will be interested in it as well. I’ve leaked the idea a little bit on Twitter, but I should be able to announce a lot more details next Monday. Watch for that next week.
Until then, it seems really appropriate at this time of Thanks to take a few seconds to recognize the many sponsors who support the work we do here at EMR and HIPAA. It’s been a really great 6 months and we’ve received a lot of amazing support. In fact, I’m really pleased by the variety of healthcare IT companies that are supporting the work we do.
I hope you’ll take a second to look over these new and renewing sponsors to see if they can help you solve some of your pressing issues.
interfaceMD – This EHR company is quite unique. Rather than try and explain their unique approach to EHR and EHR implementation, take a second and watch this video interview I did with interfaceMD CEO Joel Kanick. I think many of the things he shares will resonate with small practices out there. Joel and interfaceMD have taken a really holistic approach to implementing an EHR and all the IT in between. Check them out if you want to see what I mean.
Proven Backup – One of the biggest risks of any EHR is not having a proper backup. Unfortunately, many don’t pay attention to their backup plans until it’s too late. The best way I’ve seen to solve this is to do a mock situation where your database is corrupt. What will it take you to restore from backup? Do you have a backup that works? The beauty is that there are relatively inexpensive backup offerings like the one from Proven Backup. Done correctly, your EHR backup can be much more robust and less risky than paper ever could be.
Colocation America – One of the major features of all healthcare IT is the need for some sort of hosting. Colocation America offers a wide variety of hosting options for applications and organizations of all sizes. As a past server admin and data center manager myself, I can’t ever imagine building my own data center again. The service a hosting company like Colocation America provides is impossible for small organizations to build on their own and is likely out of reach for even the largest organizations.
HealthFusion – Some might not recognize this name, but might be more familiar with HealthFusion’s MediTouch EHR software. If you want to find out what’s unique about Health Fusion, check out this interview with HealthFusion’s Co-Founder and CEO. I was really interested with HealthFusion’s efforts to incorporate the native iPad interface in their EHR very early on. I don’t know many other EHR vendors who can say that “every EHR function that can be performed on the desktop can also be performed on the iPad.”
Doc Halo – HIPAA secure texting is starting to hit healthcare in a really big way. Many in healthcare have found the value of a simple text message communication. However, every healthcare compliance department is scared about the HIPAA implications of such text messages. The answer to this is to empower the end users to have the simplicity of a text message, but done on a secure platform like Doc Halo. If you want to learn more, the Doc Halo CEO has been contributing a number of blog posts on the subject as well.
gMed – If you are a gastroenterologist, then you need to take a look at gMed’s EHR solution. I’ve always been a fan of the specialty specific EHR software. They can offer a unique experience that gets washed over by most of the EHR vendors who want to apply a one size fits all approach to EHR. If you’re interested in Gastroenterology, you’ll want to check out this excellent whitepaper on the Future of Gastroenterology.
The Breakaway Group (A Xerox Company) – Many of you may recognize this company since they’ve been doing a monthly series of blog posts called Breakaway Thinking. You can expect a lot more amazing content on EMR and HIPAA from the talented people at The Breakaway Group. They have a lot of first hand experience with EHR training and ICD-10 training. Being on the front lines provides them some really interesting insight into the industry.
I’m always thankful for the ongoing support of our renewing sponsors. So, a big thanks to all of the companies listed below for renewing their support of us. It’s great to look over so many of these companies who have been supporting us for so many years. Here’s to many more years working together.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
Cerner – Advertising since 9/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012
Look for the really big announcement next Monday.
