October 24,2014


I keep an eye out for financial reports about IT companies. A recent article in the NYT that labeled IBM's continuing and large stock buybacks as stock-rigging caught my eye (see: The Truth Hidden by IBM’s Buybacks). Below is an excerpt from the article with details:

For the first several years of her tenure, [IBM's CEO has] managed to prop up the stock by buying back shares by the cartload. In the first six months of this year, the company spent more than $12 billion ...on its own shares....The company’s revenue hasn’t grown in years. Indeed, IBM’s revenue is about the same as it was in 2008. But all along, IBM has been buying up its own shares as if they were a hot item. Since 2000, IBM spent some $108 billion on its own shares, according to its most recent annual report. It also paid out $30 billion in dividends. To help finance this share-buying spree, IBM loaded up on debt. While the company spent $138 billion on its shares and dividend payments, it spent just $59 billion on its own business through capital expenditures and $32 billion on acquisitions....All of which is to say that IBM has arguably been spending its money on the wrong things: shareholders, rather than building its own business.“IBM’s financials make it self-evident that its stock-rigging strategy is not about value creation through ‘investment,’ ” David A. Stockman...wrote on his website earlier this year. “IBM is a buyback machine on steroids that has been a huge stock-market winner by virtue of massaging, medicating and manipulating” its earnings per share....Let’s be clear: IBM is not going out of business....The big question is whether the turnaround will be successful. Of course, there’s also the question of what IBM should have done with all that cash burning a hole in its pocket. Well, what about a major game-changing acquisition? ....There’s also a dirty secret about why some executives love stock buybacks: In certain instances, they can have an impact on executive compensation by goosing certain metrics that boards use to measure a company’s performance.

Earlier in my career decades ago, IBM was the dominant player in healthcare IT with its HIS software and, of course, its mainframe computers installed in all large hospitals. This was before the emergence of EHR software and the focus of the company was on hospital financials and what was called "patient management applications" by which was meant functions like admission, discharge, and transfer. Of course, since those days, the company has moved to the more profitable services component of IT. What I hear about IBM in relation to healthcare these days is mainly about Watson, its supercomputer, and the quest for some useful niche for it (see: IBM Watson's impressive healthcare analytics capabilities continue to evolve). Most such articles quote IBM executives about the future potential for Watson but usually scanty evidence about its utility in solving key day-to-day problems.

At any rate and through all of these corporate changes, the constant value of IBM stock has always seemed to be constant. If this article is accurate and the numbers seem to be solid, some of this value may have been the result of smoke-and-mirrors. Here what I think is the most important sentence in the above quote: While the company spent $138 billion on its shares and dividend payments, it spent just $59 billion on its own business through capital expenditures and $32 billion on acquisitions. I must say that I have never looked to IBM for innovation in healthcare IT. Perhaps this was the result of the relatively paltry amount of money the company has been on spending on its own business and on acquisitions. 


It’s been a tumultuous few months for ONC and it’s just gotten even more tumultuous. We previously reported about the departures of Doug Fridsma MD, ONC’s Chief Science Officer, Joy Pritts, the first Chief Privacy Officer at ONC, and Lygeia Ricciardi, Director of the Office of Consumer eHealth, and Judy Murphy, Chief Nursing Officer (CNO) from ONC. Yesterday, the news dropped that Karen DeSalvo, ONC’s National Coordinator, and Jacob Reider, ONC’s Deputy National Coordinator, are both leaving ONC as well.

Karen DeSalvo has been tapped by HHS Secretary Sylvia Mathews Burwell to replace Wanda K. Jones as assistant secretary of health which oversees the surgeon general’s office and will be working on Ebola and other pressing health issues. I think DeSalvo’s letter to staff describes it well:

As you know, I have deep roots and a belief in public health and its critical value in assuring the health of everyone, not only in crisis, but every day, and I am honored to be asked to step in to serve.

DeSalvo’s always been a major public health advocate and that’s where her passion lies. Her passion isn’t healthcare technology. So, this change isn’t surprising. Although, it is a little surprising that it comes only 10 months into her time at ONC.

The obvious choice as Acting National Coordinator would have been Jacob Reider who was previously Acting National Coordinator when Farzad Mostashari left. However, Reider also announced his decision to leave ONC:

In light of the events that led to Karen’s announcement today–it’s appropriate now to be clear about my plans, as well. With Jon White and Andy Gettinger on board, and a search for a new Deputy National Coordinator well underway, I am pleased that much of this has now fallen into place–with only a few loose ends yet to be completed. I’ll remain at ONC until late November, working closely with Lisa as she assumes her role as Acting National Coordinator.

