This is the next post in my series of Do’s and Don’ts Healthcare IT. As we all know, some of our most important citizens live in rural settings, small cities, the countryside, or remote areas. These areas have smaller populations and less direct access to vital healthcare resources. In the past 15 years or so we’ve made some great strides in remotely accessible healthcare; these offerings, called telemedical tools, provide important clinical care at a distance. Here are some do’s and don’ts of telemedicine:
What do’s and don’ts would you add to a telemedicine strategy? Drop me a comment below.
I recently wrote, in Do’s and Don’ts of hospital health IT, that you shouldn’t make long-term decisions on mobile app platforms like iOS and Android because the mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A couple of readers, in the comments section (thanks Anne and DDS), asked me to elaborate mobile and mHealth strategy for healthcare professionals (HCPs) and hospitals.
A couple of the key points were:
The approach I recommend right now for mobile apps, if you’re developing them yourself, is to stay focused on HTML5 browser-based apps and not native apps. So, to answer Anne’s and DDS’s question specifically, no you shouldn’t wait to allow usage of mobile apps by anyone; but, if you’re looking to build your own apps and deploy them widely (not in simple experiments or pilots) then you shouldn’t write to iOS or Android or WP7 but instead use HTML5 frameworks like AppMobi and PhoneGap that give you almost the same functionality but protect you from the underlying platform wars. In the end, HTML5 will likely win and it’s cross-platform and quite functional for most common use cases. If you’re not developing the apps yourself and using third-party apps, then of course you must support the use of iOS native, Android native, and soon Windows native apps on your network.
So, from a general perspective you should embrace mHealth but do so in a strategic, not tactical manner. Here are the most critical questions to answer in a mHealth strategy — it’s not a simple one size fits all approach:
If there is interest in this topic, I will expand on my list of Do’s and Don’ts — mHealth is a very complex topic and requires a good strategy. Just saying that you allow the use of mobile devices like smartphones in your hospital is not an mHealth strategy. 
In case you haven’t seen it, MU attestations data is now available on Data.gov and it includes analyzable vendor statistics.
The data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the National Coordinator for Health IT, Certified Health IT Products List. This new dataset enables systematic analysis of the distribution of certified EHR vendors and products among those providers that have attested to meaningful use within the CMS EHR Incentive Programs. The data set can be analyzed by state, provider type, provider specialty, and practice setting.
The data set does not include dollar amounts or the difficulty of attestation (e.g. how many times it took to pass). I’ll try and find out if that data might be available in the future. It’s also unclear whether the provider counts were broken up into each line (meaning one provider per row) or if multiple providers were aggregated into lines (meaning multiple providers were grouped).
The dataset is available now on Data.gov at http://www.data.gov/raw/5486 and is worth checking out. Since the file has been downloaded over 75 times, it’s clear some of you already know about this so if you’ve done some analysis with it; if you’ve done any analysis or posted results please drop me a note below so that everyone can benefit.
Last year I started a series of “Do’s and Dont’s” in hospital tech by focusing on wireless technologies. Folks asked a lot of questions about do’s and dont’s in other tech areas so here’s a list of more tips and tricks:
One of the most important activities you can undertake before you begin your EHR implementation journey is to standardize and simplify your processes to help prepare for automation. Unlike humans, which can handle diversity, computers hate variations. Before you begin your software selection process, get help from a practice consultant to reduce the number of appointment types you manage, reduce the number of different forms you use, ensure that your charting categories (“Labs”, “Notes”, etc.) don’t look different per patient type or physician, determine how you will manage medication lists and problem lists across the patient population, and deal with how you’ll manage paper in your digital world.
If you spend even just a few hours a week doing the prep-work before you buy any software, you will be better prepared in your selection process. Without some level of standardization your EHR implementation will either fail, be delayed, or have many unhappy users; the more you can standardize and simplify, the more likely you will have a successful outcome. A strong project manager with authority to make decisions will be the difference maker in the simplification process.
To help you with your workflow assessment and standardization efforts, check out the The Agency for Healthcare Research and Quality (AHRQ.gov) Workflow Assessment for Health IT Toolkit. Even if you’ve done workflow assessments before, the toolkit is worth checking out.
