I believe that all patients should have ready access to their medical records with only a few exceptions. One major exception is obvious: patients should not learn about a serious disease for the first time during their medical record review. Such total access is a logical step in empowering patients to take more ownership for their own health. When patients are able to review physicians' notes, I believe that the notes will become shorter and more accurate. It will also suppress the use of repetitive "templated" entries in hospital EHRs (see: Distrust of "Templated" Physician Notes in EHRs; Implications for the Future; Three Ways to Document a Physician/Patient Visit in an EMR). A recent article by Walker, Darer, Elmore, and Delbanco in the NEJM discussed the path to "transparent medical records" (see: The Road toward Fully Transparent Medical Records). Here's a short excerpt from it; link to and read the whole article if you are interested.
....[I]n 1996 the Health Insurance Portability and Accountability Act entitled virtually all patients to obtain their records on request. Today, we're on the verge of eliminating such requests by simply providing patients online access. Thanks in part to federal financial incentives, electronic medical records are becoming the rule, accompanied increasingly by password-protected portals that offer patients laboratory, radiology, and pathology results and secure communication with their clinicians by e-mail. One central component of the records, the notes composed by clinicians, has remained largely hidden from patients. But now OpenNotes...is exploring the effects of providing access to these notes. Beginning in 2010, at Beth Israel Deaconess Medical Center..., Geisinger Health System ..., and Harborview Medical Center..., more than 100 primary care doctors volunteered to invite 20,000 of their patients to read their notes securely online. Although only a small minority of these doctors' patients used the portals, the initial findings were striking. At the end of a year, four of five patients had read the notes, and among those who responded to a survey, large majorities reported having better recall and understanding of their care plans and feeling more in control of their health care. Moreover, two thirds of patients who were taking medications reported improved adherence. Doctors reported little effect on their work lives and were surprised by how few patients appeared troubled by what they read. Although the notes were not formally evaluated, the majority of doctors reported not modifying their tone or content. A minority, however, reported changing the way they addressed four potentially charged topics: cancer, mental health, substance abuse, and obesity. After the first year, 99% of the patients surveyed wanted “open notes” to continue, 85% of the patients indicated that ready access would be important for their future choice of a provider or system, and no doctors chose to discontinue the practice. Despite limitations in the sample, the findings persuaded our three institutions to implement open notes broadly.
In its web site, OpenNotes is described as a new standard of care. I don't believe that this is an exaggeration. Given that HIPAA in 1996 granted patients full access to their medical records, any further discussion of whether this is a good policy is largely moot. Here is a quote from my blog note of more than three years ago on this topic (see: Should Patients Be "Allowed" to Read Their Medical Records?):
[L]et me dismiss the idea that there is much room for debate about whether patients should be allowed to review their own medical records. HIPAA gave them the right to read, and even amend, these records years ago. Whether this is a good idea is being addressed in an ongoing study (see: Should Patients Read the Doctor’s Notes?). Regardless of whether it's a good idea, I don't think that the law will be reversed on the basis of one or more current studies.
So now we have the results of a major OpenNotes study: patients very much liked access to physician notes and the felt more in control of their care, not an unexpected outcome. As a result of their engagement, they were more compliant with prescribed drugs. The question before us now is not whether we make our electronic records available but how we make them more accessible. The obvious answer for hospitals is to give patients electronic tablets, if they do no come with their own, and then provide a unique ID and password for access to their personal records while hospitalized (see: Docs Prescribe Tablets For Better EHR Access).
I’ve been at the conference for two days and it still doesn’t have a clear identity in my mind. Others told me the same thing – it’s unfocused and hard to describe, much like “mHealth” itself.
The term “eHealth” was coined a few years ago and was quickly hijacked by companies and people who didn’t have much credibility in the non-eHealth world. Everybody else piled on to avoid being seen as passe’, turning eHealth into a frothy marketing term that meant whatever you wanted it to mean. It didn’t take long to shake out the 80 percent of that movement that was unsound and absorb the rest into the mainstream of healthcare IT. The term was retired because it was no longer necessary.
The concept of mHealth as a separate area of focus needs to be retired. It no longer means anything. It was born when so few healthcare people were using smartphones that it seemed like a geeky special interest that required intentional cultivation.
Since then, the mission has been accomplished. Mobile is a given. Nobody spends their lives perched in front of a desktop PC or even a “mobile” computer on wheels. You’re mobile if you use a connected smartphone, laptop, or tablet. That’s pretty much everybody, which means the mobile device itself as a common thread of interest is no longer compelling.
The mHealth Summit features topics that have little in common. Some themes might be:
The HIMSS conference has a lot of subject areas as well, but it’s so big and the content so deep that any attendee can create their own track and feel fulfilled. Most of them are hospital people, but those from other work settings (practices, research, technology, etc.) can find plenty to keep them busy and justify their employer’s cost to send them.
Not so at the mHealth Summit. Few people make “mHealth” their living, so most of what is being presented is irrelevant to any given individual. If you are interested in physician mobile access to enterprise systems, you aren’t likely to care about SMS health messaging in Africa or some cool gaming app for nutrition. The fact that they both run on smartphones is irrelevant.
Most of the people I saw at the conference seemed to be wandering around in a daze trying to figure out what they should be doing. I felt the same way. I spent time in the exhibit hall trying to find something that interested me and came up short for the most part. I couldn’t find many compelling educational sessions, especially after ruling out those that didn’t involve a vendor.
Health 2.0 offered a co-located afternoon track. Someone remarked to me that the mHealth Summit probably needed Health 2.0 more than the other way around. Both place heavy emphasis on startups, mostly those selling to consumers, sometimes for passionate health-related reasons but often because their people and products are too rough around the edges to sell into the conservative hospital and physician practice market.