As Reider mentions, Lisa Lewis who is currently ONC’s COO will be serving as Acting National Coordinator at ONC.

What’s All This Mean?
There’s a lot of speculation as to why all of these departures are happening at ONC. Many people believe that ONC is a sinking ship and people are doing everything they can to get off the ship before it sinks completely. Others have suggested that these people see an opportunity to make a lot more money working for a company. The government certainly doesn’t pay market wages for the skills these people have. Plus, their connections and experience at ONC give them some unique qualifications that many companies are willing to pay to get. Some have suggested that the meaningful use work is mostly done and so these people want to move on to something new.

My guess is that it’s a mix of all of these things. It’s always hard to make broad generalizations about topics like this. For example, I already alluded to the fact that I think Karen DeSalvo saw an opportunity to move to a position that was more in line with her passions. Hard to fault someone for making that move. We’d all do the same.

What is really unclear is the future of ONC. They still have a few years of meaningful use which they’ll have to administer including the EHR penalties which could carry meaningful use forward for even longer than just a few years. I expect ONC will still have money to work on things like interoperability. We’ll see if ONC can put together the patient safety initiative they started or if that will get shut down because it’s outside their jurisdiction.

Beyond those things, what’s the future of ONC?

A few days ago the borders for the 30 new Primary Health Networks (PHN) which will replace the 61 Medicare Locals were announced.Here is the link:http://www.health.gov.au/internet/main/publishing.nsf/Content/primary_Health_NetworksThe most interesting part of this transition I find is this description of what these new PHNs will do.Here is what the Department of Health says:What will PHNs do? The PHN name reflects the critical role they will play in networking health services across local communities so that patients, particularly those needing coordinated care, have the best access to a range of health care providers, including practitioners, community health services and hospitals.PHNs will achieve this by working directly with GPs, other primary care providers, secondary care providers and hospitals. Care will be better coordinated across the local health system so that patients requiring help from multiple providers receive the right care in the right place at the right time. PHNs...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

October 23,2014

HIMSS Europe20 - 21 March 2015, Antalya, Turkey.
HIMSS Turkey, a joint initiative between the Turkish Ministry of Health and HIMSS, returns for a second edition in 2015 after a successful event in 2014. Next year's Conference main themes will be:

If a picture is worth a thousands words, the above picture is worth about 10,000. I think this picture is best summed up by saying that the medical device industry is a heavily regulated industry. You can see why EHR vendors don’t want to be regulated by the FDA. It would get pretty crazy.

This image also illustrates to me why a company that’s built an FDA or medical device compliance capability has something of real value. Navigating the process is not easy and it helps if you’ve been there and done it before.

As to Dr. Wen’s comment on the tweet. There are a lot of challenges when it comes to medical device security. Definitely no antivirus and many are running on old operating systems that can’t be updated. We’re going to have to put some serious thought into how to solve problems like these in future medical devices.


I participated two days ago in a Deloitte webinar that addressed healthcare lifestyle analytics (see: Consumer Behavior Over Lab Results: The Power of Lifestyle-Based Analytics). The basic concept here is that healthcare organizations are able to collect various types of publicly available "social" information about individuals and, using "big data" techniques and predictive analytics, make inferences about their health status or goals. For example, a middle aged woman who takes yoga classes, is an avid golfer, and patronizes local health spas will probably have a special interest in wellness. Contrariwise, a woman of a similar age in the same town who has high TV consumption indicators, rents an apartment, and is a fast food purchaser may not be so disposed. 

A key question relating to this topic is what a health system or a health insurance company engaged in this type of research plans to do with the findings. For a retail merchant selling, say, electronic gear, it would make sense to direct its advertising toward individuals predisposed to buy its products. Health insurance companies, on the other hand, make more money if their clients don't utilize healthcare services. That's the reason they pay for smoking cessation programs or offer lower rates to non-smokers. The use of lifestyle analytics by such insurance companies provides at least the basis for cherry-picking clients or choosing to not sell insurance in a state with unhealthy populations. 