As most of my regular readers know, I work as a technology strategy advisor for several different government agencies; in that role I get to spend quality time with folks from NIST (the National Institute of Standards and Technology), what I consider one of the government’s most prominent think tanks. They’re doing yeoman’s work trying to get the massive federal government’s different agencies working in common directions and the technology folks I’ve met seem cognizant of the influence (good and bad) they have; they seem to try to wield that power as carefully as they know how. Since most of you are in the technology industry, albeit specific to healthcare, I recommend that you learn more about NIST and the role it plays – they can make your life easier because of the coordination and consensus building work they do for us all. I, for one, was thrilled when NIST was picked as the governing body for the MU certification criteria. These guys know what they’re doing and I wish they got more involved in driving healthcare standards.
A few years ago NIST came up with the first drafts of the seminal definitions of Cloud Computing; they ended up setting the stage for communicating complex technical concepts and helping making “Cloud” a household name. After 15 drafts, the 16th and final definition was published as The NIST Definition of Cloud Computing (NIST Special Publication 800-145) in September. It’s worth reading because it’s only a few pages and is understandable by the layperson. No computer science degree is required.
Yesterday I was speaking to a senior executive in the EHR space and we had a great discussion on what healthcare providers are doing in terms of cloud computing and how to communicate these ideas to small practices as well as hospitals. It reminded me of the numerous similar conversations I’ve had with other senior executives we serve in the medical devices and other regulated IT sectors. In almost every conversation I can remember about this topic over the past couple of years, I had to remind people that NIST has already done the hard work and that we can, indeed, rely on them. Most of the time the senior executive was unaware of where the definitions came from so I figured I’d put together this quick advisory.
My strong recommendation to all senior healthcare executives is that we not come up with our own definitions for cloud components – instead, when communicating anything about the cloud we should instruct our customers about NIST’s definition and then tie our product offerings to those definitions. The essential characteristics, deployment models, and service models have already been established and we should use them. When we do that, customers know that we’re not trying to confuse them and that they have an independent way of verifying our cloud offerings as real or vapor.
Below I have copied/pasted from NIST 800-145 their key definitions. Imagine how many debates you would avert with technicians at clients when, during conversations with a client, you communicated some of the following information first, showed them how it was a “standard definition” and handed them a copy of the publication, and then mapped your offerings and discussions to the different areas. Your sales teams and the marketing teams would appreciate the clarity, too.
Note that you do not need to map every offering you have to every definition – just start mapping the obvious ones and then figure out how you can communicate the “gaps” as being not applicable to your products / services or if those gaps will be filled in the future as part of your roadmap. Treat these definitions as canonical but not inclusive – meaning that just because your SaaS offering doesn’t fit every essential characteristic doesn’t mean that you’re not “cloud” – it just means partially cloud.
If you’ve got questions about how to map your product offerings, drop me some comments and I’ll assist as best as I can.
Here are the key definitions from NIST 800-145, copied directly from the original source:
Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics, three service models, and four deployment models.
Essential Characteristics:
On-demand self-service. A consumer can unilaterally provision computing capabilities, such as server time and network storage, as needed automatically without requiring human interaction with each service provider.
Broad network access. Capabilities are available over the network and accessed through standard mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile phones, tablets, laptops, and workstations).
Resource pooling. The provider’s computing resources are pooled to serve multiple consumers using a multi-tenant model, with different physical and virtual resources dynamically assigned and reassigned according to consumer demand. There is a sense of location independence in that the customer generally has no control or knowledge over the exact location of the provided resources but may be able to specify location at a higher level of abstraction (e.g., country, state, or datacenter). Examples of resources include storage, processing, memory, and network bandwidth.
Rapid elasticity. Capabilities can be elastically provisioned and released, in some cases automatically, to scale rapidly outward and inward commensurate with demand. To the consumer, the capabilities available for provisioning often appear to be unlimited and can be appropriated in any quantity at any time.
Measured service. Cloud systems automatically control and optimize resource use by leveraging a metering capability1 at some level of abstraction appropriate to the type of service (e.g., storage, processing, bandwidth, and active user accounts). Resource usage can be monitored, controlled, and reported, providing transparency for both the provider and consumer of the utilized service.
Service Models:
Software as a Service (SaaS). The capability provided to the consumer is to use the provider’s applications running on a cloud infrastructure2. The applications are accessible from various client devices through either a thin client interface, such as a web browser (e.g., web-based email), or a program interface. The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings.
Platform as a Service (PaaS). The capability provided to the consumer is to deploy onto the cloud infrastructure consumer-created or acquired applications created using programming languages, libraries, services, and tools supported by the provider.3 The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, or storage, but has control over the deployed applications and possibly configuration settings for the application-hosting environment.