Both conferences seem to highlight companies that are just as interested in selling themselves as their products. The mHealth Summit feels like a speed-dating event for questionable companies and wary investors, with all of us other attendees there trying to educate and entertain ourselves around the commerce-driven mating rituals. Maybe that’s what the mHealth Summit should morph into – a conference purely for startups and investors. They dominate the proceedings anyway and that would at least allow prospective attendees to plan accordingly.
I wonder how many of this year’s attendees are first-timers and where the returning attendees work. My speculation is that people from broad healthcare IT go once and don’t find a reason to come back, while the company and investment people dutifully return hoping to raise or invest money, find partners, and recruit staff.
It’s interesting to me that the mHealth Summit is run by HIMSS Media, which probably explains the both heavy presence and promotion of its own advertiser-driven products and the appearance of vendors in nearly every aspect of the conference, including opening keynotes by company executives who were mostly pitching their companies. Even the wildly commercialized HIMSS conference doesn’t usually give company CEOs timeslots in the first morning’s session where attendees don’t have alternatives (both conferences, however, shut down the educational track for blocks of hours to herd attendees into the cash machine of the exhibit hall.) The pre-HIMSS mHealth Summit featured keynoters from the National Institutes of Health or heads of foreign governments rather than VPs from Qualcomm and AT&T.
A few random observations:
Lorre wants to thank our exhibit hall booth neighbors from Endeavour, who helped her hang our banner and took messages from booth visitors while she was away from the exhibit hall running the DocuSign webinar. On the other side of our booth, the Kore rep let her plug in her laptop to charge since she knows I would have vetoed $100 a day for a power strip. Across the aisle, Geoff from AT&T was really friendly and tracked down our expensive Freeman-provided chair that someone in another booth took because they hadn’t rented their own. We don’t know anything about exhibiting, so Lorre appreciated the support from folks who weren’t new to it.
I took a look at MediVu, which offers a tablet-based EMR view that gives doctors the big picture of all their patients. It was pretty cool, although I bet interfacing to the EMR would be ugly.
I saw a brief demo of MediSafe, a family-oriented medication adherence solution that lets you visually follow your own medication schedule or monitor the adherence of a loved one. They sell the software and partner with another company to provide the pill bottle sensors.
AT&T demoed some cool solutions in their ForHealth lineup. EverThere is a hands-free personal monitoring device that monitors a person’s activity with fall detection and connects to a call center. The real-time graph was pretty slick – it was easy to detect changes in movement pattern or a fall to a horizontal position.
I also looked at Toggle from AT&T, which allows enterprises to create a virtual desktop-type setup on a person’s individual mobile device to allow them to securely run enterprise apps in BYOD situation. They’re offering a 30-day free trial, according to Lorre’s friend Geoff who gave me the demo.
The VGo mobile telepresence robot was interesting.
mHealth Summit Observations from Anonymous CIO
I saw the HIStalk booth and stopped by and introduced myself to Lorre. I thought she represented the site very well.
This is my first time at this conference. I came with a set of expectations that does not seem to align with what I’ve seen. In my view, a mobile health strategy for a provider should address all four quadrants found below (sorry for the rudimentary examples in each category).
Much of what’s been presented at the educational sessions and on the exhibit floor focuses on the Patient Health quadrant. A tiny bit addresses the physician component. (I thought that the Wired Magazine Health Conference in NYC a month or so ago did a better job, in a shorter, less expensive forum, providing a greater breadth of info – and much, much better food included in the price.)
I am surprised to see how few — relative to vendors or developers – hospitals and health systems seem to be represented here. When at HIMSS, I can barely move five feet without encountering someone I’ve worked with during the decades of my career. Here, I’ve found barely one. So it begs the question, what are providers doing about developing a mHealth strategy?
Some of the sessions I attended were completely mislabeled. As an example, a session called “Adopting mHealth Strategies to Remain Competitive” was nothing more than four independent vendors promoting their wares. (I notice that this conference does not ask for participant feedback on each session – probably a good thing).
The Executive Breakfast that I paid additional money to attend, entitled “The World is My Waiting Room” I thought would be chock full of discussion about patient outreach in a variety of ways, seemed like nothing more than friendly banter amongst the presenters. The “breakfast” was nothing more than croissants, yogurt, fruit and coffee – none of it remarkable. I left disappointed and hungry. I paid to attend tomorrow’s breakfast as well. I’ll eat before I go.
Weather apparently kept more than a few presenters away, so maybe this isn’t the right time of year for this forum.
All your comments about the venue and location itself I agree with.
So maybe I expected too much? Maybe this part if the industry is too new to provide what I’m looking for? I don’t know. What I do know is that in my new role in the health system into which we’ll be merging, I’m tasked with developing and implementing a Phase One mHealth strategy, and thus far, this conference isn’t giving me much to work with.
For whatever reason, the sessions I attended seemed more interesting than yesterday’s. In most cases providers, were interspersed with technology providers. A lot more real-life stories of how to deploy technology for the betterment of a certain patient population were told.
At the Executive Breakfast, Nasrin Dayani from AT&T for Health and David Levin from Cleveland Clinic brought real passion to the discussion about mHealth’s role in patient engagement. Still stumped as to why I had to pay to attend this session – which was full. This panel seemed just like all the others in content and message.
At today’s keynote, both Astrid Krag (Denmark) and Muhammad Yunus (Bangladesh) did a great job speaking about how technology improves a population. Is it wrong to say I admire what I perceive as somewhat homogenously populated countries who seem to be able agree on an agenda to actually get things done? Eric Dishman’s personal story was effective too.
One of the two most significant sessions for me was “Aligning mHealth to Your Strategic IT Plan.” That’s just what I showed up to this conference to hear and I took away really useful info.
At “Streamlining Chronic Care: Keeping the Patient and the Bottom Line Healthy,” I’m not sure they effectively covered all of that, but all presenters were really good and spoke to actual experience in the mHealth space.
