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The Healthcare IT Guy

January-17-2012

8:00

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:

  • Do use commonly available web meeting and online video tools bring expert caregivers anywhere. WebEx, GotoMeeting, Adobe Connect, Skype, and a variety of other “web meeting” tools used mostly in professional office settings and remote sales pitches are wonderful tools to connect caregivers in populated communities to their rural patients. A simple $30 to $50 per month account on the physician side with almost no direct cost for the patient is an excellent way to engage with patients. These kinds of web meetings can happen securely either at the patient’s home or patients can be brought into satellite offices with high-quality telepresence. Then, instead of waiting for days or weeks for a health professional to travel to an area or patients having to take off many hours or entire days traveling to experts in big cities, care can be given almost immediately with less inconvenience. Don’t assume that kinds of web meeting solutions are HIPAA compliant out of the box; however, do realize they can be made HIPAA compliant with appropriate protections.
  • Do use medical devices for remote monitoring of in-home care improve clinical observations. While web meetings are great for basic primary care, it’s not perfect for elder care, long-term care, and other types of clinical requirements. There is a new class of devices that can put near-hospital-quality patient monitoring devices into patient homes and “beam” that data to monitoring centers that can watch for important events across many patients in different geographical areas. Toss in a nurse or other caregiver that can visit once a week or once a month to calibrate the devices and you can see how much more convenience patients can have and have their physicians, wherever they may be, have immediate access to their actual vitals and clinical status.
  • Don’t assume that medical device connectivity will be fast or easy to do on your own — you’ll need something like Qualcomm’s 2net platform. 2net is a trustable, Class I FDA-listed, standalone gateway with an embedded cellular component that sends clinical data truly “in the cloud” without requiring local internet connectivity. Medical data can be sent from devices in the same way that e-books can be read on Kindle devices – using 3G cellular, from mobile phones, and software APIs.
  • Don’t always send patients to labs; instead, take labs to patients with mobile imaging and lab specimen collections that allow remote reading and web-based report distribution. It’s difficult for many rural communities to have their own full diagnosticians but mobile imaging centers and lab specimen “kiosks” can do the X-rays, take pictures, and perform collections and then send the data electronically to large populated centers where they can be “read” and analyzed; the reports can be distributed via secure e-mail or other web-based applications to doctors in the rural areas or physicians remotely available and connected through web meeting or other similar tools.
  • Do try and make behavioral health, mental health, and related care made more accessible. Veterans of our foreign wars are coming home with many problems that can be easily diagnosed with proper access and many of the veterans live in rural communities; while primary care and specialty care is difficult to get in smaller population regions, behavioral and mental health is even harder to access. Telemedical assistance through online chat, Skype-like video conversations, and secure online messaging can provide quick relief.
  • Don’t leave patients on their own and encourage them to join online communities. Online community building tools allow populated city citizens to meld with their rural counterparts. Patients helping other patients is a terrific approach to extending care; sometimes what a patient needs is not necessarily a health professional but a curated session with fellow patients going through the same problems. Online, electronic, community tools such as PatientsLikeMe.com can connect geographic communities and bring them closer together without increasing costs or requiring anything more than a simple mobile phone or computer.

What do’s and don’ts would you add to a telemedicine strategy? Drop me a comment below.

January-13-2012

7:39

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:

  • (Anne) how can you avoid making long-term mobile decisions at this point?  After all, hospitals that don’t steer their doctors are going to be managing whatever technology the doctors invest in, aren’t they?
  • (DDS) the risk is that people will take this to mean that they shouldn’t move at all on mobile app platforms, and this would be a mistake. This is the perennial issue with health IT; if it’s not perfect, then wait.

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:

  • How will you allow doctors’ or patients’ own devices within your hospitals / organizations — simply by providing connectivity and wireless access on the production network or some other means?
  • How will you allow doctors’ own devices to connect to hospital IT systems?
  • How will you extend hospital IT systems via hospital-owned mobile devices?
  • How will you allow the hospital or organization to “prescribe” the use of apps to patients and track the usage of apps?
  • How will you approve or deny the use of certain apps that may not meet FDA regulations if they get close to MDDS or Class 1/2/3 devices?

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. :-)

January-10-2012

6:45

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.

January-8-2012

21:01

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:

  • Do start implementing cloud-based services. Don’t think, though, that just because you are implementing cloud services that you will have less infrastructure or related work to do. Cloud services, especially in the SaaS realm, are “application-centric” solutions and as such the infrastructure requirements remain pretty substantial – especially the sophistication of the network infrastructure.
  • Do consider programmable and app-driven content management and document management systems as a core for their electronic health records instead of special-purpose EHR systems written decades ago. Don’t install new EHRs that don’t have robust document management capabilities. Do consider EHRs that can be easily integrated with document and content management systems like SharePoint or Alfresco.
  • Do go after virtualization for almost all apps – as soon as possible, make it so that no applications are sitting in physical servers. Don’t invest more in any apps that cannot easily be virtualized.
  • Do start looking at location-based asset tracking and app functionality; your equipment should be aware of where it’s physically sitting and be able to “find itself” and “track itself” using location-based awareness. Don’t invest heavily in systems that can not support location-based awareness (like potentially allow or disallow logins based on where someone is logging in from as well as enable / disable certain features in applications on where logins are occurring).
  • Do start implementing single sign on and common identity management with CCOW integration. Don’t invest in any systems that cannot meet common identity or SSO requirements.
  • Don’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 platform that looks strong today may be weak tomorrow and become legacy quickly; however, HTML5 is not going anywhere and will be ultimate winner of the next 15 years just like HTML4 is the winner from 1995 to now. Do start investing in HTML 5 and CSS3 and away from HTML4. Don’t install any more apps that require IE6/7 or older browsers and don’t invest in systems that don’t have HTML5 in their roadmaps.
  • Don’t write applications on top of legacy EHR platforms; write applications with proper HL7 connectivity and platform independence. Most EHR platforms are using technologies that are either ancient or need to be replaced; by integrating deeply but remaining independent of their technologies you’ll get the best of both worlds.
  • Don’t buy any medical devices from vendors that don’t have a deep and thorough medical device to healthcare IT enterprise connectivity strategy. If a device doesn’t have wired or wireless TCP/IP access, doesn’t have data export or HL7 connectivity is not worth purchasing.
  • Don’t buy any thick-client applications that do not have thin-client “remote viewers” available.

January-2-2012

10:57

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.

December-24-2011

8:59

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).

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EMR and EHR

January-19-2012

20:10

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.


January-18-2012

14:28

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.

Related posts:

  1. Finding an EMR Job Champion
  2. Emdeon Gets in the Holiday Spirit with Donation of EHR Technology
  3. EMR Job Seekers Get Their Big Break


January-17-2012

12:22

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?

Related posts:

  1. How do ACOs Deal with Non-compliant Patient?
  2. Watching the Leaves Fall and EMRs Install in North Carolina
  3. What’s Next in Health Information Exchange (HIE)?