Infrastructure as a Service (IaaS). The capability provided to the consumer is to provision processing, storage, networks, and other fundamental computing resources where the consumer is able to deploy and run arbitrary software, which can include operating systems and applications. The consumer does not manage or control the underlying cloud infrastructure but has control over operating systems, storage, and deployed applications; and possibly limited control of select networking components (e.g., host firewalls).
Deployment Models:
Private cloud. The cloud infrastructure is provisioned for exclusive use by a single organization comprising multiple consumers (e.g., business units). It may be owned, managed, and operated by the organization, a third party, or some combination of them, and it may exist on or off premises.
Community cloud. The cloud infrastructure is provisioned for exclusive use by a specific community of consumers from organizations that have shared concerns (e.g., mission, security requirements, policy, and compliance considerations). It may be owned, managed, and operated by one or more of the organizations in the community, a third party, or some combination of them, and it may exist on or off premises.
Public cloud. The cloud infrastructure is provisioned for open use by the general public. It may be owned, managed, and operated by a business, academic, or government organization, or some combination of them. It exists on the premises of the cloud provider.
Hybrid cloud. The cloud infrastructure is a composition of two or more distinct cloud infrastructures (private, community, or public) that remain unique entities, but are bound together by standardized or proprietary technology that enables data and application portability (e.g., cloud bursting for load balancing between clouds).
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, “going forward”:
The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Source:
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”
The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.
As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after “eating” too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).
HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.
What does all this mean? Well, as my mother always told me: You can’t do everything. I’d always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.
Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I’m going to have to apply a pretty strict filter.
What then are my filters?
First, if you’re an EHR company, then I’m probably interested in connecting with you in some form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I’m going to bring around my flip video and do an EHR series called “5 Questions with EHR Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.
However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I’m a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?
The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I’ll love you and likely write about that content.
I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I’m trying to discover what stories are being told at HIMSS that are worth telling. I’m always happy when people help me find interesting stories.
Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that’s an almost impossible task to ask anyone to do.
Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:
HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.
New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.
Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s been in the past. I personally like these dates better than the other ones.
There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d love to hear if you’re going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.
And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.
No related posts.
One thing that I love about this industry is its willingness to collaborate, and I’m not just talking about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you’re going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.
I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.
In his comments, he advocates for a mentor-protégé program: “Students still need some more help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing students with industry professionals who can mentor them into the industry. I’ve passively done that…to success. I think that will work.” He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.
I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:
It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really been tightly coupled with the workforce development program.
When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS’ career development page to look around and see what they have out there. I’m thinking of how we can connect [what they’re already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s what’s really necessary to get people plugged into this profession – especially if they’re coming from outside of this profession.
HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so they’ve been developing their career development program. They’re near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don’t need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they’re looking to get a job. That could be part of the whole mentorship program concept.
Isn’t there a double-edged sword to it financially? Wouldn’t students have to become paying members of HIMSS, and then would they have to pay for certification? If they’re looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There’s a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that’s going to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out to HIMSS.
One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.
I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.
If you’re in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.
This is part of the whole brainstorming session that I’m going to try to have over the next month or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up with a good strategy by the end of February. And then we’ll start piloting it in the March timeframe.
I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog comments, might actually create job opportunity in the industry.
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I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.
Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.
One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.
The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.
HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.
I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.
The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.
In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.
So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.
The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.
Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?
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EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know I have. My New Year resolution was a very unambitious I will exercise at least every other day, and I couldn’t hold on to that for a week. However, all is not lost. Even if you’re falling short on fulfilling your resolutions, you can still make a compelling video on some kinds of health IT related resolutions and maybe walk away with a decent cash prize. Don’t know what I’m talking about?
The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.
Here are some examples listed on the ONCHIT website:
I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.
I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.
I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)
I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.
I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.
I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.
Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to get creative and create your own HIT resolutions.
Of course, being as it is 2012, and well into Web 2.0fication of our lives, it’s not enough to make resolutions about improving our health. If you want to participate in the ONCHIT challenege, you’ll have to find ways to incorporate health IT into your resolution. I’ve worked pretty much my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT can only solve some classes of problems, so I’m a bit wary when developers and programmers bring their hey-I-can-create-an-app-for-that attitudes whenever they’re confronted with any problems. That said, I do think some aspects of health IT can be useful. And I’m excited to see what creative things people will come up with.
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Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips
10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.
9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.
8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.
7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.
6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.
If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.
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As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at most conferences, it’s hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES Press Room. Although, I must admit that I haven’t found too many things all that impressive. More on that later.