My other favorite session was “Lessons Learned from the mHealth Grand Tour.” It showed what breaking down the walls of politics and connectivity can do to achieve something great for a specific population group, in this case, diabetics, in mHealth.
Sometimes at these events, I’ll buy my lunch and look for random folks join at a table to start a conversation. I actually picked a great table and the conversation was flowing. It got even better when Kyle Samani sat down with is Google Glass.
The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
It seems like meaningful use is in a constant state of flux with moving deadlines and multiple stages that apply to each organization differently. With meaningful use stage 2 just around the corner for many providers it is worth taking a quick look at where we are on the journey to meaningful use.
Meaningful Use Timelines
The most important thing many organizations need to remember is the various timelines for each meaningful use stage. This can be pretty complex because it changes based on when you first attest to meaningful use. Plus, last Friday CMS announced an extension to meaningful use stage 2 and a delay of meaningful use stage 3 for one year.
Before this recent change, CMS put out the following chart which clearly illustrates how much EHR incentive money a provider will get for showing meaningful use of a certified EHR. Plus, it shows which meaningful use stages you will have to comply with based on the year you started attesting to meaningful use. After the aforementioned announcement, the only change to this chart would be that both meaningful use stage 3′s would become meaningful use stage 2.
The above chart is just for EHR incentive money under Medicare. The chart for Medicaid is much simpler and hasn’t changed much since the EHR incentives were first announced.
While the incentive money for EHR is important for many, it seems like doctors are motivated as much or more by the Medicare adjustments that will be enforced if they aren’t meaningful users of a certified EHR system. Here’s the timeline for the EHR payment adjustments:
There are a number of hardship exemptions that a provider can claim to avoid the penalties. If you plan to pursue one of these hardship exemptions, you have to apply for one by July 1, 2014. CMS has put out a nice tipsheet covering payment adjustments and hardship exemptions. As you can see, the exemptions are pretty narrow. Although, maybe they’ll create more exemptions over time like they did with the eRX penalties.
Other Notable Meaningful Use Updates
Regardless of what stage of meaningful use you are at or any prior years reporting, all eligible professionals will only have to attest to 90 days of meaningful use in 2014. This change was made to give organizations plenty of time to upgrade to the 2014 certified EHR technology. However, many EHR vendors have taken this extra time into account and are still not 2014 certified because they know eligible providers only have to attest to 90 days in 2014. Anyone attesting to meaningful use regardless of meaningful use stage will have to be on a 2014 certified EHR. The 2011 EHR certification will be expired and not accepted.
It is also worth noting that those who have not begun participation in the Medicare EHR incentive program will need to attest to meaningful use in 2014 if they want to be eligible for any EHR incentive money.
Meaningful Use Audits
If you’ve already attested to meaningful use stage 1, then you better make sure your documentation is in order. Meaningful Use audits have already begun and a number of organizations are getting caught without the proper documentation. This is worth also noting for those planning to attest to meaningful use for the first time. Make sure that you keep all your meaningful use attestation documentation in case you’re ever audited.
The most common audit issue organizations have is with core measure 15 which requires an organization to conduct a security risk analysis. Many organizations checked off this box without actually doing a security risk analysis. That’s a very risky proposition. This is one meaningful use requirement where you can’t rely on your EHR vendor to do it for you. This is not a hard task and many organizations will be happy to come and do one for you. Just make sure you’ve actually done it before you attest.
Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.
Brian Ahier publishes a revised Meaningful Use Attestation table that helps clarify the impact ONC’s stage 2 extension will have.
A recent KLAS report finds that healthcare providers do not believe that the underlying technology an EHR is built on is a true predictor of its capability or clinical success.
The FDA, ONC, and FCC will issue a joint report early next year outlining the federal government’s strategy for promoting innovation in health information technology.
A report from the Office of the Inspector General says that HHS’s Office for Civil Rights, which is responsible for enforcing HIPAA, has failed to comply with a number of federal cyber security requirements.
Practice Fusion closes a $15 million Series D round led by Qualcomm Ventures, bringing the company’s total funding raised to date to $149 million.
From Lorre: “Re: mHealth. So many people were coming up to me asking if I was Inga that I finally had to make this sign. I am going to get a well-made one for HIMSS. At one point today I showed someone my shoes and he said, ‘Yeah, you’re not her.’” Lorre was holding court at our little HIStalk booth at this week’s mHealth conference. I’m going to recommend that she not only get a better sign for HIMSS but step up her shoe attire, just to confound suspicious readers.
From Helen: “Re: mHealth Summit. I met Lorre – she rocks!” Lorre enjoyed meeting those (few) readers who attended the conference this week. I’m not sure it was relevant enough for a return next year, but we’ll see.
From ASMD: “Re: floppy disks. New York Times or Dilbert?” An article points out that government is not the most sophisticated technology user, noting that The Federal Register often receives submissions from federal departments via 3.5” floppy disks.
Acquisitions, Funding, Business, and Stock
HealthLoop, which offers an automated patient follow-up solution, raises $10 million in Series A funding led by Canvas Venture Fund. The company’s CEO is Todd Johnson, the former CEO and president of Salar.
IMS Health, a big data firm that aggregates and sells large databases of de-identified healthcare data, acquires Pygargus, a Swedish health analytics firm. Bloomberg, by the way, reports that IMS Health is considering an IPO in 2014 and may seek a company valuation of at least $8 billion.
The Indiana HIE selects AT&T’s healthcare Community Online information exchange platform for clinical messaging and medical record sharing.
Crystal Run Healthcare (NY) selects the Health Catalyst data warehousing and analytics platform.
UF Health Shands (FL) contracts with Besler Consulting for its Transfer DRG recovery services.
HMS Holdings names Joel Portice (Verisk Health) divisional president of government solutions and corporate strategy and Douglas M. Williams (Aveta) divisional president of commercial solutions.
Teleheatlh solution provider AMC Health appoints Lisa J. Roberts (Viterion Corporation) SVP of its government market division.