January-16-2012

10:06

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.

No related posts.


January-13-2012

12:40

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.

Related posts:

  1. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85
  2. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 61-65
  3. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 41-45


January-12-2012

13:16

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:

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.

No related posts.


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ADVANCE Perspective: HIM

December-14-2011

10:39
As the economy continues to squeeze donors, a recent report conducted by Campbell Rinker showed disturbing results-that nearly 7 in 10 Americans say they will give more sparingly to charities in the coming months. As a result, people are looking for other...(read more)

December-12-2011

13:10
(Editor's note: This guest blog was submitted by Life Coach Teri Johnson. She is a writer, speaker and personal growth expert who is the founder and President of Keeping it Personal. Here she provides tips for surviving less than perfect holidays.) For...(read more)

December-1-2011

13:05
The American Health Information Management Association (AHIMA) proudly announced that the National Commission for Certifying Agencies (NCCA) granted accreditation to AHIMA's Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-based...(read more)

November-30-2011

11:22
(Editor's note: This guest blog is written by M. Christine Kalish MBA, CMPE, Executive Consultant, Beacon Partners.) Recently the American Medical Association (AMA) passed a resolution at their 2011 Interim Meeting, mandating the group to "vigorously...(read more)

November-29-2011

8:53
(Editor's note: This blog was written by Scott Warner, author of the "Stepwise Success" column for ADVANCE for Medical Laboratory Professionals . He has been a hospital laboratory generalist for more than 30 years and manager since 1998.) According to...(read more)

November-23-2011

14:53
The Association of Health Information Outsourcing Services (AHIOS), an organization committed to promoting excellence in the handling and dissemination of confidential, patient-identifiable information, held its annual meeting in Salt Lake City, Utah,...(read more)
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Fred Trotter

January-15-2012

13:59
Lately I have become interested in running motivation.  I am launching a <a href=’http://runorelse.com’>running motivation</a> app next week, and I thought I would give my readers a little taste of the process that brought me to design and build the new site. Running is one of the best exercises. There are several that really compete [...]

January-5-2012

12:21
Just so my RSS feed readers know, I will now be blogging at Programmable Self and at O’Reilly Radar. I hope this helps everyone to keep track of what is going on. -FT

November-9-2011

23:06
Over on the Society for Participatory Medicine mailing list we have been discussing the recent Readers Digest blog post titled: 50 things your nurse wont tell you. You really have to read it before reading this article, this post will only make so much sense without that. I suggested that part of being an epatient [...]

October-12-2011

23:13
Joe Conn, one of the best Health IT reporters I know, has been denied FOIA access to breach data reported to the Office of Civil Rights. Honoring FOIA requests is a critical part of how the people ensure that the government is not abusing its power. That might sound paranoid, but blanket rejections like this [...]

October-5-2011

21:01
Today, Steve Jobs died. This blog post will be only one among thousands of posts devoted to his drive and his genius. Thousands will celebrate a technical legacy that almost no technologist can hope to replicate. The original Macintosh, those early films from Pixar, the iphone… hell I am typing this on a Macbook Pro [...]

August-31-2011

18:10
[Update 2011-10-19 Many of the issues here applied only to the initial launch of OSEHRA and began to be addressed almost immediately. Do not assume everything you read below still applies] As typical, I was alerted to the fact that Tiag, the winner of the Open Source VistA custodial agent competition, has launched a website [...]
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Healthcare IT Weblog

December-1-2011

12:25

Doctors’ adoption of health information technology doubled in two years, according to a new report, Department of Health and Human Services Secretary Kathleen Sebelius released Wednesday. Sebelius also announced extension of the meaningful use qualification date to 2014. See link for more info – http://www.healthcareitnews.com/news/hhs-extends-mu-stage-2-deadline-spur-faster-emr-adoption?topic=01,08


September-13-2011

19:59

The survey I posted earlier has now been completed – here are the results.

http://blog.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/


September-12-2011

14:53

High physician fees, rather than factors such as practice costs, volume of services or tuition expenses, were the main drivers of higher U.S. healthcare spending and physician income, according to research presented in the September issue of Health Affairs.

The study, conducted by Miriam J. Laugesen, PhD, and Sherry A. Glied, PhD, both of the Mailman School of Public Health at Columbia University in New York City, found that in some cases, physicians in the U.S. are paid as much as double their counterparts in other countries. There is also a larger gap between fees paid for primary care and fees paid for specialty care, particularly orthopedic surgeons, in the U.S. compared to other countries evaluated by the study.

Fees paid by public and private payors for primary care office visits and hip replacements were compared in six countries: Australia, Canada, France, Germany, the U.K. and the U.S.

Laugesen and Glied found that primary care physicians in the U.S. were paid, on average, 27 percent more by public payors for an office visit, and 70 percent more by private payors for an office visit, compared to the other countries. The largest difference in fees paid between countries was for hip replacements. Physicians in the U.S. were paid 70 percent more by public payors and 120 percent more by private payors for these procedures as compared with physicians in the other countries.

Across the fees analyzed by the study, the biggest disparities in pay to U.S. physicians existed on the private side. Fees paid by private insurers in six markets in the U.S. averaged about 33 percent above Medicare rates for primary care and 50 percent above Medicare rates for hip replacements.

“Our analysis suggests that policymakers in all countries need to consider how differential prices paid by both public- and private-sector payors to specialists influence specialty choices,” wrote the authors. “Furthermore, this analysis suggests a need for greater standardization of cross-national data on the nature of physician services provided, fees, education and incomes to allow ongoing comparative research on the relationship between prices and healthcare spending growth.”

Incomes were also higher for U.S. primary care and orthopedic physicians compared to their foreign counterparts.

The authors said other factors thought to contribute to physicians’ fees, such as high medical education tuition costs for American physicians or increased work volume, could not fully explain the disparity in fees when compared across the countries.

“Although the tuition cost of medical education in the U.S. borne by individuals is substantial, it cannot fully account for the observed differences between the earnings of U.S. physicians and physicians in all other countries,” wrote Laugesen and Glied.

For the services examined by the study, higher physician incomes did not appear to be due to a higher volume of services, though the authors acknowledged the rates of other procedures not studied may be higher and contribute to the elevated fees and incomes.

One possible explanation offered by the authors for the high U.S. physician fees was the notion that higher fees may reflect the cost of attracting highly skilled candidates. When physician fees in each country were compared to the mean incomes of the top 1 percent of households within that country, the results were broadly consistent, suggesting higher U.S. fees were the result of a “society with a relatively more skewed income distribution,” according to Laugesen and Glied.