For today, I thought I’d give you a little picture view of what I call the Garden of Eden booth that United Health Group has at CES (click twice to see full size image):
They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They’re also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I’m not bitter).
Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get the word out to more people. SOPA is an abomination that they’re trying to push through Congress. Here’s the tweet I sent out recently about it:
Join me & change your profile picture to protest SOPA: BlackoutSOPA.org #BlackoutSOPA #vegastech #HITsm
— John Lynn (@techguy) January 12, 2012
As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I’m good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.
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“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
References:
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
The Centers for Medicare and Medicaid Services (CMS) yesterday clarified that a 1988 law setting up national quality standards for medical testing labs does permit the labs to electronically exchange test data, an essential feature of the administration’s health IT adoption plan.
In issuing guidelines on the Clinical Laboratory Improvement Amendments (CLIA), CMS aimed to clear up confusion about the impact of the law on fledgling health information exchanges and networks.
“We have the concern that the interpretation of CLIA has sometimes stood in the way of easy info exchange,” said Dr. David Blumenthal in remarks made yesterday at the Healthcare Information and Management Systems Society annual conference in Atlanta.
In some cases, for instance, providers said they believed the law permitted only physicians who ordered a test to receive the results, according to hearings conducted last year by a panel of the Health IT Policy Committee, which advises Blumenthal.
In its revised guidance, CMS said lab results could be sent to the ordering physician as well as others designated by the physician. That includes providing patients access to their lab data unless a state specifically prohibits it, CMS said.
Experts predict a surge in the number of physicians using electronic medical record systems
By dangling as much as $20 billion in front of physicians to encourage their adoption of electronic medical record (EMR) systems during the next few years, Congress has created a new and expensive challenge for the nation’s clinical laboratories. That challenge is the need for every pathology laboratory to establish a high-function interface from its LIS to the office-based physician’s EMR.
Joe Biden (D): His home state of Delaware is a leader in adopting new health information technology, and the candidate notes the Delaware Health Information Network (DHIN) is a state-wide health information and electronic data interchange network for public and private use. Biden says the potential savings to the health care industry from full adoption of electronic medical records is substantial. He notes that researchers at the RAND Corporation estimated that full adoption of electronic medical records could save $77 billion annually. RAND also determined that by 2004, 15 to 20 percent of U.S. physician offices had adopted electronic medical records systems. 
Sam Brownback (R): Brownback advocates for lifetime electronic medical records. On his Web site, he notes that he is " ... the sponsor of a bill that would offer patients both ownership and control over their personal health information and ensure that personal health information is not used by third parties without the consent of the patient. This proposal would also offer patients debit-like cards containing their private and portable personal health information."
Hillary Clinton (D): In her comprehensive plan for health care reform, Clinton pledges to ensure that all health care providers and insurance plans use privacy-protected information technology. She says her proposal will give doctors financial incentives to adopt health information technology and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded. Clinton also notes on her Web site that the Business Roundtable, SEIU and AARP estimate that “widespread adoption [of such IT reforms] raises the potential savings to $165 billion annually.”
Chris Dodd (D): In his plan, Dodd says health insurance premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs and incentives for adoption of information technology and savings from better care. He implies that technology such as electronic health records and practice management software systems will help integrate clinical information tools, monitoring technologies and care management such that chronic diseases are kept under control.
Rudy Giuliani (R): Giuliani has pledged to invest in health information technology to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors. He sais public-private partnerships to improve and set standards for health IT but without overbearing regulations can play a major role in improving quality of care and reducing health care costs.
Mike Gravel (D): It does not appear that Gravel has a position on the role of information technology in health care reform; if he does, we were unable to find it.
Mike Huckabee (R): Huckabee is famously known for losing 100 pounds after being diagnosed with diabetes, and for his steadfast support for preventive health care. He has not released a comprehensive plan for health care reform, but he does note that health care can be made more affordable by adopting electronic record keeping, among other strategies such as medical liability reform and health insurance portability.
Duncan Hunter (R): There's no mention of health care on his Web site, let along discussion of electronic medical records.
Dennis Kucinich (D): Kucinich has proposed a universal, single payer health care plan completely funded by the U.S. government, called the United States National Health Insurance Act (H.R. 676). In his proposal, he calls for the creation of a "standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy," and that "notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record."
John McCain (R): He says that reforms to federal health care policy and programs should focus on enhancing quality while controlling costs, but we were unable to find any references to health care information technology in his campaign materials.