The webinar speakers acknowledged the possibility of cherry-picking by health systems and health insurance companies with access to lifestyle data but emphasized the potential for positive actions by health systems equipped with such information. Such positive benefits included proactive patient care coordination, personalized medicine services, measuring patients' propensity to change, developing targeted interactions with patients, and assessing a patient's preferred mode of engagement. All of this makes sense to me. In short, lifestyle analytics in healthcare can be used mainly for the benefit of patients or the opposite direction. Moreover, deleterious actions can be cloaked in what appears to be benign intentions.

For me, all of the positive aspects of lifestyle analytics are encompassed in their use for proactive care as discussed in the article quoted below (see: Lifestyle-based analytics hold promise for proactive care). Here's a key quote from it:

Lifestyle-based analytics may be an "emerging" predictive health model, but experts note that it's "simply taking data that we already have at our fingertips" and analyzing it in ways that weren't possible before. The benefit? “Moving from a reactive mode to a proactive mode” in healthcare....In the past, predictive healthcare modeling has used claims data, but the majority of the population doesn’t have good data – making predictions about life events and diseases difficult....This data also provides high correlations for lifestyle-based diseases, which account for 75 percent of the total medical dollars spent in the U.S.... [Healthcare analytics] can allow health insurers and providers to be proactive and not wait to do something until they are sick, which lowers overall healthcare spending. But the model can also indicate an individual's “willingness to change.” 


World Series: SF GiantsDuring this tech boom, is it a coincidence that the tech savvy San Francisco Giants are in the World Series for the third time since 2010? In this post, we take a look at the relationship of technology, leadership, big data analytics, and baseball. In particular, we explore how Major League Baseball manages its player/patient population, and the trends they are following since converting players from paper medical records to EHR.

The New Frontier in Baseball Data: Medical Analysis and Injury Prevention

Baseball teams are very secretive about how they use their data. Teams, like the San Francisco Giants, employ a slew of data analysts and data tools, but every team is reluctant to share how data is used, and where they derive insights. According to the 2014 SABR Analytics Conference, the new frontier of baseball data is not just about scouting players, but keeping players healthy and injury-free. The new area of research, just in in its infancy, is marrying baseball statistics with medical injury research.

Medical analysts are the new data darlings of baseball operations.

Chris Marinak, Sr. Vice President of Major League Baseball, implemented MLB’s switch to electronic medical records, and believes medical injury research will provide new insights over the next five or ten years,

I actually joined MLB in 2008, and I was shocked to see that we didn’t have a system for tracking injuries or medical information at a de-identified level. We were literally keeping a lot of paper documents and putting them into a filing cabinet. It was time for us to get into the 21st century.

So starting in the 2010 season, we rolled out an electronic medical records system working with the players’ association that allows our medical staff to enter in medical information on every single player injury and the treatments that those players get. And then that information is all stored in one place, so that when you go from one team to the next, it flows along with you.

Marinak says the ancillary benefit is that MLB now has an injury tracking system where they can track trends in the industry.

  • What are the most common injuries?
  • How many collisions at home plate?
  • How many concussions?
  • How many UCL surgeries?

This data is analyzed at a de-identified level to find the drivers of lost time, and the injuries keeping players off the field. “So we can hopefully keep them healthier,” according to Marinak.

Baseball is a Data Driven Industry

Baseball is a sport that has always been hungry for statistics. Sabermetrics, the study of baseball’s in-game play, has been around since the middle of the 20th century. But in 2002 and 2003, Sabermetrics became “Moneyball” as the Oakland As advanced to the playoffs with their analytic approach to assembling a competitive team, despite a lack of competitive dollars.

Video, Biomechanics, and Data

Matisse VerDuyn Fastest Bat Speed 101 MPH


With the advent of new technologies, PITCHf/x data and Sportsvision video in 2006, the world of baseball was set to explode with big data and predictive analytics. Detailed data became accessible for every hit and pitch in a game.

Batting and pitching biomechanics also started to be video analyzed at the high school level. In 2009, my son clocked an official bat speed of 101 miles per hour, one of the fastest recorded bat speeds in the country for any amateur or professional player.

Bat speed is recorded via a static ball test, hitting off of a tee; exit speed is recorded hitting a pitched ball.

An injury sidelined his play, so he started experimenting with this new PITCHf/x data. His early web-based program would let you compare MLB pitchers and batters, and team matchups. Having baseball experience would help him provide insights for an individual player’s performance enhanced by data visualizations like heat maps.