September-7-2011

12:40

http://healthpolicyandreform.nejm.org/?p=15235


September-7-2011

12:37

The New York Times (9/6, B1, Freudenheim, Subscription Publication) reports, “Under heavy pressure from government regulators and insurance companies, more and more physicians across the country are learning to think like entrepreneurs.” One result is the rapid growth in joint M.D./M.B.A programs to 65 at present with an estimated 500 students. Some intersperse business courses with medical courses while others have students complete their medical training and add a year or more of business education. “Dr. Barry R. Silbaugh, chief executive of the American College of Physician Executives, a professional society that provides medical education courses and career counseling, said more start-ups were being run by doctors.” He explained that some “are focused on adapting technology to health care, not just electronic medical records,” adding, “The use of social media is of great interest to many younger physicians, and so is health care analytics.”


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Chilmark Research

January-11-2012

15:02

Admittedly, our predictions for 2011 were modest. Most of those predictions were logical and did not take a whole lot of imagination to envision thus our success rate, 7 “hits”, 2 “toss-ups” and 2 “misses was quite high. And though are biggest accomplishment, predicting Blumenthal’s departure just a few short weeks before he actually announced such intentions is laudable, by and large these predictions just didn’t go far enough. So for 2012, rather than make simplistic predictions such as “analytics will be a high growth area” or “mHealth will create greater security concerns” or even “ACOs will begin to take hold” as none of these are all that thought provoking, we’ll go out on a limb with many of our predictions. Hopefully that limb won’t crack sending us crashing to the ground.

Without further adieu, here are our predictions:

Consumer/Patient Engagement – Not What it Seems
Despite the best efforts of the team at ONC to beat the consumer/patient engagement drum, providers by and large are still struggling with such basic issues of taking live their certified EHRs, making the transition to ICD-10, meeting physician demands to have everything served up on their new iPad and of course mapping out future strategies in anticipation of payment reform. Thus, we foresee consumer engagement remaining a tertiary issue in 2012. Just too many other pressing priorities at the moment. WebMD’s implosion on Jan. 10th may portend that this is not such a bad move – at least in the near term.

Bloom is Off the Rose, EHR Market Plateaus
Going out on a limb, we see 2012 as the year when we start talking of the post EHR-era. Yes, there will be plenty more EHR sales in the year to come but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4’12. You heard it here first folks, it is time to collect your EHR winnings and seek new places to invest.

Finally, We’ll See Some Fairly Competent Tablet Apps from Legacy Vendors
Though physicians continue to adopt iPads at a rapid rate, they struggle to effectively use them in the hospitals to which they are affiliated simply because most hospital HIS cannot serve up an application effectively on an iPad. Sure, many have tried using Citrix as a stop-gap measure but this is just isn’t cutting it. In speaking to one CIO of a major IDN recently, he was so frustrated with his core EHR vendor’s slow pace of development that he is about ready to self-fund the development of an App for his physicians. Fear not CIOs and frustrated physicians, we have had the opportunity to see several alpha versions of iPad Apps that major EHR vendors are developing and they actually look pretty good. Look to Q2-Q3 ’12 for general availability release of these touch-screen native (mostly iPad-centric) Apps.

At Gunpoint, Direct Project Gains Traction
In 2011, the message came down from on high, or at least from the feds, that all State HIEs must include the use of Direct in their strategic plan. Pretty clear that this was politically motivated as to date, for the $500M plus we, as taxpayers are spending on these public HIEs, there is very little to show for it and we are now running headlong into an election year and this administration needs to show something, anything, in the way of success as it pertains to health information exchange. Sure Direct facilitates health information exchange (the verb), but so does a fax machine and frankly, Direct is only a modest step beyond faxing. Therefore, Direct will gain traction in these “forced” instances but we do not see it extending its reach into the much larger market of private, enterprise HIEs (does not sufficiently support care coordination, population health and analytics) and thus Direct’s overall impact in the market will be small and fade to nothing in three years time.

First CPT Codes for mHealth Apps Issued
mHealth Apps for care provisioning have not seen any significant adoption beyond pilot studies, studies which typically show some efficacy in their use. The big hang-up is a simple one, the risk to reward ratio for physicians to adopt and use mHealth Apps as part of the care process is too low. What might change that risk-reward ratio though is a CPT code whereby a physician actually gets paid to use, or have a patient use an App as part of the care process. WellDoc is one of the few mHealth App companies that is quite aggressive in moving the ball forward and we would not be too surprised if WellDoc did industry ground-breaking work to secure the first CPT codes for their diabetes management App.

Train has Left the Station as Supreme Court Rules on ACA
Though the Supreme Court will hear arguments for and against the constitutionality of the Affordable Care Act (ACA), it is unlikely that their subsequent ruling will throw out all of ACA (they may prune it). More importantly, the move to value-based reimbursement models is already in full swing, which is something that will not be reversed. Whatever the Supreme Court rules, its impact will be minimal and the numerous changes we are seeing take place today (move to accountable care models, patient centered medical home, etc.) will continue as the train has already left the station.

Changing of the Guard as Dynamic Duo Departs
Last year we predicted the departure of ONC head, Dr. David Blumenthal. This year is an election year and it is expected that there will be a significant changing of the guard across the administration. We predict that the dynamic duo that is Aneesh Chopra, White House CTO and Todd Park, HHS CTO will both be leaving their posts by end of the year.

M&A Continues, but at far more Reasonable Valuations
Okay, yes we have had this prediction for three years running, but we just can’t help ourselves as we see far too many vendors in this market (some 300+ EHR vendors alone!) and some rationalization must enter at some point. We are seeing rationalization on valuations (e.g., no one was willing to pay what Thomson Reuters wanted for their healthcare business unit despite there being a sizable number of bidders) and this will create an opportunity for acceleration in M&A activity in 2012.

Floundering HITECH Initiatives Attract Political Spotlight
Yes, we are seeing some modest success and adoption of EHRs as a result of the HITECH Act but the preponderance of such success is at hospitals that first have had some form of EHR already in place and also have a lot to lose if proposed reimbursement cuts from CMS come to fruition at the end this multi-year march to certified EHR adoption and meaningful use. Yet, under the covers we are still not seeing wide-spread EHR adoption at the ambulatory level, especially among smaller practices, State HIE initiatives struggle to define what they’ll actually be when the grow-up, the Beacon programs have not reached the promise land, and the RECs, well we were never a big fan of these for obvious reasons we outlined previously. As this is an election year, healthcare and anything with the stamp of the Obama administration on it, will become fair game and dragged into the limelight. Get ready for healthcare to become the political piñata of 2012

HIE Vendors Stumble
By the end of 2012, the final awards for State HIEs will conclude and with it the evaporation of the $500M plus honey-pot that attracted so many vendors into this space. What’s next for these vendors? Some will stumble out of the market with little to show for their efforts. Others will work with their public clients to stand-up these public HIEs in order that they provide value to their respective communities, which will not be easy and lead to more stumbling. And of course HIE vendors who have traditionally been focused on public markets will reposition themselves for the private, enterprise market. Some of these vendors are now stumbling in this transition to the enterprise market (requires different sales resources and tactics, technology requirements, etc.). This will result in yet another shakeout in this niche industry sector. (Our forthcoming HIE Market Report will provide further details)

The funny thing about doing these predictions is that as one actually goes through the process of thinking about this market, which is currently going through nearly unprecedented change, one ponders so many other predictions that just end up on the cutting room floor. Some of those include:

Payers continue to struggle with exactly what they’ll offer on the State Health Insurance Exchange.