Ron Paul (R): He's a Medical Doctor, but he has not proposed a plan for health care reform, and makes no mention of electronic medical records in his campaign materials.
Bill Richardson (D): To achieve health care for all, Richardson proposes streamlining health care administration by using "21st Century Health Care Bonds" to invest in health information technology, thereby saving the system $22 billion per year.
Mitt Romney (R): In August, Romney shared his health care reform plan with physicians in Florida, where he underscored the importance of bringing market dynamics and modern technology to health care. In his presentation, Romney supported the idea of federal incentives to foster more widespread adoption of electronic medical records technology.
Tom Tancredo (R): He has announced a very basic plan for reform, but there's no mention of electronic medical records or other types of information technology.
Fred Thompson (R): Thompson says he is committed to a health care system with five key attributes. One of those five guiding principles: "Modernized delivery and administration of care by encouraging the widespread use of clinical best practices, medical information technology, and other innovations."
We were included in a nice article on EMR consulting and it's impact on adoption.
Waldren says it often becomes a quandary for physicians because they don’t have the financial resources or desire to pay for expert advice, but they are reluctant to start the process of EMR adoption due to fears that the wrong decisions will be made. “You need to show value, and you need to build trust. Those are the two things consultants have to answer for,” Waldren emphasizes. “I do see some uptake [with EMR consultants], but I also see that they have a difficult marketing challenge ahead of them [with physicians].”
That pretty much encapsulates both the article and our feelings on the subject. But do click through so you can read my quotes!
Buzz is growing for Sermo, an online information sharing community "developed by physicians, for physicians." Check it out.
Welcome to the only online community where physicians around the nation exchange the latest medical insights with each other and improve patient outcomes - 24/7.
We've posted on Practice Fusion before here and the feedback we've heard was that using "de-identified" patient data to subsidize a free EHR was going to be a serious problem. Practice Fusion just announced a partnership with Google wherein the web-based application will still be delivered for free but now it will be subsidized by advertisements that come up based on keywords in the patients' records. No word as to whether the initial model has been scrapped or if this new concept is complementary. One thing's for certain, it still raises the hackles of privacy advocates.
"It still comes down to the fact the company is using people's sensitive, personal information for profit," said Allison Knight, staff attorney for the Electronic Privacy Information Center in Washington.
We've seen much debate in the past on security and patient privacy. Here's a brief reminder that (as we've argued) security is an ongoing process and not a one time fix.
“There’s nothing in security that you can do once,” says Kate Borten, president of the Marblehead Group, a consulting firm in Marblehead, Mass. “Risk assessment never stops. This is supposed to be ongoing.”
Everyone benefits when organizations focus on putting policies in place that make it more difficult to steal (or lose) sensitive data.
FierceHealthcare.com posts on a recent survey of "550 randomly chosen general internists" that suggests that primary care physicians agree in principle that physicians should be rewarded for a high level of care but are not happy with the current P4P schemes.
While most PCPs felt that physicians should be rewarded for providing high quality care--provided that the measurements were accurate--less than one-third felt that current measures would do the trick. A majority (66 percent) felt that health plans and the government were unlikely to exert the effort to make such measures accurate. Roughly eight out of ten worried that pay for performance schemes would force doctors to avoid high-risk patients--or even kick such patients out of their practices.
Tim Gee at Medical Connectivity Consulting reviews the latest entry on the medical tablet scene.
Did I mention it has a 12 hour battery life? Wow, I'm impressed. We have yet to reach perfection, but this device comes close for a clinician carried use model. This is a very, dare I say, sexy device.
Unfortunately the target market is physicians. There are several large institutions that could spring for a device like this, but nothing like a majority of the hospital market. Another bit of a miss is targeting EMR applications - actual EMR adoption is quite a bit behind all the hype - although the early adopters will probably be the large institutions who might actually buy something like this for their physicians (places like Kaiser, Cleveland Clinic, Mayo and large university teaching hospitals come to mind).
While I definitely had quite a bit of excitement over this year’s CES and Digital Health Summit, I have to admit that I ended up leaving CES a bit disappointed. I’m trying to decide if it being the fifth year I’ve attended CES is making me immune to the hype that surrounds the event or if I’ve just been going to too many conferences in general and so I’ve already heard much of the hype. At the end of the day, I describe this year’s CES as incremental versus trans formative.
There were a few exceptions of things that caught my eye while navigating the CES circus that are worth mentioning.