Juan Diaz (Association Capital Resources) joins The HCI Group as SVP/general counsel.
Bobbie Byrne, MD is named SVP/CIO of Edward-Elmhurst Healthcare, created by the merger of her former CIO employer Edward Hospital and Elmhurst Memorial Healthcare. She will also have responsibility for the facilities and construction departments at Edward as well as the two locations of the Edward Cancer Centers.
Next Wave CONNECT names Doug Cusick (HP/IBM), Robert Cothron (Singing River Health System), Becky Heflin (IBM), John McDowell (Oslo’s), and Sherry Reynolds (HHS) to its community management team.
Announcements and Implementations
St. Mary’s Health Care System (GA) makes the Epic MyHealth portal available for hospital patients.
Billings Clinic (MT) implements Omnicell automated dispensing cabinets integrated with Cerner Millennium EHR via the CareAware iBus.
Mercy Medical Center (MD) deploys BridgeHead Software’s Healthcare Data Management for the protection of its Epic system data.
PA eHealth, eVantage Health, and Caradigm will complete the pilot for their HIE project in early 2014.
The Mount Sinai Health System (NY) will use $5 million in funding from the NYC Economic Development Corporation to establish the Mount Sinai Institute of Technology. The Institute will initially focus on digital health technologies, biologically integrated technologies, and prescription technologies.
Government and Politics
The FDA, ONC, and FACC will release a report early next year outlining strategies and recommendations on an HIT framework that promotes innovation, protects patient safety, and avoids regulatory duplication.
Do as I say, not as I do: the OIG finds that the HHS Office of Civil Rights failed to comply with certain federal cybersecurity requirements for the IT systems used to store HIPAA-compliance investigation data. The OCR says all deficiencies have now been corrected.
Almost 76 percent of the largest not-for-profit senior living organizations are implementing EHR technology and 83 percent are implementing point-of-care systems.
KLAS finds that despite vendor claims of the importance of technology differentiation, providers find that technology platforms do not accurately predict EMR capabilities or clinical success.
Also from KLAS: StatRad, Rays, and TRS earn top scores for overall customer satisfaction in a report on teleradiology in the ED.
Thanks to Brian Ahier for forwarding an updated graphic that clarifies the newly proposed timeline changes for MU. Brian notes, “I think the important point here is that although there will very likely be more changes to come, healthcare organizations and providers should not count on any delay or changes but prepare for plans to proceed under this current current regulatory framework.”
Further thoughts on the MU Stage 2 extension: the Stage 2 timeline is unchanged, as Brian’s graphic depicts. Just because Stage 3 has been pushed back a year doesn’t mean that ONC is ignoring concerns about Stage 2 as CHIME and other groups seem to assume by their ballistic reaction to the Stage 3 announcement. ONC’s decision-making process has been thoughtful, participative going back to when Farzad was named National Coordinator. ONC announced the Stage 3 decision Friday and mentioned this week that it will offer a public comment period for the regulatory strategy being worked on with HHS and FDA when that report comes out in in early 2014. Those events show show that nothing has changed just because Farzad has moved on – ONC is listening and won’t blindside anyone with salvos of dictatorial imperatives. The pundits are also missing another important point – decoupling product certification from MU gives vendors more predictable certification updates and the change to give input. Vendors can deliver what the market wants (usability and patient safety features, for example) instead of chasing certification checkboxes.
A Massachusetts man spends about $10 and 20 minutes to make a prosthetic hand for his 12-year-old son on a 3D printer using plans he found on the Internet. The estimated cost for a traditional prosthetic hand is $20-$30,000.
This week I’m attending the mHealth Summit in Washington DC. One of the interviews I’ve had at the event was with Dan Cane, CEO of Modernizing Medicine. You might remember my previous post talking about Modernizing Medicine’s unique interface (and it’s still unique). However, Dan demoed their ICD-10 interface which was like none other I’ve seen.
What I found unique about the Modernizing Medicine ICD-10 interface was that the ICD-10 codes were identified algorithmically as opposed to doing a search. In fact, it begs the question: are there other EHR vendors that algorithmically choose an ICD-10 code as opposed to providing some interface where the user has to search and identify the code? I don’t know of any other EHR software that do this.
Certainly there are plenty of ICD-10 interfaces that let you search for the ICD-9 code and then let you find the ICD-10 code. While it’s an extra step, this can be one way to filter down the vast ICD-10 codes. I’ve also seen other interfaces that after doing a search group the various ICD-10 codes and allow you to drill in to find the right code. However, it’s very different for the EMR to use the data you’ve entered into a note to determine the ICD-10 code for you.
The problem that most EHR vendors have is that they don’t have the EHR data recorded in a way that they could create an algorithm to identify a specific ICD-10 code. Is this even possible to do with a template or macro based EHR documentation system? The only possibility is to take something like Watson together with NLP technology to try and identify the ICD-10 code. The results of such a thing would vary greatly by doctor. Watson can’t magically know right or left (or choose something more esoetric) if you don’t document it.
Why does this matter? If it takes you can extra 1-2 minutes per patient finding the ICD-10 code, that’s going to be a major issue. The moral of the story is that even though your EHR vendor might say they’re “ready” for ICD-10. Are they really ready? Just because a program can do something doesn’t mean it does it well.
Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.
The date for compliance with ICD-10 has been pushed back to October 13, 2014, from October 2013, but this doesn’t mean delaying implementation is in your best interest.
The move to ICD-10 is a dramatic change that should not be taken lightly because this change permeates many layers of a hospital, clinic, or practice. This extends to vendors’ ability to support ICD-10 and payers’ ability to process claims accurately and on time. The ICD-10 pilot identified end-to-end testing as the most challenging area of the conversion.
To use the extra time proactively, the following questions should be considered to help you successfully complete the migration to ICD-10.