Pharma companies look to insert themselves directly into physician workflow, via HIT.

Despite rising cost share, consumers still struggle to make intelligent, informed decisions.

Telehealth gets some wind under its wings as big telecoms start aggressive lobbying efforts.

You get the idea, plenty of turmoil, no lack of potential trajectories in technology adoption and use within the healthcare sector and we here at Chilmark Research look forward to continuing to provide thoughtful insight on this ever evolving market in 2012.

So now it’s your turn. Are we on the mark with our predictions? Did we reach too far? Is there a particular prediction that you have which we totally missed? It is you, the community of readers that make this site far richer than we ever could do on our own and we look forward to your feedback.


December-23-2011

12:06

It is almost becoming the norm to say that it has been another tumultuous year in the healthcare IT market. Market consolidation, pushback on timelines, growing chorus from IT departments that enough is enough against the backdrop of the political circus in Washington and across the land as we prepare for the 2012 election year. If 2011, was a bit bumpy, believe we will see craters in the road to HIT enlightenment in 2012. But we’ll save that discussion for our future predictions for 2012 post, which we hope to get to next week. (Editor’s Note: Don’t hold your breath though, if the snow flakes are flying, we’ll be on the slopes next week.)

Today’s post takes a look back on 2011 by reviewing our predictions earlier in the year and assessing where we hit the mark, where we missed and if there is such a thing, where we came close. So without further adieu…

1. MU Initiatives Move to Tactical 
Hit This did come true as meaningful use, while still top of mind for the CIO, is not top of mind for others in the executive suite who are now looking at how to compete in the future as reimbursement models shift from fee-for-service to value-based contracts.

2. C-Suite Strategy Focuses on New Payment Models 
Hit An admittedly “softball” prediction, this was a natural fall-out of prediction numero uno. And yes, the consultants are making out like bandits as we predicted they would helping senior execs figure out their future competitive strategy.

3. RCM & Charge Capture Systems Require Overhaul 
Miss By and large, most vendors in this sector have not done a whole lot yet as they await to see how the market develops. With most healthcare organizations struggling to get the basics done (e.g., meet MU requirements, ICD-9 -> ICD-10, apply analytics, etc.) we are not seeing big demand from customers and subsequently, not a big push by vendors.

4. Mergers & Acquisitions Continue Unabated
Hit Another “gimme” of sorts for we had this prediction in 2010 and it was a “hit” and need only look at this market with its some odd 300+ EHRs to choose from, everyone wanting to call themselves at HIE vendor (last we checked, HIMSS listed some 189 HIE vendors alone), countless other HIT solutions to see that this market is far from mature. But arguably the biggest news in 2011 was Microsoft’s capitulation that despite the billion dollar plus investment, it wasn’t cut out or the clinical market and dumping its HIT assets into a new joint venture with GE. What we are also seeing is some rationality return as valuations have moderated. This may have led to Thomson Reuters’ recent decision to not sell-off its healthcare division – no one was willing to pay the high price tag they had on this property.

5. Federally Funded State Initiatives Struggle
Toss-up There has been some progress and there are those that would vehemently argue that Beacon Communities, RECs and state HIEs are moving ahead briskly. But then again, we do get some disturbing reports that all is not progressing as once envisioned, one might even go so far as to say some of these programs are beyond just struggling, but clearly going off the tracks. We’ll reserve judgment until we see clear evidence of such pending disasters, which will likely be prevalent, but highly distributed.

6. Changing of the Guard at ONC
Hit Not long after we posted our 2011 predictions, Blumenthal announced his resignation from ONC. We could not have been more prophetic if we tried.

7. Physicians will continue to go Ga-Ga over the iPad and the fast-following touchscreen tablets much to the chagrin of CIOs.
Hit Enabling physicians access to health information systems via their hand-held mobile devices, including touch-screen tablets is still a struggle for most organizations. At first, IT departments turned to Citrix as stop-gap measure, but the UX was far from ideal. In our recent research we found many an IT department still struggling to address this issue. mobile enablement of physicians is a top priority.

8. Apps Proliferate: Consumer-facing First, Private Practice Second, Enterprises Dead Last
Hit In hindsight, another admittedly easy prediction to make. What may be a more interesting prediction is when will mHealth Apps really become a truly viable market? Does the profitable exit of iTriage/Healthagen, which was picked up by Aetna portend such? By our standards, no. Go back to our recent post from the mHealth Summit for more in-depth analysis.

9. The Poor Man’s (doctor’s) HIE Takes Hold
Miss We thought that the Direct Project would quickly take hold and see rapid adoption among smaller physician practices and those organizations looking to “connect the last mile” to small affiliated practices in their network. Not happening yet though the current administration is doing its best to push this technology by requiring all state designated entities that are standing up statewide HIEs to include Direct in the strategic operating plan.

10. Analytics & Business Intelligence Perceived as Nirvana 
Hit, kind of… 
In retrospect, not even sure this was really a prediction but simply more of a statement as to where healthcare organizations are headed with their HIT investments. We have a long ways to go, though there is certainly no lack of vendors that now are touting some form of analytics capabilities. Our advice, tread carefully as most solutions today are half-baked.

11) The Buzz at HIMSS’11? Everything ACO! 
Miss 
While some vendors were discussing ACO enablement at the 2011 HIMSS, the vast majority were not with the key focus continuing to be meeting Meaningful Use requirements. As mentioned in previous prediction, we see MU as a tactical issue with the strategic issue being: How do we leverage IT infrastructure to support communities of care? Maybe at HIMSS’12 we’ll see more discussion of this issue, but we’re not holding our breath.

This may have been our best year yet with our predictions having only 3 clear misses out of 11 predictions made. Granted, some of those predictions were not exactly the most profound or shall we say big stretches, but we do take some satisfaction in really nailing a few.

And while we intend to provide our own 2012 predictions, no time like the present to begin the process. So we ask you dear reader, what is your 2-3 top predictions for 2012? Will Todd Park stay on at HHS? Will forced budget cuts decimate HITECH? Will the Supreme Court’s ruling on ACA have any impact on HIT spend by either payers or providers? Will mHealth Apps such as WellDoc’s for diabetic care finally receive a CBT code thereby accelerating adoption of such tools?  We look forward to your input.

And of course we wish everyone a Joyous holiday season and wish you and yours continued good health in the new year to come.