Ion Proton Genetic Sequencer
Probably the most amazing thing I saw for healthcare was the Life Technologies Ion Proton Genetic Sequencer. Plus, I’m not alone with this feeling. Dan Costa of PC Mag called it “The Coolest Thing I Saw at CES 2012.” To be quite frank, it is pretty amazing. It’s part of the amazing movement happening in bringing genomic data to healthcare.
The Ion Proton Genetic Sequencer (they need a better name) is awesome cause you can do a full genome in a day on a machine that costs about the same as an MRI machine. Plus, I personally think they’re just getting started on optimizing the technology. As they continue to improve the technology the cost of the machine and the time and cost to do the analysis will continue to drop. We still don’t know exactly how to use the genomic data in healthcare, but machines like this are going to make it possible for us to find new ways to use this data for good.
I still can’t help but imagine an EHR having all of our genomic data available to it.
Liquipel
Probably the coolest general technology and innovation that I saw at CES was called Liquipel. Liquipel is a technology that makes your device repel water using a nano coating. The best way to understand how it works is to check out some of the Liquipel videos and I’ll embed one below that gives a nice overview.
Of course, they have the disclaimer that it should never be submerged in water, but it was amazing to see it repel the water and still work. Plus, probably the coolest demonstration they did was with a Kleenex. They’d applied the nano-coating to a Kleenex and then they placed it in water. You’d think it would shrivel up and absorb the water. Nothing. I then asked if I could touch the Kleenex to see if I could feel the coating. Nothing. It felt like a Kleenex.
Many health IT people would love this technology. Then, it wouldn’t be such a concern to put your iPad next to the sink in the exam room. I wonder if the nano technology can do anything with infection control with devices. I imagine it doesn’t solve that issue.
I’m sure many are wondering how they can get their device treated with Liquipel. Right now they said you have to drop it by their office in California to get it done over a lunch or something. However, they’re working with phone manufacturers to get their technology in every phone. Pretty amazing stuff.
John Sculley
Another highlight of CES for me was the chance to hear John Sculley talk at the Digital Health Summit. I can’t say he said anything too groundbreaking. Although, he did say that health IT companies should stop focusing their revenue model on corporate health programs. I found that interesting. The most interesting comment came from colleague Dan Munro after John Sculley’s talk. He commented how interesting it was that so many of these older ex-CIO’s of major tech companies are getting into healthcare. I carried the thought through for Dan that as you age, you start to care about healthcare a lot more than you did when you were younger and healthier. I wonder if we’ll see this trend continue as more tech people get older and start to care more about healthcare.
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For that don’t know, there’s a really strong chat happening on Twitter each Friday morning around the hashtag #HITsm. The number of people showing up is growing and growing and quite frankly it’s almost impossible to be able to keep up with all the tweets that are flying around along with the back channel conversations with those participating in the chat as well. It’s an hour long Twitter chat where you’re flooded with interesting bits of health IT information.
Of course, some of you might be overwhelmed by the thought of a Twitter chat. The key is to realize that you don’t have to know anything about Twitter to participate. To get started, just visited this #HITsm twitter page and hit the reload as it tells you there are more tweets. This is like turning on the TV and watching what’s on. Nothing wrong with being a lurker of the #HITsm Twitter chats if that’s what you prefer.
Now for those like me who can’t keep their mouth tweet shut, you’re going to want to participate as well. It’s easy and free to sign up. I’m sure many of you are like my Health IT friend Stacey who is fantastic at Health IT, but was a little nervous on how to start down the Twitter path. I told her to just go for it and now you can find her @HealthITgirl.
I introduced her to 3-4 people on Twitter and she already has 19 people following her on Twitter. Those followers will get her started off right and then as she adds more people and interacts with more people she’ll start to find the real value of Twitter.
Let me repeat my most common comment about Twitter: Twitter is about connecting people.
Certainly Twitter can be used for other things, but Twitter’s most powerful function in my opinion is to connect people. The other thing to realize is that you can’t break it, you can’t break the rules, and there’s no right or wrong way to use Twitter. So, just start using it and testing what ways it can be valuable to you.
If you’re on Twitter or sign up for Twitter let me know @techguy and/or @ehrandhit. I’ll be happy to introduce you to some smart people on Twitter too.
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I first heard about the new Secure, Branded App Store for Hospitals and Healthcare called Happtique in early December on Techcrunch. At its core, I think it’s an interesting idea to try and filter through what the article claims are “23,000 mobile health apps available for iOS and Android.” Helping physicians and hospital administrators filter through these apps could be valuable. Plus, most hospital administrators would love a way to have a phone that was limited on which apps it could download.