Although PITCHf/x stated its data could not be used for commercial purposes, it didn’t take long for the financial world to play ball – Bloomburg Sports was born in 2011. The company’s latest technology (recently sold) has the capability to create every imaginable data point from video captured from play performance, whether that video is captured live or from a stream.

Do you want to know how many times a player licks his lips before fielding a ball? – Dan Cohen, Bloomberg Sports

Tracking Body Movements

Dr. Glenn Fleisig of the American Sports Medicine Institute says they look at what a person’s body is doing and that’s what biomechanics is, “Tracking where the ball went is all good, but we look at how did their body get there. The new thing teams are embracing is biomechanics.” More information will come from wearable tech and self-tracking technologies.

MLB is doing a lot more tracking of player movements utilizing Trackman and through studies at MIT. Marinak says having more of that information publicly available will be important to innovation, but right now it’s just too big, “A game’s worth of data in Trackman is 7 terabytes. So we’re talking about big data at a massive scale.” He cautions that how this data is treated will be different because it is medical information, and keeping a player’s medical information needs to be private.

Dr. Stan Conte (formerly with the SF Giants and now with the Los Angeles Dodgers) is a leading expert in medical injury research in baseball. He says they focus on “changes” in the data. He explains medical data is dirty data, so it is very difficult to analyze.

The data is getting better, and with more data, we’ll be able to go into areas that we hadn’t thought about before. – Dr. Stan Conte

296Baseball28They Might Be (Tech) Giants

The SF Giants already have a reputation as the tech giants in baseball. Where else would you expect to see players taking batting practice with Google Glass?

But now that PITCHf/x also tracks every defensive play, it has been reported that the San Francisco Giants do defensive shifts better than all MLB teams. Is the team’s proximity to Silicon Valley, and its innovative CIO Bill Schlough, its World Series advantage? Or is it their overall focus on innovation?

The only team with “innovation” built into their mission statement.

The San Francisco Giants are dedicated to enriching our community through innovation and excellence on and off the field.

In 2004, the SF Giants were the first to offer Wi-Fi throughout their stadium. Today, approximately 35% of fans are online at games. The stadium’s “fat pipe” allows fans to easily upload content via the Giants app or social channels like Faceboook, Twitter, and Instagram.

In 2009, SF Giants CIO Bill Schlough introduced dynamic ticket pricing (DTP), allowing the price of game tickets to go up or down depending on popularity and availability. Other teams now use DTP, and the idea has spread to restaurants, movie theaters, and the performing arts.

Healthy Eating: Let Them Eat Kale

This year, the SF Giants opened a 4,320 sq. ft. edible garden and restaurant, affectionately called the “kale garden”, that sits overlooking center field. In addition to providing healthy fare for fans and players, the innovative garden will be used as an open-air classroom for students during the Giants’ off-season, where Bay Area youth will go to learn about sustainability, urban farming and healthy eating.

Gaining respect early as a technology leader was key for Schlough’s career, as the Giants let him run his own department with the ease and precision he wanted to do it in. It’s tremendous the impact Schlough has had on the Giants, but eventually that impact will affect the MLB as a whole.  – Justin Kasser

Now, let’s play ball!

Categories: News and Views , All

This is what we all dislike about healthcare today, the constant changes as we no sooner adjust to one change and there’s 10 waiting for us.  The pace of what is happening in the world of health insurance is becoming more than most can fathom at times.  Health insurance companies are fine tuning all their profit lines and that means shifting, changing doctors, changing hospitals.  The pace has picked up so much with analytics and subsequent contracts, people are now having problems finding a doctor and a hospital in the same policy at times.  I’ve written about that issue a couple of times.  A few months ago, I somewhat blatantly stated that Obamacare is a bunch of broken or killer algorithms as they don’t work together. 

Obamacare - One Big “Attack of the Killer Algorithms” No Matter Which Direction You Turn, Compounded With a Lot of Government and Consumer “Algo Duping”….

We have all known what open enrollment is and that puts you in place with an insurance plan that is supposed to cover your for a year, but it’s not working that way with all the constant changes that are happening today.  The Affordable Care Model when it was designed has indeed come with a lot of surprises and it depends on IT Infrastructures of health insurance companies to work with the government and we have all read tons of stories where that is not the case and that is what we hate.  Anybody in Health IT knows the website will be giving back glitches for some time to come with the way the launch was handled, by novices making the decisions to open it up before it was ready.  At this point that is spilled milk to talk about; however the subsequent data issues are not and new glitches will arise every time an algorithm that functions on the site is modified or a new one is added. 