Home for Christmas by Thomas Kinkade


December-9-2011

16:37

As many readers know, Chilmark Research has been a strong proponent of mHealth for several years. Despite this enthusiasm, we sometimes come away from a conference, such as this week’s mHealth Summit, with the feeling that the only ones making a living with mHealth are conference organizers. Maybe it was the format of this particular conference – too many presentations that were not well vetted for relevance and content. Maybe it was the lack of exhibitors – where is the rest of the legacy HIT market who are all claiming to be bringing mHealth solutions to market? Maybe it was hearing too many mHealth vendors with weak value propositions asking the Feds to step in and jump start this market. Or maybe it was the over reliance on government presentations and an ill-fated alliance with HIMSS, who sponsored less than visionary sessions. Hard to point to any single thing that contributed to this ho hum feeling, so let’s just chalk it up to all the above.

That being said, however, the mHealth Summit, now in its third year, is the best conference one can attend in the US if one wants to get the global pulse on all things mHealth.

From its humble beginnings where the first conference was quickly over-subscribed and held in a small DC amphitheater, this year’s event drew over 3,000 attendees to the massive Gaylord Resort outside of Washington DC for three days of countless sessions running concurrently covering every aspect of mHealth one could imagine. While most sessions were structured as panels with several short presentations, one was thankful that presentations were indeed short for few had substance. But nearly every session had one stellar presentation that kept one hopeful. Those were the gems of this event and like any event, the networking that occurs in the halls.

And then there were those sessions that took a close look at mHealth adoption in developing countries. This is the current market for mHealth (albeit almost all nonprofit) for these countries have real health needs having to deliver healthcare to a highly distributed and often rural population with too few doctors and lack a robust land-line network (no Internet cafes here folks). But what they do have are cell phones – lots of them and they are not tied to legacy systems and associated processes. Even among some of the poorest countries, the rapid adoption of cellphones by the populace is staggering (e.g., India alone now represents 20% of all cellphones in use worldwide). Combine the need with very little in the way of legacy HIT infrastructure and the ubiquitous nature of cellphones and you have a ripe opportunity to redefine care delivery models. Look overseas to these developing countries for the real future of mHealth for this is where best practices in mHealth-enabled care delivery will likely develop and later be adopted in more developed countries, US included.

That is not to say they are no advances occurring here in the US. One of the keynote speakers, cardiologist Eric Topol, gave several live demos during his talk of the mHealth tools he is already using including stating that he has not used a stethoscope in two years, instead preferring to use mobisante’s ultrasound wand and iPhone App.  Then there was our conversation with WellDoc’s CTO who informed us that they are currently being deployed at a number of institutions and hope to have a host of CPT codes that doctors can bill against in late 2012. And there was the small start-up we spoke with who has done the hard work of first identifying what the value proposition is for all stakeholders in a community (payers, providers and consumers) and then developed an extremely compelling solution (think analytics & automated quality reporting, tied to reimbursement, tied to consumer engagement) that has a lot of promise in a market where physicians’ pay will increasingly be based on outcomes and ability to meet pre-defined quality metrics

Therein lies arguably the biggest take-away from the mHealth Summit. As one individual put it, ‘There was a bit of whining about getting the government to force large corporations to form strategic partnerships with smaller organizations.” But what these start-ups really need is to simply focus on addressing the age old question: ‘What’s in it for me?’ These companies need to stop the whining and do their homework defining the value proposition for not just the consumer, or just the doctor, but think more broadly of the impact their solution may have on the delivery of care, and how each stakeholder may benefit. Unfortunately, as these conference clearly showed, the mHealth market is still heavy on hype and little on substance.

Addendum:
For a slightly different take, check out the post by VC firm Psilos’ Managing Partner Lisa Suennen’s. Well worth the read. And more recently, Charles Huang, formerly of Spark Capital, provides his own view of the mHealth Summit, including a a call that once and for all, we need to kill the term mHealth.

Also, the image used for this story was taken by Joel Selanikio, CEO & co-founder of DataDyne.org an organization focusing on mobile data collection, particularly, the App EpiSurveyor. Thanks Joel. 


December-8-2011

15:32

Today, GE and Microsoft announced a joint venture (JV) that will lead to the formation of a new company (NewCo) targeting the clinical healthcare market sector. The NewCo will be located near Microsoft HQ in Redmond, WA, start with roughly 700 employees and combine the remaining Microsoft clinical products, Amalga UIS and the former Sentillion products Vergence and expreSSO with GE’s eHealth and Qualibria suite. NewCo’s new CEO will be GE’s Michael Simpson, who has been heading up the combined Qualibria-eHealth group since earlier this year after a re-org at GE. Along with this announcement, Microsoft’s Health Solutions Group (HSG) leader, Peter Neupert stated that he’ll be retiring.

Combine the above announcement with Microsoft’s long anticipated sale of Amalga HIS, which went to Orion Health in October, and you are left with Microsoft completely pulling out of the clinical market. Sure, they’ll claim to be still in healthcare by directly selling their horizontal products (e.g., SharePoint, MS Office, various server products, etc.) into this sector and having a stake in this JV, but it is also exceedingly clear that Microsoft will no longer have any direct involvement in this market, that will be left to GE. That being said, Microsoft did state that they’ll hang onto HealthVault, but even here, that is more likely a by-product of no one wanting to take on HealthVault rather than Microsoft’s strong desire to continue to try and build a viable, revenue generating entity out of it. Do not be too surprised if, in a year’s time, HealthVault falls to the wayside much like Google Health did this year.

During our briefing call with Microsoft and GE we learned the following:

Core to NewCo’s objectives is to leverage the joint assets of Microsoft and GE to build out an entirely new platform that will focus on four key areas to begin with:

  • Clinical surveillance to identify such things as infection outbreaks within an acute care facility before they run rampent.
  • Population health management to facilitate care management processes, which is a productization of work GE has been doing with Geisinger as part of the Keystone Beacon program.
  • Reduce hospital readmissions by leveraging analytics to identify patients at risk and initiate appropriate interventions.
  • Facilitate transitions in care, which like reducing hospital readmissions, is something that is on the mind of every senior healthcare executive we talk to.

These four target areas are nothing new or inspirational as just about every vendor we talk to has some program in place or under development to address these four areas as well. The product roadmap does not have much hitting the market until 2014.

Financial terms were not disclosed but our guess is that Microsoft contributed IP and the development team behind these products. In return, they will receive some sort of royalty stake in future sales. GE will lead the new organization, contribute its Qualibria/eHealth IP and GE sales and marketing will take the product(s) to market. Thus, most sales and marketing folks and other support staff in Microsoft’s former Health Solutions Group are being shown the door, which is unfortunate as we head into the holidays.

A couple of things come across as a bit ironic. First, Microsoft executives time and again stated that they knew what they were getting into when they entered this vertical and that it would take patience to build a viable presence. So much for patience. Second, Microsoft sold off the Amalga HIS product as many a potential HIT partner was wary of partnering with Microsoft as long as Microsoft had under ownership an EHR. Now what does Microsoft do, it joins in partnership with a struggling HIT vendor in the acute care market. Will any of the other major or even second tier HIT vendors partner up with the GE/MSFT NewCo – don’t bet on it.

The announcement also raises more than a few questions such as:

What becomes of Microsoft’s existing HIE contracts, particularly the one they pulled all the stops out to win, the Chicago HIE which is now under development?