Rehabilitation Psychology - Vol 55, Iss 3
Dezutter, Jessie; Casalin, Sara; Wachholtz, Amy; Luyckx, Koen; Hekking, Jessica; Vandewiele, Wim
Purpose: This study aimed to investigate 2 dimensions of meaning in life—Presence of Meaning (i.e., the perception of your life as significant, purposeful, and valuable) and Search for Meaning (i.e., the strength, intensity, and activity of people’s efforts to establish or increase their understanding of the meaning in their lives)—and their role for the well-being of chronically ill patients. Research design: A sample of 481 chronically ill patients (M = 50 years, SD = 7.26) completed measures on meaning in life, life satisfaction, optimism, and acceptance. We hypothesized that Presence of Meaning and Search for Meaning will have specific relations with all 3 aspects of well-being. Results: Cluster analysis was used to examine meaning in life profiles. Results supported 4 distinguishable profiles (High Presence High Search, Low Presence High Search, High Presence Low Search, and Low Presence Low Search) with specific patterns in relation to well-being and acceptance. Specifically, the 2 profiles in which meaning is present showed higher levels of well-being and acceptance, whereas the profiles in which meaning is absent are characterized by lower levels. Furthermore, the results provided some clarification on the nature of the Search for Meaning process by distinguishing between adaptive (the High Presence High Search cluster) and maladaptive (the Low Presence High Search cluster) searching for meaning in life. Conclusions: The present study provides an initial glimpse in how meaning in life may be related to the well-being of chronically ill patients and the acceptance of their condition. Clinical implications are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
ETH-Zurich biotechnologists have constructed an implantable genetic regulatory circuit that monitors blood-fat levels. In response to excessive levels, it produces a messenger substance that signals satiety (fullness) to the body. Tests on obese mice revealed that this helps them lose weight.
Genetically modified cells implanted in the body monitor the blood-fat level. If it is too high, they produce a satiety hormone. The animal stops eating and loses weight. (Credit: Martin Fussenegger / ETH Zurich / Jackson Lab)
Back in the day, I was a Girl Scout. Yes, I sold cookies, which probably prepared me for the sales hustle I’d have to do as a physician, trying to convince patients to do things that were good for their health but that they didn’t always want to do. That sales hustle has also been useful in working with reluctant physicians to convince them the EHR isn’t out to get them. My favorite cookies are the Samoas and Thin Mints, in case you’re wondering. Besides the camping and badges one thing I remember is how we used to close our meetings. We crossed arms and sang a song: “Make new friends, but keep the old; one is silver and the other gold.”
That small song was on my mind this week for a variety of reasons. For many people, the holidays are a time of stress, and Thanksgiving kicks it off. I got to spend the holiday cooking with my grandmother and my mom, who finally let me make the gravy, so I guess I have arrived as an adult. She also shared her secret recipe for stuffing. In yet another stroke of good luck, this year’s Thanksgiving conversations were light on the Obamacare and more focused on whether Thanksgiving shopping is good or bad. Social Security and Medicare weren’t topics either. which made the holiday table even more enjoyable.
This was my holiday to be the on-call executive in the event of an unexpected downtime or problem with a critical system. I was keeping my phone close. Halfway through the dishes, I heard a text message come in. I’m still a little adrenaline-tuned with message indicators on my phone, so I only use them when I have to – probably Pavlovian conditioning from all the years carrying the code pager in medical school and residency – so when it dinged I picked it up with more than a little trepidation.
The message that came in, however, was just what I needed. A colleague halfway across the country making an ongoing joke that started more than three years ago and wishing me a Happy Thanksgiving.
It was a small thing, yet it got me to thinking about the friendships I’ve made and the relationships I’ve built since I’ve been in the CMIO trenches. Before I went into informatics, my circle of colleagues was pretty small – a handful of friends from medical school and residency, my referral base, and other physicians on staff at my hospital. Now I am grateful to have colleagues across the country and around the globe. I’ve had the privilege of bouncing ideas off of people from rural Iowa to the Arabian Peninsula. It’s heartening to know that no matter where we work we’re all dealing with similar challenges.
It’s not just the other CMIOs, though, for whom I am grateful. I appreciate the relationships I’ve built with our vendors. They haven’t always been easy, but the bonds that are forged in adversity are pretty tough to break. I’ve enjoyed getting to know all the analysts in our department and watching some of them grow from interns to respected leaders on the team. We’ve had weddings, babies, and funerals, and even in the sad times, it’s heartening to watch people genuinely care for each other. Sometimes the day-to-day knowledge makes things fun: knowing who in the office wants the leftover deli pickles nobody else wants; knowing who can be bribed with chocolate cake; and knowing that surprising someone with a cold Diet Coke at the right time can make all the difference.