Create a basic checklist. According to a HIMSS Whitepaper on ICD-10, a basic checklist for the implementation of ICD-10 should include a complete list of interfaces that are associated with ICD-9 and/or ICD-10 codes. This also includes reports that may be generated from primary and secondary systems which use ICD-9/ICD-10 as a data element, or reports created and sent to external agencies or organizations.
Once pertinent information is compiled, the next step is to determine what needs to be tested. The following questions should be considered:
After testing, potential scenarios need to be reviewed, including:
Part of the challenge includes competing organization priorities, which restricts many organizations from participating. Some recommendations from the ICD-10 pilot include creating a test plan in which multiple clinical scenarios can be checked during end-to-end testing as a collaboration across the healthcare groups.
Now is the time to assess, test, implement, and evaluate all systems and determine whether contingency plans are needed in preparation of the ICD-10 Big Bang. Are you ready?
More assistance and information on the conversion to ICD-10 is available in the ICD-10 playbook on the HIMSS website.
Free cloud-based ambulatory EHR vendor Practice Fusion raises another $15 million on its series D round, bringing the round total to $85 million and its lifetime fundraising to nearly $150 million.
In England, Royal Berkshire NHS Foundation Trust has suspended two contracts it has with Cerner worth $10 million. The contracts were awarded in 2012 for 10 years of customer support for the Trust’s Cerner Millennium EHR. The contracts were cancelled due to due to higher than anticipated operating costs associated with the project. To bring costs back in line, the Trust cancelled the support contracts and plans to train internal staff to fill the support roles instead.
IMS Health, a big-data firm that aggregates and sells large databases of de-identified healthcare data, acquires Pygargus, a Swedish health analytics firm.
The Atlantic discusses overconsumption of healthcare services in America. According to a recent Institute of Medicine report, 30 percent of total healthcare expenditures in the US are for unneeded care. 42 percent of doctors surveyed in a 2011 Archives of Internal Medicine study reported thinking that their patients were getting more care than necessary.
I’m at the mHealth Summit at the Gaylord National Resort and across the Potomac River from Washington, DC on the Maryland side. It’s a 2,000-room hotel surrounded by chain restaurants and stores in one of those destination developments aimed squarely at tourists who want to travel without being exposed to anything new, or heaven forbid, local (think Orlando on the Potomac. ) The weather has been terrible with snow and freezing rain, which has added to the feeling of captivity of being in a hotel intentionally located far from competing restaurants and stores and with no convenient shuttle service or Metro station access, meaning everything you eat or drink will cost twice what the market would otherwise command. It’s an expense account crowd, so they don’t seem to mind.
The last time I attended this conference was in 2010, when it was still being run by the Foundation for the National Institutes of Health and held in the Washington Convention Center. HIMSS took over in the meantime and attendance has more than doubled to around 5,000. Quibbles aside, HIMSS knows how to run conferences much better than the NIH, meaning there is good signage, an annoyingly peppy opening session featuring questionable curated pop music and lighting, and a strong vendor and commercial presence. It’s much more enjoyable.
I felt as though I had intruded on a geeky academic conference in 2010, although with Bill Gates, Ted Turner, and Aneesh Chopra speaking, the keynote star power was a lot higher then than now. Presentations back then were often about public health projects in Africa, government informatics research, and government policy. The “exhibit hall” was mostly just a part of the hallway where public health poster presentations were displayed, along with a modest presence by the telecom companies. I felt somewhere between virtuous and bored being there.
HIMSS, as it usually does, put all of that unsexy and unprofitable subject matter almost out of sight. Now the conference is a freewheeling ode to capitalism showcasing companies willing and able to pay big bucks for space in the exhibit hall and in the endless number of HIMSS-owned publications. The exhibit hall is like a downsized version of that at the HIMSS conference and most of the educational sessions are either about companies or feature vendor people as presenters or moderators. The attendee demographic seems to have shifted from a heavy non-US presence to the same kind of minimally diverse suited people who go to the HIMSS conference, except few of the folks here are from hospitals since we hospital rabble are seen as part of the problem, not of the solution.
HIMSS seems to be positioning the mHealth Summit as the minor league of its conference portfolio. Most of the small mHealth exhibitors will be toast in a couple of years, but those who survive will graduate to the big show, the HIMSS conference. It’s an untapped market for HIMSS since companies at this conference aren’t selling to hospitals and practices. It’s become more of an investment conference than anything else.
The same issues dominated this year as in 2010. Nobody’s really sure what mHealth is, basically punting off by saying anything that runs on a smart phone must be, which means the subject matter is entirely unfocused and confusing. Startup companies keep trying to convince each other that they can hang on long enough to be bought out. Everybody fervently believes that mobile apps and brash startup spirit can transform the US healthcare system into one that’s cheaper, more health-focused, and more consumer driven. It’s always easy for me to be cynical and dismissive, but especially so at the mHealth Summit.
Speaking of disruptive, I had firsthand experience with a business that truly is. Take a look at Uber, which is fairly new to DC and several other cities. Cab companies and the local governments that regulate and tax them are freaking out over Uber. You punch up on your smart phone that you need a run (either a limo-type service or cab). Uber tells you how many minutes it will be until your car arrives, and you can watch it moving toward you in real time on a map. Your driver calls to confirm, takes you to your destination, and then you just walk away since Uber charges your credit card plus a 20 percent gratuity automatically. You don’t have to flag down a cab, figure out the whole payment forms/ tip / receipt issue, or explain on the phone where you need picked up. It’s pretty amazing, and clearly the deceptively simple app is connected to a super-sophisticated back-end system. I loved everything about it except the two cab problems that even it apparently can’t solve – my driver spoke no English and never heard of National Harbor so I had to punch it up on my phone and show him the screen so he could type it into his phone’s GPS.