What becomes of Microsoft’s recently announced relationship with Orion Health? Will Orion now be partnering with NewCo, which is essentially GE?  GE, with its own HIE solutions targeting enterprise accounts, is a direct competitor to Orion.

What becomes of HealthVault Community Connect, which combined Amalga with HealthVault and SharePoint? Is this now a dead product or will NewCo simply use the Centricity patient portal?

As you can probably tell by the tenor of this piece, we’re not a big fan of this announcement and are disappointed that Microsoft has decided to fold-up its tent and retreat. Unlike the legacy HIT vendors in this market, Microsoft could lay the claim to some neutrality and potentially build-out an Amalga-based ecosystem platform. But business is often not kind to those that have an altruistic bent and in this case Microsoft simply made a clear-cut business decision to unleash an asset that was not meeting internal metrics despite what some believe may have been an investment in excess of $1B in the last 5 years to build-out HSG.

Once again, another company with grandiose plans to change healthcare has quietly walked away leaving this market to the incumbent HIT vendors. We also do not see strong prospects for the future build-out of a robust ecosystem of partners on the combined Amalga-Qualibria platform that NewCo proposes as there are too many competitive issues that just get in the way. We could be wrong on this one, but our guess is that NewCo is likely to struggle as much as Microsoft has in the past for relevance in this fractious HIT market.

Addendum:
Sean Nolan, chief architect for Microsoft HealthVault, provides his own view on this JV announcement. While his view differs from ours on the implications and future of this JV and HealthVault, one thing we do hope that Sean proves us wrong on, is the future success of HealthVault. We would love nothing more than to see it succeed but at this juncture, we remain pessimistic. 


November-28-2011

12:42

While it would be much better to give thanks prior to our (the US’s) big Thanksgiving holiday, sometimes things just get in the way as has been the case this fall. In fact, many things have gotten in the way – all good things, very good things, but gotten in the way nonetheless leaving you dear reader, far less to actually read from Chilmark Research. Truly wish that this was not the case , but alas, as a small but growing analyst firm, we are seeing our own challenges in scaling up Chilmark Research to meet demand. And yes, we are seriously looking into revamping some of our own internal processes to insure that we continue to deliver timely, relevant and cogent posts on HIT market trends.

Which brings us to our first pause to give thanks.

This fall has seen an explosion of activity for us, activity that has us juggling so many balls and somehow managing to keep them all in the air. That explosion of activity has come in the form of numerous client engagements that has provided Chilmark Research with an opportunity to further delve deeper into a number of healthcare sub-sectors including:

mHealth adoption of patient-provider engagement Apps. A larger report for the general market will be released in February.

Concierge Care: market drivers, key players and future forecast.

Aging-in-Place telehealth and remote sensing market opportunity assessment.

Strategy workshops with several clients helping them map out their HIT strategy.

Deep dive research on current and future state of imaging exchange to promote collaborative care processes, which has also resulted in our first time trip to RSNA.

For all of these clients and those we may have the opportunity to serve in the future, we wish to give thanks for these opportunities always teach us something new. At Chilmark Research we have an insatiable appetite for learning.

We also wish to give thanks to you, our readership for first inspiring us to write these posts through your comments, your inputs, your private emails to us. When first starting Chilmark Research, these posts were used for marketing, to build credibility in a market we knew little about. The process of writing these posts built readership, but more importantly, it forced us to do good research. You can’t build credibility with lame posts that are no more than a rehash of some press release or fail to take to task questionable moves by policy makers or vendors.

But now writing these posts is not so much about marketing for Chilmark Research. From those humble beginnings several years ago, we have built a substantial readership that includes quite a few extremely senior and influential HIT market movers and shakers. Also, based on the volume of inquiries we now receive for future engagements, it appears that Chilmark Research has indeed established a reputable brand in the HIT market. Therefore, we want our posts to be seen more as our way of contributing to the discussion, a discussion that will help others better adopt, deploy and use HIT to not only deliver better care, but to create a health system that is more responsive to and inclusive of the needs of patients and their loved ones.

Lastly, we wish to thank all of those who have helped us along the way. From the numerous clients who early on had faith in Chilmark Research and hired us on to provide specific research services to the countless educational mentors in the healthcare market who have taken us under their wing providing us sage advice along the way on the structure of what appears to be is a convoluted market. There are far too many to list here but they know who they are. Thank you once again for all of your assistance along this journey, we would have never gotten this far without you.


November-4-2011

15:51

Acquisition fever has set in and they’re dropping like flies, independent HIE vendors that is. Earlier today, Siemens announced its intent to acquire enterprise HIE vendor MobileMD. So in little over a year we have seen IBM snag Initiate, Axolotl fall into the hands of Ingenix/United Health Group (Ingenix is now known as OptumInsight), Medicity tie the knot with Aetna, Harris pick-up Dept of Defense clinician portal darling Carefx and Wellogic, a damsel in distress, being rescued by Alere. Elsevier also announce an intent to acquire dbMotion for a whooping $310M, but nothing came of that other than a substantiation of the rumor that dbMotion was being shopped.

That does not leave many small, independent HIE vendors that have some traction left in the market. Following is our list of such vendors and what might become of them:

4medica: A relative new comer to the HIE market, 4medica will be profiled for the first time in the upcoming HIE Market Trends Report which is scheduled for release in early 2012. 4medica is quite strong on lab information exchange. Future: 4medica still remains under the radar screen as it completes its platform to truly serve all HIE needs. Once that process is complete, the company is likely to gain increasing attention and will be acquired in 18-14 months.

Care Evolution: Privately owned and self-funded, founder has every intent to stay independent. As he has told us on more than one occasion, I’ve already made plenty of money and this is not about cashing out to the highest bidder. Future: Everyone has a price but this company may be one of the last to fall into the arms of another.

Certified Data Systems: Appliance (think small router with embedded HIE functionality) HIE vendor that has close, yet non-exclusive partnership with Cerner. Would not be surprised if they struck a similar deal with Epic as Epic struggles to connect to EHRs outside its system. Future: Fairly new to the HIE market but gaining traction. Will stay independent for next 12-18 months, after that, anyone’s guess.

dbMotion: One company already made a bid, but pulled back, thus pretty clear this company will be acquired, question is how much and we suspect it will be significantly less than what Elsevier was planning to pay. Future: If price is right, could be acquired at anytime.

HealthUnity: Small HIE vendor from the Pacific Northwest that made a big splash when with Microsoft (Amalga UIS) they won the big Chicago HIE contract. Future: With Microsoft cozying up close to Orion, HealthUnity will be looking hard for other partners and/or to be acquired. Will give them 12-18 months as an independent.

ICA: Another small HIE vendor that has had a few wins here and there but will come under increasing pressure from larger, better funded HIEs. Future: Likely to be acquired in next 6-12 months, maybe even earlier.