Having friends in all parts of the EHR universe has been a great experience, though sometimes a challenge. Whether it’s schmoozing developers in the hopes of speeding enhancement requests into code or playing incredibly bad golf in front of the entire IT department, being in this position has taken me places I never thought I’d go, both figuratively and literally. (There are still a few places I’d like to go, but I guess I’ll have to keep holding out for that CMIO gig in Italy.)
Even with the busy holiday week, I had a chance to meet up with a health IT friend I usually see only at HIMSS. The conversation was so easy it was as if we see each other all the time. It was great to share war stories, catch up on family news, and gaze at the crystal ball to see what HIT will bring us in the coming year. This fall has been very good to me. I’ve had the pleasure of meeting great people at a recent national meeting I attended and the comfort of being able to lean on friends both old and new when trouble crossed my path.
As I head towards my fourth HIMSS as a member of the HIStalk crew, I realize what a privilege it is to be part of this team and what an adventure it has been. I never dreamed I would have fans who send me pictures of their favorite shoe finds or even an actual chocolate shoe, but they’re out there and I appreciate each and every one of you and hope to see you at HIStalkapalooza (anonymously, of course). We never know who is going to cross our paths or where things will head, but that is part of the thrill.
While I was looking for a graphic to go with today’s piece, I learned that the song actually has several other verses. One is about a circle being round and having no end, which is touching, but I found another verse that I like even better: “New made friends, like new made wine; Age will mellow and refine.” So I will raise my virtual glass to all our HIStalk readers and to my friends and colleagues old and new. Here’s to the next adventure.
Email Dr. Jayne.
The Nov. 15 #HITsm Chat kicked things off with the following question, that I thought was worth preserving via blog post:
“The most overused term in #healthIT is ______?”
It’s a fun question and so as you might expect, we got a few answers, but before you jump the gun and check out our list, take a crack at it yourself – what do you think the most used terms are?
According to fellow #HITsm’ers, the most overused buzzwords are…
— georgemargelis (@georgemargelis) November 15, 2013
— Julie Maas (@JulieWMaas) November 15, 2013
— Ryan Lucas (@dz45tr) November 15, 2013
— Bob Green (@HealthcareNovel) November 15, 2013
— Charles Webster, MD (@wareFLO) November 15, 2013
RT @RickeyGillespie: Patients & lifelong learning should be our focus instead of the medical acronym (CPT, RVU, EMR, MOC, CME, EBM) horde.
— Inge Roeniger (@ingeroeniger) December 2, 2013
I’m a little torn on this tweet. While I agree that there is too much administrative overhead in healthcare that distracts from patients and lifelong learning, I also think that things like EMR could contribute to both. A well implemented EMR software can help doctors focus on patients and help the doctor learn. This is certainly not the way most doctors look at EMR. Is this an EMR image problem or EMR software that’s not living up to its potential?
— Mandi Bishop (@MandiBPro) November 26, 2013
Of course, you have to take this tweet with a grain of salt since it comes from our very own Big Data Geek, Mandi Bishop. However, it’s an interesting topic of discussion. How important is the EMR data in healthcare today?
— Versus Technology (@VersusTech) November 25, 2013
This tweet is related to the healthcare data tweet above. We all know that the EHR data isn’t perfect. Although, it’s worth noting that the paper chart wasn’t perfect either. However, I was more interested in the idea of real-time EHR data. I don’t think we’re there yet, but I’m interested to see how we could get there.