The opening keynotes I saw all involved vendors or investors. It almost made me miss the puzzlingly unrelated but occasionally interesting HIMSS conference speakers, like Dana Carvey or that mountain climber who sawed his own arm off. The Qualcomm guy proudly mentioned its venture arm’s new investment in Practice Fusion, which has zero to do with mHealth, but given that everybody wanted to talk about investments and valuations, maybe he was just caught up in the moment.
Investor Ester Dyson was interesting, although a bit prickly. She observed that cell phones didn’t compete with land lines, they just showed up and created their own market. She said that mHealth is like that, where it doesn’t have to compete with or earn the approval of entrenched companies. She also observed that mHealth has too many iffy apps and not enough real companies.
AOL founder Steve Case said mHealth needs to move from features to products to platforms. He gave an example in the early days of the PC, companies did nothing but sell printer drivers, but that didn’t last long. He says the market will open up in 5-10 years (the timeline apparently hasn’t changed much since the 2010 conference since that’s what they were saying then). Steve’s Revolution Health was a flop so he got rid of most of it and turned it into an investment vehicle that doesn’t seem to have kicked much of a dent in the universe either, so I don’t know if finding a rich, clueless buyer for AOL right before the dot-com bust makes him a sage, so take it for what its worth.
Dyson made an observation I heard a couple of brave skeptics utter at the 2010 conference. All of these cool apps haven’t had much impact on health. One company doubled the rate of smoking cessation, but that was still a jump from just 5 percent to 10 percent. In 2010 they were talking about the need for more outcomes research; apparently there still isn’t much of it. Case may have explained that in his talk – healthcare and education are the two sectors in which consumers have so little influence (and government has so much influence) that you can’t encroach on them via consumer pressure, you have to partner with the entrenched players.
I floated around some sessions and the exhibit hall, not really seeing much that interested me. Apparently the Twitter crowd was more easily impressed since they were lighting up the Twittersphere with observations about both the educational sessions and the exhibits. The biggest and busiest booths were Qualcomm and the National Institutes of Health, which should illustrate my “unfocused” observation pretty well.
I went to a session on government mHealth policy and outcomes. Jodi Daniel of ONC said the FDA, HHS, and ONC are working on a draft strategy report related to the FDASIA report and the FDA’s potential role in regulating healthcare IT. She said the report will go out for public comment in early 2014. Credit ONC for always trying to get input from all stakeholders before just laying the law down.
The exhibit I appreciated most was Alego Health, which not only had a bartender handing out wine and beer, they also had a nice cheese board that prevented me from having to pay $8 for a cold wrapped sandwich. I looked them up and they do EMR consulting, which doesn’t seem like a good fit for this conference, but I was glad to see them.
The exhibit hall had an Innovation Zone, where smaller, newer companies got a small demo space in a dedicated area in the back.
We had a little HIStalk booth (a freebie from the conference people as a media partner, meaning we write about the event, like right now) where Lorre said hi to anyone who dropped by. Enough people were convinced that Lorre is actually Inga and challenged her on it, so we made her a sign to put front and center assuring that she isn’t. She will be in the booth again tomorrow (#1305).
I’ve chosen some session for Tuesday that sound interesting. It’s fun to see a different side of healthcare and healthcare IT than I’m used to as a hospital person. If you’re at the conference, feel free to leave a comment with your takeaways so far. Let me know if you saw something amazing in the exhibit hall that I shouldn’t miss.
In a note on November 29, 2013, I discussed how the FDA was clamping down on the consumer-oriented genomic testing site called 23andMe (see: The Dispute between the FDA and 23andMe; What's Really Going On?). Here's how the company has decided to respond (see: Genetic Tester to Stop Providing Data on Health Risks):
The company will continue to take orders for new tests but will provide only ancestry information and raw data, without interpretations of the health implications. It said it might resume providing health data if it receives regulatory approval.
Here's an excerpt from an email sent to me personally on December 6, 2013, as a previous customer:
If you are a customer whose kit was purchased before November 22, 2013, your 23andMe experience will not change. You will be able to access both ancestry and health-related information as you always have. 23andMe has complied with the FDA's directive and stopped offering new consumers access to health-related genetic results while the company moves forward with the agency's regulatory review processes....We stand behind the data we have generated for customers. Our lab partner adheres to strict quality standards that are part of the Clinical Laboratory Improvement Amendments of 1988 - known as CLIA. These are the same standards used in the majority of other health and disease-related tests.
In my blog note, I suggested that the company should redefine its services in order not to fall under the FDA definition of a medical device. I also suggested that it put more warning labels on its reports. Ezra Klein provides some other ideas in Bloomberg View (see: 23andMe Challenges a Creaky Regulatory State)
...[T]here’s a benefit derived from upstarts such as 23andMe bristling at creaky, old rules: They force a re-examination of laws that are, sometimes, genuinely outdated.“The legal question is pretty simple,” said Daniel Carpenter, author of “Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA.” The definition of a device under the Federal Food, Drug and Cosmetics Act, Carpenter said, “is anything intended for the use or diagnosis of a disease or other conditions.”But the FFDC was passed in 1938. The section on medical devices was updated in 1976. The personal genetic test ...didn’t exist when the regulations were written. The short-term plan for 23andMe is a traditional pay-for-product model in which consumers hand 23andMe $99 to test their saliva and get a genetic report. But the long-term play is more interesting: 23andMe wants to aggregate the genetic information of millions of individuals, then mine that data to make medical connections, find disease markers and discover treatments at a faster rate than would be possible using traditional techniques. It’s an experiment in big-data genetics. Consequently, the value of the product now...says very little about how effective and valuable it might be in 20 years.