ICW: InterComponent Ware is a German HIT company and a sizable one at that with over 600 employees. To date, ICW has a very small presence in the US HIE market so an acquisition, if there were one, would have little impact.  Future: Their foreign ownership, size and interests in several health related markets make them an unlikely candidate for acquisition.

InterSystems: Arms dealer to all, InterSystems Cache and Ensemble are widely used in the market and the company has built upon these core technologies to get into HIE market. Future: Fiercely independent and senior team is basically the same since founding this company will remain independent.

Kryptiq: Having signed a strong partnership deal with Surescripts, Kryptiq is unlikely to be interested in any acquisitions talks. Future: Will remain independent for time being and if Surescripts’ Clinical Interoperability solution gains significant traction, Surescripts will likely acquire Kryptiq outright.

Orion Health: New Zealand-based, privately owned with good prospects in markets beyond America’s shores, this company will likely want to stay independent (future IPO) unless of course a very large software company (think IBM, Microsoft, Oracle etc.) gives them an offer they can’t refuse. Future: Will stay independent.

Getting back to the Siemens/MobileMD deal…

While we have not had an opportunity to talk with either Siemens or MobileMD (will provide follow-on update once we do) here are some quick take-aways:

Siemens has chosen to buy. This is unlike other EHR vendors who have either built their own HIE solution (athenahealth, eClinicalWorks, Epic, NextGen) or have partnered with others (Allscripts, Cerner, GE).

Existing partner doesn’t cut it. Siemens has an existing partnership with NextGen for ambulatory but NextGen’s HIE is a closed system. This prevented Siemens from being able to leverage this partnership to serve their client needs, which most often includes a multitude of EHRs in the ambulatory sector to interface with.

Lacked sufficient internal resources. By buying into the market, Siemens has signalled that it does not have the development resources to respond quickly enough to customer demand (not too surprising, Siemens has been struggling in the North American market for sometime). This also signals that they could not find the right partner outside of their NextGen relationship, which is a tad puzzling as we are quite sure they paid a premium for MobileMD.

Paid a premium. We estimated MobileMD sales in 2010 just shy of $8M in our 2011 HIE Market Report. HIE vendors are selling at a premium, even second tier ones such as MobileMD. Assuming industry average growth in 2011 (we peg it at 30%) that would give MobileMD sales of ~$10.5M for 2011. We put the final strike price for MobileMD at $95-110M.

Existing MobileMD customers relived. Unlike the acquisitions of Axolotl and Medicity, which both fell into the hands of payers, MobileMD is going to a fellow HIT vendor which must assuage the fears of more than a few MobileMD customers and prospects. Siemens intends to keep MobileMD whole, bringing on-board MobileMD’s president and founder, again contributing to continuity.

ADDENDUM: Please excuse our lack of posting on industry trends in a more frequent manner. Like many in the healthcare sector, Chilmark Research is struggling to keep up with demand and recruit top-notch resources. We seem to have hit our stride in this market, are receiving countless engagement inquiries and engaging in most of them. All good problems to have, but you dear reader are the one who ultimately suffers from our lack of posts. Thank you for your patience to date and know that we are doing our best to keep you informed with some of the best research and analysis of this critically important and meaningful market.


Blog url: 
http://chilmarkresearch.com/
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MedTech and Devices

Open Healthcare Framework

December-19-2007

19:24
Version 0.2.1 of STEM is now available! To get the latest version, please see the OHF Downloads page. Builds are available for Windows, Linux, and Mac OS X.New for version 0.2.1 are over 100 bug fixes, additional features and additional built-in Scenarios. The new features include new "Time Series" and "Phase Space" views. The first view plots graphs of the values of disease variables over Matt Davishttp://www.blogger.com/profile/00454758764053983536noreply@blogger.com12

July-13-2007

17:17
In the lines of the last post, we would like to get some community feedback in order to help us better decide on our future plans. We will start to post some polls and post them in the OHF site. We'll publish a note about new polls in the OHF newsgroup, so please pay attention if you wish to influence.The first poll will be about the ultimate question:To be or not to be? That is XDS.b ...Eishay Smithnoreply@blogger.com1

July-13-2007

14:29
As we are starting to rump up towards the 2008 IHE Connectathon we recognize we're going to have a better manage user community scalability issues.Last year we had a nice small user community with about fifteen ISVs going with us to the Connectathon and few more how used OHF in the NHIN prototypes and other projects.Those where fun days! We gave our emails to everyone and had an open Skype Eishay Smithnoreply@blogger.com1

July-9-2007

17:58
A team lead by Senthil Nachimuthu (MD, University of Utah) will conduct an Open Source Workshop at AMIA 2007 in Chicago (Nov, 2007). Contributed to the workshop paper where Thomas Jones, Jon Teichrow, Paul Biondich, Cal Collins, Will Ross, and myself.The workshop will include representatives from the open source projects:* Eclipse Open Healthcare Framework* Machine Learning Tools* Mirth* Tolven* Eishay Smithnoreply@blogger.com1

June-18-2007

14:32
The recent announcement of the of STEM triggered tons of press and blogs articles about STEM and OHF which was great. It lead a significant increase in the web and mailing list traffic.In the IHE front, our user community is helping us a lot to push the word out. I was told by few attendees of the IHE Workshop occurred last week that Jyran Glucky of BlueWare did a lot of OHF promotion.At about Eishay Smithnoreply@blogger.com0

June-8-2007

1:29
Today IBM officially announced the contribution of the source code and resources for the Spatiotemporal Epidemiological Modeler (STEM) to the Eclipse OHF Project. In conjunction with this announcement, OHF is also pleased to announce that STEM version 0.2.0 Milestone 1 is available for download. Packaged versions of STEM are available for Windows and Linux. For help using STEM, please see the Matt Davishttp://www.blogger.com/profile/00454758764053983536noreply@blogger.com2
Blog url: 
http://ohf-dev.blogspot.com
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Watching Health Care IT

April-23-2006

16:24
During today’s broadcast of The McLaughlin Group [1], there was a statistic tossed out about how $16

April-5-2006

22:55
A Cincinnati newspaper, citing state public access to documents, successfully argued that HIPAA does

February-28-2006

0:00
The 2006 HIMSS convention took place in San Diego, and I was able to spend two days seeing everythin

January-15-2006

0:00
Popular Mechanics is reporting a “top 15 new technology concept for 2006″ implanted medical devices

October-21-2005

0:00
From the Beating a Dead Horse Dept.: You have to wonder how long this failed project is going to b

October-21-2005

0:00
I don’t know whether its a problem that Microsoft wants to collide product names with the public do
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MedTech and Devices

EMR and HIPAA

January-19-2012

14:38


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.

Related posts:

  1. Healthcare Invades CES – Digital Health Summit
  2. No @ Sign for Healthcare
  3. Jeopardy!’s Watson Computer and Healthcare

January-18-2012

18:18


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.

Related posts:

  1. Thoughts on Top #HITsm Contributor Awards
  2. HIPAA and Football #HITsm
  3. Email and Twitter Follow Up With Patients

January-17-2012

13:13


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.