Much in the news recently is the friction between the FDA and 23andMe. I have blogged about the company and its goal of providing genetic testing directly to healthcare consumers (DCT testing) (see: Clinical Labs Have Much to Learn from the Genetic Testing Web Sites; 23andMe Requests FDA Clearance for DNA Saliva Testing). I am very much in favor of this goal. I think that the NYT presented an important slant about this dispute (see: F.D.A. Orders Genetic Testing Firm to Stop Selling DNA Analysis Service). Here is an excerpt from the article:
The...[FDA] seemed most concerned about a test for mutations that indicate a woman would have a very high risk of getting breast cancer. It said a false positive on such a test could lead to an unnecessary preventive mastectomy. Scott R. Diehl, director of the center for pharmacogenomics at Rutgers, welcomed the F.D.A. action. He said tests for breast cancer risk and drug side effects required guidance from doctors and genetic counselors, and “really have no place” being offered directly to consumers. But Misha Angrist, an assistant professor at the Institute for Genome Sciences and Policy at Duke, said that with DNA sequencing becoming cheaper and easier, the F.D.A. would ultimately fail in keeping people from having access to their own genetic information. “Is the only pathway for me to get access to the contents of my cells via some guy in a white coat?” he said. “F.D.A. clearly thinks the answer is yes. I find that disappointing and shortsighted and naïve.”Dr. Angrist said it was “borderline absurd” to think someone was going to get a mastectomy based on a $99 test, without follow-up.
I have personally ordered the test battery from 23andMe. For $99, the consumer receives some 200 test results. Some of them are trivial such as whether your hair is likely curly and others are highly significant such as the possibility of cystic fibrosis or breast cancer. SNPs (see: Single-nucleotide polymorphism) are usually being analyzed to generate these results but such an approach can't reveal all of the complex information at a genetic locus like BRCA1/BRCA2 that are defined by multiple base pairs. The company thus offers what I would describe as broad genetic screening for which there will be both false negatives and false positives like with all lab testing. Here's a key passage from a blog note about the complexity of genetic testing by Michael Eisen who is an advocate for open access to science and who also serves as a member of the scientific advisory board of 23andMe (see: FDA vs. 23andMe: How do we want genetic testing to be regulated?):
If genetics were simple and our understanding of it were complete, companies could provide accurate reports that say “based on your genotype, your age and personal history, you have a 7.42% chance of developing ovarian cancer in the next 10 years.” However, we are far, far, far away from this....The data are, at this point in time, very very messy. I don’t think anyone disagrees with that. The question is what to do about that. One the one side you have people who argue that the data are so messy, of so little practical value, and so prone to misinterpretation by a population poorly trained in modern genetics that we should not allow the information to be disseminated. I am not in this camp. But I do think we have to figure out a way for companies that provide this kind of information to be effectively regulated. The challenge is to come up with a regulatory framework that recognizes the fact that this information is – at least for now – intrinsically fuzzy.
The immediate question at hand is whether the FDA will be able to work with 23andMe to "develop a regulatory framework" for conveying fuzzy but complex data to consumers and functioning as a clinical lab. In my opinion, the answer to this question is no. The agency is rigid, bureaucratic, and terrified of mistakes that will show up in the news and embarrass the government. The agency has been quite opaque when dealing with experts in the field such as in digital pathology as a result of which it has brought an entire industry to a standstill for the lack of an effective dialogue. Here's some more reading on this same topic with some other ideas and opinions: THE F.D.A. VS. PERSONAL GENETIC TESTING; Why The FDA Can't Be Flexible With 23andMe, By Law. I will post more notes about this dispute as it evolves.
I think that 23andMe needs to try to negotiate with the FDA to develop a a solution whereby the company's reports to consumers do not fall under the agency's definition of a medical device. Such negotiations will be very difficult because the agency has been aggressively expanding its regulatory authority rather than seeking to diminish it. In the end, I suspect that 23andMe will need to print a strong warning label on its reports to the effect that the test results have little medical significance and must not be used to make any important diagnostic or treatment decisions by consumers without confirmation by a CLIA-certified lab and a qualified physician. I don't think that such a warning will hurt its business and consumers will continue to have access to interesting and useful genetic screening test results.
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