In the FDA’s letter to 23andMe, it cites potential harms from genetic testing; all are bank shots. After all, swabbing your saliva carries very little risk. So the FDA focuses instead on the possibility that a test will lead consumers to do something else that actually harms them. Consider, the FDA suggests, a 23andMe test that reports a false positive for a cancer gene: “It could lead a patient to undergo prophylactic surgery, chemoprevention, intensive screening, or other morbidity-inducing actions, while a false negative could result in a failure to recognize an actual risk that may exist.”Don Taylor, a genomics researcher at Duke University, delivers the obvious rebuttal: “Something has to happen in between that readout and the mastectomy,” he said. “There needs, for instance, to be a surgeon there.”The risk posed by 23andMe is closer to that posed by WebMD.com or fortune tellers than to the risk of having your health damaged by an X-ray machine. The danger isn’t that a genetic test will harm you directly but that you will act rashly on the information it provides. But is preventing patients from making bad decisions the FDA’s mandate? To Taylor, this is a “new technology bumping into an old regulatory approach.” The FDA is treating 23andMe as a medical device instead of as information.
I agree with Klein's arguments and ideas. First of all, it does not make sense to me for the FDA definition of medical device to encompass medical information. This definition dates back to 1938 with a revision in 1976. It's out of step with modern genomics and the increasing importance of "big data." The FDA and other critics of 23andMe conveniently forget that physicians are interposed between data provided by 23andMe and, say, the performance of a mastectomy. In a similar way, the agency is blocking approval of digital pathology technology for primary diagnosis, forgetting that there is a pathologist interposed between the image of a biopsy and its interpretation.
One final point. There is still the possibility of false negatives with 23andMe reporting. This could result in a false sense of security about, say, the risk of a woman developing breast cancer if she is not aware of the limitations of this testing. Therefore, I will repeat my suggestion in my note of November 29, about the need for more rigorous warnings about consumers taking some action on the basis of 23andMe test results before consulting a physician.
The Background Story
A number of months ago, a marketing manager at an EHR vendor asked me if I knew of any Healthcare IT focused marketing conferences. As I considered the question, I realized that there wasn’t a conference focused on B2B healthcare marketing. Sure, there were plenty of general marketing conferences. There were even a few consumer/patient focused marketing events. However, I didn’t know of any B2B marketing conferences that understood the unique characteristics of marketing to hospital executives and doctors.
After telling this marketing manager that I knew of no such event, she replied that I should create the event and that she’d be the first to register. It took me a little while to see if indeed their was a need for this type of event and if I could create an event that provided real value to those who attended. After careful consideration and planning, I’m extremely excited to announce the inaugural Healthcare IT Marketing and PR Conference.
The Conference Content
As I started thinking about what a conference like this would look like, I realized pretty quickly that I needed to have both PR and marketing involved in the event. I believe the line between PR and marketing is getting grayer and grayer every day (although, I’m looking forward to a healthy debate about the difference at the event). Hopefully the event can help both specialties discover new techniques and improve on their current techniques.
I also decided early on that this event should include a healthy dose of marketing and PR experts from outside of healthcare to balance out the normal healthcare IT marketing and PR discussions. By incorporating interdisciplinary learning from other industries, I believe that we can stretch our thinking and discover new ways of doing health IT marketing and PR.
Besides the speakers, the conference will provide a great opportunity to network and connect with so many great healthcare IT marketing and PR professionals. As is often the case with conferences, some of the best learning happens while breaking bread with your peers.
The conference will be held April 7-8, 2014 in Las Vegas. On the website, you can sign up as a Founding Attendee today. Along with a pass to the conference, Founding Attendees will also get their company promoted on EMR and HIPAA (this website), admission to a Founding Attendee ONLY dinner on April 8th, and our love and appreciation for supporting the conference. We’ll only be offering the Founding Attendee registration until we roll out the full conference website in early January.
Below, you’ll find the four founding sponsors for the inaugural event. Each of these companies are deeply involved in healthcare IT marketing and PR and bring a lot of expertise and experience to the conference. I appreciate their faith in trust in our ability to put on a really great event. I’m proud to have each of them as founding sponsors of the event.
Over the next few months we’ll be announcing all the details for the event. Be sure to follow @HITMarketingPR on Twitter to see the latest event updates and announcements. In the mean time, I look forward to hearing your thoughts and questions in the comments or on our Contact Us page.
We’re back again with our weekend Healthcare IT Central jobs post. Healthcare IT Central recently passed a really amazing milestone. The HIT Central jobs newsletter now gets sent to over 14,000 health IT professionals (See this week’s newsletter for an example). When I look through the list of people who read the newsletter, I’m in awe at the quality of professionals on the list.
I guess I shouldn’t be surprised when I look at the quality of jobs listed on the site. Not to mention the companies behind those jobs. Check out the Healthcare IT Central mini job site for these 3 companies to see what I mean:
If you’re looking for a particular type of Health IT job, you can always use this Health IT jobs search page. Also, here’s a list of links to some of our most popular search terms:
As always, I love to hear your feedback on the site.
Real-Time fMRI Pattern Decoding and Neurofeedback Using FRIEND: An FSL-Integrated BCI Toolbox.
PLoS One. 2013;8(12):e81658
Authors: Sato JR, Basilio R, Paiva FF, Garrido GJ, Bramati IE, Bado P, Tovar-Moll F, Zahn R, Moll J
Abstract. The demonstration that humans can learn to modulate their own brain activity based on feedback of neurophysiological signals opened up exciting opportunities for fundamental and applied neuroscience. Although EEG-based neurofeedback has been long employed both in experimental and clinical investigation, functional MRI (fMRI)-based neurofeedback emerged as a promising method, given its superior spatial resolution and ability to gauge deep cortical and subcortical brain regions. In combination with improved computational approaches, such as pattern recognition analysis (e.g., Support Vector Machines, SVM), fMRI neurofeedback and brain decoding represent key innovations in the field of neuromodulation and functional plasticity. Expansion in this field and its applications critically depend on the existence of freely available, integrated and user-friendly tools for the neuroimaging research community. Here, we introduce FRIEND, a graphic-oriented user-friendly interface package for fMRI neurofeedback and real-time multivoxel pattern decoding. The package integrates routines for image preprocessing in real-time, ROI-based feedback (single-ROI BOLD level and functional connectivity) and brain decoding-based feedback using SVM. FRIEND delivers an intuitive graphic interface with flexible processing pipelines involving optimized procedures embedding widely validated packages, such as FSL and libSVM. In addition, a user-defined visual neurofeedback module allows users to easily design and run fMRI neurofeedback experiments using ROI-based or multivariate classification approaches. FRIEND is open-source and free for non-commercial use. Processing tutorials and extensive documentation are available.