Related posts:

  1. Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth
  2. CCHIT Certification as Default Certification
  3. CCHIT As The HITECH Certification Criteria Poll

January-16-2012

11:24


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.

Related posts:

  1. Are You Ready for 2012? – Meaningful Use Monday
  2. How Critical is the October 1, 2011 Deadline? – Meaningful Use Monday
  3. Exemption from 2012 eRx penalties: The Process is Now in Place – Meaningful Use Monday

January-16-2012

0:18


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.

Related posts:

  1. The Healthcare Scene Writers
  2. EHR Summit by Healthcare Billing and Management Association (HBMA)
  3. What Keeps EMR and HIPAA Running and New Healthcare Scene Service

January-13-2012

17:57


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.

Related posts:

  1. Nuance and MModal – Natural Language Processing Expertise
  2. Think About the Problems with Paper Charting
  3. Customized EHR Content, 6 Week EMR Implementation, Redundant Charting, and Increased HIT Investment

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October-29-2010

11:39

Just today we announced the expansion of HealthVault in China, specifically in the Jiangsu province of Wuxi. This is definitely a big step in the international expansion of HealthVault outside of the United States and joins the other international deployments in Canada (doc), Germany and the UK.

Microsoft Corp. and iSoftStone Information Technology (Group) Co. Ltd. have signed an agreement that enables iSoftStone to introduce Microsoft HealthVault technology to the Chinese market. HealthVault, a personal health application platform, enables individuals to store and manage their health information in a personal, online account. Initially focused on Wuxi, in the province of Jiangsu, the vision of the Microsoft-iSoftStone relationship is to enable citizens to connect to various health systems and services run by government organizations, physicians, hospitals, pharmacies and even fitness facilities for a comprehensive view of their personal health information. iSoftStone will be the exclusive operator of HealthVault in Wuxi and will develop and offer the HealthVault-based services to developers, application providers and device manufacturers to provide citizens with tools that will help foster dynamic, trusted and personalized healthcare.

Check the rest of the press release online.

iSoftStone Signs Agreement With Microsoft to Develop Citizen Health Solutions in China Using HealthVault: Digital health innovation center is first step of a joint healthcare effort in Wuxi, China.

December-10-2009

11:27

Well, this is at least a partial excuse for my absence from this blog :-)

Today we announce the acquisition of Sentillion, Inc demonstrating again Microsoft’s level of commitment to the healthcare industry.

Many of you reading this are familiar with Sentillion and this acquisition is the culmination of years of successful partnership between the two companies. Our primary goal with the acquisition is to make it easier for healthcare professionals to deliver better patient care by streamlining access to multiple IT applications and patient data by combining Amalga UIS and Sentillion’s solutions for single-sing-on and context management.

So far we have received excellent feedback and I am really excited about the Sentillion folks joining the ranks of the Health Solutions Group and Microsoft.

For more detail please have a look at the press release.

May-1-2009

2:04

Connected Health ConferenceThe HealthVault Solution Conference that we did last year has evolved into a broader event that includes more of the solutions that Microsoft has to offer in Health.

The Connected Health Conference will be held on June 10-12 in Bellevue, WA and we’re going to feature a lot of content both around Amalga UIS and HealthVault and an exceptional lineup of speakers including David Kibbe, Governor Michael Leavitt, Uwe Reinhardt, Mark Smith and Peter Neupert. Lastly we’re going to have a few surprises in store both for HealthVault and Amalga UIS, so make sure you rush and register, we have limited space available and we expect a lot of people!

April-16-2009

15:46

Recently we worked with Gartner Group on a webcast outlining the issues that healthcare provider organizations face when it comes to data integration and how solutions such as Amalga UIS 2009 can help address these issues and provide organizations with more tools and better ability to view, analyze and act upon information that they already own, but rendered inaccessible by the silos in which it’s locked.

The twenty minute long webcast features: GG’s Dr. Tom Handler and Vi Shaffer, two of our customers Brad Kappalman and Dr. Mark Smith (Medstar WHC) and Kim Pemble (WHIE), Jon Handler and Peter Neupert.

The webcast is available at this address. Enjoy!

April-10-2009

23:00

Amalga UIS 2009Ok, I have been to a few HIMSS with Microsoft now, but I must say that this one, by all means exceeded my expectations.

We had two days of in-depth training with our field before the show and that was great. All the content was spot on (at least from my perspective :-), we had a great representation from across the company and an awesome session with two of our current customers.

The show was the busiest for Microsoft in all the 8 years I have been at HIMSS. I was there most of the time and I literally did not have the time to shut up for more than 2 minutes. I talked to our current customers about the new release for the product, prospect customer about the value of Amalga UIS and how that can be used to help address their problems and potential partners about what opportunities exist for them on Amalga UIS. All the demos rocked and the booth design was absolutely great.

The great thing was the response we got from the people there. Many heard about the product before or were referred by a friend or person they knew. It is amazing to see the difference one year makes in awareness. I must thank of course our customer for being great advocates and showing new and innovative uses for the product.

This is all happening before and while we announce two major pieces of news:

  • New York Presbyterian Hospital is the first Amalga UIS customer to connect Amalga UIS and HealthVault to provide their customers with online access and control over their health records with the mynyp portal. This leverages a feature of Amalga UIS that allows direct connection to HealthVault.
  • A new version of Amalga UIS is released to the market. This is the second major release of the product after the acquisition from Medstar in 2006. The product is also renamed from Amalga to Amalga Unified Intelligence System or Amalga UIS. This is to distinguish from our Amalga HIS product. The name Amalga stays and it’s meant to address the entire family of enterprise products: Amalga UIS and Amalga HIS

As part of the announcement we also announced three modules for Amalga UIS:

Each module has its unique value proposition, but each one of them leverages the ability for Amalga UIS to aggregate data in real time from multiple systems and present that in an amalgamated (pun intended :-) fashion. I will go into more detail for the modules in a future post.

We also released a new, improved version of the web site with more information and details about the product, in particular:

Other health groups at Microsoft have also been very busy and we released a new version of the Connected Health Framework – Architecture and Design Blueprint. Kudos to Teddy, Ilia and all the people that have contributed to this new version!

I look forward to share more of the exciting things we’re working on with you. Stay tuned!

April-3-2009

19:59

We just issued a press release outlining some of the cool things that you’ll see at HIMSS 2009 from Microsoft.

At HiMSS09, the annual conference and exhibition for the Healthcare Information and Management Systems Society (HIMSS), Microsoft Corp. will showcase in its booth (No. 1232) new solutions designed specifically for healthcare providers, caregivers and patients, as well as partner and customer success stories

Specifically:

Microsoft will also be present at the Interoperability Showcase thanks to the work that Teddy is driving.

Also check http://www.mshimss2009.com/ for more detailed info.

Media Alert: Microsoft Showcases New Health Solutions to Enhance Patient Experience and Improve Operations at HiMSS09.

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