Well, it seems that the company has shifted gears a little bit. As Brian Dolan from Mobi Health News reported, Happtique is taking the first steps to setting up a certification for mobile health apps.
Happtique, a healthcare-focused appstore, announced plans to create a certification program that will help the medical community determine which of the tens of thousands of health-related mobile apps are clinically appropriate and technically sound. The company has tapped a multi-disciplinary team to develop the “bona fide mHealth app certification program” within the next six months. The program is open to all developers and will be funded by developer application fees.
It will certify apps intended to be used by both medical professionals and patients.
While I think that providing some way for people to filter through the large number of mobile apps, I think certification is a terrible way to go about it. Many people know I’ve written many an article about CCHIT pre-EHR incentive money and how screwed up the CCHIT EHR certification was for the industry. I think it’s just as bad news for Happtique to create a certification for the mobile health industry.
Turns out that Happtique seems to have agreed with this idea back in October 2010 where they said in a MobiHealthNews interview, “We are not in the business of opining whether an app is ‘good’ or ‘bad’ though. That’s not our role. Apple doesn’t do that and others don’t either. If the FDA indicates that an app is a medical device and needs to be regulated, well, that’s a different situation and we can take it out of the store.” Seems they’ve seen a different business opportunity.
They have a couple recognizable names on their board to create their certification including Howard Luks and Dave deBrokart (better known as e-Patient Dave), but I believe they’re going to find that it’s an impossible task. First, because they won’t have the breadth of knowledge needed to create certification requirements for every type of mHealth app. Second, what value will the certification really provide? Third, how do you make the certification broad enough to apply to all 20,000+ apps while still providing meaning to those using a very specific mHealth app? Plus, I’m sure there are many other issues I haven’t thought of yet.
The problem with these certification ideas is that they start with great intentions, but always end up bad.
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HITECH Answers recently posted a great post that gives a run down of the EHR Incentive program’s progress in 2011. Here’s their list with my own analysis and commentary of each point.
123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to meaningful use in the Medicare program.
This seems like such a HUGE difference in numbers. That’s just over 12% of Eligible Professionals that registered attested to meaningful use. Does this mean that we’re going to see a tidal wave of meaningful use attestation in 2012? Possibly.
I believe that we’ll see more eligible professionals attesting to meaningful use in 2012. However, the question is how many of those other 108,666 will attest to meaningful use in 2012 and how many are like the Happy EMR Doctor who just registered to see the MU process. I wonder how many first hand meaningful use experiences by doctors will scare doctors away from MU attestation.
3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.
This is almost 20% of hospitals that have registered that have attested to meaningful use. It’s not surprising that this number is a lot higher than eligible professionals. I still believe that the wave of meaningful use attestation will come from these other 2473 hospitals and probably many more that still haven’t registered. I haven’t seen a good number of how many hospitals are in the US. Does anyone know that number? The EHR incentive money that goes to hospitals will dwarf those of eligible professionals.
$2,533,689,145 has been paid out in Medicare and Medicaid Incentives.
$2.5 billion sent out in 2011. I just went back to the first time I tagged meaningful use on this site on April 3, 2009 (coincidentally I have 19 pages of 10 posts each tagged with Meaningful Use). Amazing to think that it’s taken basically 3 years to spend $2.5 billion on EHR.
277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.
That’s about half of the hospitals that have attested to meaningful use under Medicare are also getting the Medicaid EHR incentive money as well.
22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.
I must admit that I would have thought that the percentage of family doctors that got paid EHR incentive money would have been a lot higher. I guess when you have so many other specialty areas I shouldn’t be that surprised. I also wonder why the internal medicine number is so high. These numbers actually make me believe that a lot of family practice doctors are sitting out when it comes to meaningful use.
41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
I wonder what’s holding back the other 7 states. From what I’ve seen all the states will eventually get there.
More than 1500 EHR products have been certified by ONC-ATCBs.
That’s a lot of EHR software. I still put the EHR company list at about 300 EHR vendors. 1500 includes multiple versions of the same software, partial EHR certification for products like data warehouses, ePrescribing, etc. The best thing that’s come from the ONC-ATCB program is that it has made EHR certification basically irrelevant in the EHR selection process. Every EHR vendor is certified now. This is much better than the false assurances that EHR certification provided before. I still dislike what EHR certification has done to the industry, but at least it’s not misleading doctors the same way it was before.