Take back your mornings with the iMirror – the interactive mirror for your home. Watch the video for a live demo!
University at Buffalo researchers are developing brain-computer interface (BCI) devices to mentally control robots.
“The technology has practical applications that we’re only beginning to explore,” said Thenkurussi “Kesh” Kesavadas, PhD, UB professor of mechanical and aerospace engineering and director of UB’s Virtual Reality Laboratory. “For example, it could help paraplegic patients to control assistive devices, or it could help factory workers perform advanced manufacturing tasks.”
Most BCI research has involved expensive, invasive BCI devices that are inserted into the brain, and used mostly to help disabled people.
UB research relies on a relatively inexpensive ($750), non-invasive external device (Emotiv EPOC). It reads EEG brain activity with 14 sensors and transmits the signal wirelessly to a computer, which then sends signals to the robot to control its movements.
Kesavadas recently demonstrated the technology with Pramod Chembrammel, a doctoral student in his lab. Chembrammel trained with the instrument for a few days, then used the device to control a robotic arm.
He used the arm to insert a wood peg into a hole and rotate the peg. “It was incredible to see the robot respond to my thoughts,” Chembrammel said. “It wasn’t even that difficult to learn how to use the device.”
The video (below) shows that a simple set of instructions can be combined to execute more complex robotic actions, Kesavadas said. Such robots could be used by factory workers to perform hands-free assembly of products, or carry out tasks like drilling or welding.
The potential advantage, Kesavadas said, is that BCI-controlled devices could reduce the tedium of performing repetitious tasks and improve worker safety and productivity. The devices can also leverage the worker’s decision-making skills, such as identifying a faulty part in an automated assembly line.
The big news of the week just came out of CMS at 4 PM EST on a Friday. Feels like they’re trying to bury the news story, but maybe it was just the way the timing worked out. Either way, there’s no way anyone who lives in the EHR and meaningful use would miss the announcement (not to mention I’ve already seen it posted on every major health IT news site). CMS is proposing an extension of meaningful use stage 2 another year through 2016 and so that means a delay in meaningful use stage 3 until 2017.
Here’s how Robert Tagalicod, Director, Office of E-Health Standards and Services, CMS and Jacob Reider, MD, Acting National Coordinator for Health Information Technology, ONC described the change in meaningful use timeline:
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.
Meaningful Use Stage 2 and 3
This shouldn’t come as a surprise to many. In fact, we’d been discussing the possible meaningful use stage 2 extension in the comments of my post: ICD-10 will be delayed. We thought meaningful use delay was possible, and now it’s happened.
I do like that this delay gives CMS and ONC more breathing room to know what to include in meaningful use stage 3. Plus, maybe they’ll get the MU Stage 3 certification requirements out in plenty of time for EHR vendors to be able to update their software.
One thing that is really interesting about this delay is that meaningful use stage 3 won’t go into effect until after the Medicare EHR incentive money is over. The Medicare EHR incentive money is only scheduled to be paid through 2016. Medicaid wasn’t implementing MU stage 3 until year 6, so I expect there’s no change there. While you won’t have to show MU stage 3 for Medicare EHR incentive money, you will have to attest to meaningful use stage 3 in 2017 if you want to avoid the EHR penalties (Payment Adjustments if you prefer CMS’ terminology). In 2017, those EHR penalties will be at 3%.
Many have called for a delay to meaningful use stage 2 as well, but that didn’t happen today.
2015 Edition EHR Certification
The other part of the CMS announcement is the 2015 Edition EHR certification. They propose having an additional 2015 EHR certification that sounds like it would amount to an update to the 2014 edition. The 2015 edition would fix any issues with the 2014 edition and update any changes to interoperability standards. Sounds like an EHR certification patch.
The catch is that EHR vendors that are 2014 Edition EHR certified wouldn’t have to do 2015 Edition. This is good since we don’t need software vendors having to certify again (as much as certifying bodies would love the new revenue). Although, I won’t be surprised if most EHR vendors take the new standards in the 2015 edition and update their software to those standards. Let’s just hope that if they choose to do so, it doesn’t kill their 2014 Edition EHR certification. We should all be using the latest and greatest standards. Even more important, we need to all be on the same standard.
What do you think of the announcement? I look forward to hearing your thoughts in the comments.
HIMSS Response – HIMSS Supports Stage 2 Extension
CHIME Response – Meaningful Use Timeline Shift Does Not Afford Flexibility in 2014
Just announced today from the Centers for Medicare & Medicaid Services (CMS) is a new timeline for Meaningful Use Stage 2 and Stage 3. Although there has been speculation about delays in these two stages, this is the first real step to implement a new timeline. Highlighted below are some key points from the CMS announcement.
In fall of 2014:
“…CMS will release of proposed rulemaking (NPRM) for Stage 3 and corresponding ONC NPRM for the 2017 Edition of the ONC Standards and Certification Criteria will be released in the fall of 2014, which will outline further details for this proposed new timeline. The final rule with all requirements for Stage 3 would follow in the first half of 2015.”
With these proposed changes, many providers and vendors may welcome the added time to meet the criteria and continue implement the supporting technologies to make health care work in a more efficient and effective way.
What are your thoughts on the new timelines? Given the challenges with Healthcare.gov, will more time raise the opportunity for success? Join the conversation.