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Here is a quick look at some of the other articles recently posted on some of the other HealthcareScene.com websites:
EHR and EMR Videos
David Collins of HIMSS Discusses the Course of Global Health at the 2011 mHealth Summit- David Collins, Senior Director of Professional Development at HIMSS, speaks at the 2011 mHealth Summit about HIMSS’ involvement in this year’s Summit, and about how HIT X.0 is affecting the course of Global Health.
Cerner Smart Room Technology Overview Video- An updated view of Cerner’s Smart Room technology. The Cerner Smart Room incorporates technology and workflow software to improve consumer care and clinician efficiency. The Smart Room is powered by CareAwareTM device connectivity architecture.
EHR and EMR Screenshots
These three posts provide numerous screenshots from the DentiMax Dental Practice Management Software. Are there special considerations for a dental practice as opposed to a regular medical practice when it comes to EHR/EMR/PM?
Screenshots from the DentiMax Dental Practice Management Software
More Screenshots from the DentiMax Dental Practice Management Software
Appointment Book Pro Screenshots from the DentiMax Dental Practice Management Software
Smart Phone Health Care
How to Get Physicians Onboard with mHealth- No matter how great an app or device may be, it will be difficult for any developer to be successful if they don’t get some level of buy in from physicians in general. People will always resort back to their physician when it comes to the quality of medical products.
Axial’s Care Transition Suite Wins “Ensuring Safe Transitions from Hospital to Home” Mobile App Challenge- In a recent online discussion I had concerning an article I recently wrote, the point was raised that for an app or device to be successful it must fulfill a need. While I don’t think that it is absolutely essential to success, it certainly makes the path to success much more realistic.
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I recently started to think about some of the implications associated with multiple languages in an EHR. One of my readers asked me how EHR vendors correlated data from those charting in Spanish and those charting in English. My first response to this question was, “How many doctors chart in Spanish?” Yes, this was a very US centric response since obviously I know that almost all of the doctors in Latin America and other Spanish speaking countries chart in Spanish, but I wonder how many doctors in the US chart in Spanish. I expect the answer is A LOT more than I realize.
Partial evidence of this is that about a year ago HIMSS announced a Latino Health IT Initiative. From that today there is now a HIMSS Latino Community web page and also a HIMSS Latino Community Workshop at the HIMSS Annual Conference in Las Vegas. I’m going to have to find some time to try and learn more about the HIMSS Latino Community. My Espanol is terrible, but I know enough that I think I could enjoy the event.
After my initial reaction, I then started wondering how you would correlate data from another language. So, much for coordinated care. I wonder what a doctor does if he asks for his patient’s record and it is all in Spanish. That’s great if all of your doctors know Spanish, but in the US at least I don’t know of any community that has doctors who know Spanish in every specialty. How do they get around it? I don’t think those translation services you can call are much help.
Once we start talking about automated patient records the language issue becomes more of a problem. Although, maybe part of that problem is solved if you use could standards like ICD-10, SNOMED, etc. A code is a code is a code regardless of what language it is and computers are great at matching up those codes. Although, if these standards are not used, then forget trying to connect the data even through Natural Language Processing (NLP). Sure the NLP could be bi-lingual, but has anyone done that? My guess is not.
All of this might start to really matter more when we’re talking about public health issues as we aggregate data internationally. Language becomes a much larger issue in this context and so it begs for an established set of standards for easy comparison.
I’d be interested to hear about other stories and experiences with EHR charting in Spanish or another language. I bet the open source EHR have some interesting solutions similar to the open source projects I know well. I look forward to learning more about the challenge of multiple languages.
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| Healthcare IT, also known by the acronym HIT, is all about using information technology solutions such as hardware, networking, and software to help improve healthcare, save lives, reduce costs, and improve profit margins for healthcare organizations. Healthcare IT has always been important but recently it has been receiving more attention because the government and consumers (patients) | are demanding better service from care providers and healthcare IT is a good way to improve service.The healthcare system, especially in the USA, has some critical problems such as nurse and physician shortages, spiraling costs, poor consumer (patient) service, and lower revenues which lead to mergers | or acquisitions. Healthcare IT is in even worse shape because outdated infrastructure, legacy architectures, and monolithic applications prevent positive change from occurring. Healthcare IT can, if used properly, help reduce costs, improve care provider productivity (which can then alleviate some of the shortages), and significantly improve customer service to patients. |