HHS and CMS Are Going to Be Digging Their Graves With Flawed Data-Inconsistencies With Obamacare Insurance Information-Lots of Flawed Data, Payback For Opening Healthcare.Gov Before It Was Done..

Health insurers are now more than every hiring more Quants for analytics, just look at the classifieds sometimes.  In addition they have a bit of a data addiction going on with collecting everything and anything they can that gives information about us, for fear they might miss something.  I said they are going off a cliff with non relevant data and when we reach the point to where all of this data, cost to process, etc. reaches the point to where there’s no ROI or it costs more to process than the value, perhaps some of this will chill off a little bit. 

Health Insurance Business Is Driving Itself Off a Cliff & Doesn’t Know When to Stop With Collecting, Analyzing and Processing Non Relevant Data With Little Or No Impact On Giving Good Care..

In addition, we all pretty much know by now about the data selling epidemic that is happening in the US and that supplements the cost of processing data, yes selling our personal data.  It’s a monster out there and is adding to accelerated loss of dignity for consumers as well as not allowing for enough privacy.  Consumers at some point will totally revolt when the banks and corporations over step their bounds and when their algorithms really become more of a menace than a utility and I think in some area we are there now.  I used to be a developer and it’s not hard at all to follow the money and the code and figure out what’s going one as once you’ve been a query monster yourself you know how the addictive process works to try and find some value.  The problem is today is that a lot of this is driven beyond the real cost of running a business.  Software and analytics is the easiest thing in the world to sell and make a case to the buyer. 

It’s only later the buyer see’s what they bought and a lot of it has no ROI.  Furthermore this becomes even more exaggerated to somehow look and see if they can find value with use in another fashion or context and then the fun starts with quantitated justifications for things that are not true.  More at the link below on that juicy topic and scroll down and watch video #1 in the footer “Context is Everything” and you’ll have a better idea of the madness.  Right now with big data everyone thinks they are missing some big pot of gold, and after money, time and expense of working with the data, sure there might be some revelations but it’s the pot of gold or the algorithmic fairies they thought they bought at all. 

Quantitated Justification For Believing Things That Are Not True And Using Mathematical Processes To Fool Ourselves-The Journalistic Bot Functionality Debuts As Media Can’t Resist the Formulas…

Below is  a really good interview with Quant Cathy O’Neill and if you don’t know what a Quant does, tune in.  Keep in mind she goes back to her time at a hedge fund but the same mentality is working at health insurance companies, they forget there are humans attached to those numbers and we are seeing it now in healthcare with this constant shifting, constant variables that we can hardly live with.  Some quants have left hedge funds and now work for insurers.  Again the big thing to listen to here is the mind set of how they function and think.  So next time when all the disruptions come down the tubes from your insurance company, keep in mind this is the mind set of the quants that work there and the models they design.  It’s almost a game she says at some point and why shouldn’t we take advantage as we are smarter than you are and the talent is the brain and math power.  She’s also writing a new book called “Weapons of Math Destruction” and I don’t know when it will be out but keep that thought. 

Again the mindset of people who create these models are almost bliss to the fact that there’s people that have to work and adjust to what they create and sometimes the models are broken and they are pushed on consumers anyway as they mean shareholder profits.  She left the business as she felt it was wrong using math models in such a fashion that messes with and depletes retirement funds.  We all know what that’s about today too as it’s getting worse with risk.  You’ll hear her say they didn’t even want her risk models and went ahead with risky investments anyway. 

Another great article from a journalist who sees this as well.  Felix Salmon can’t make it any clearer with this quote from his article…so there you go, models that encourage cheating…anyone ever going to ask about the models and code?  Probably not, there’s too much verbiage to look at to think about this side that executes everything (grin).   He’s telling you the same thing so again this is what’s directing all the action at health insurers today and again they don’t know when to stop. 

“Once quants disrupt an industry, they often don’t know when to stop—and they create systems that encourage cheating.”

“On a managerial level, once the quants come into an industry and disrupt it, they often don’t know when to stop. They tend not to have decades of institutional knowledge about the field in which they have found themselves. And once they’re empowered, quants tend to create systems that favor something pretty close to cheating. As soon as managers pick a numerical metric as a way to measure whether they’re achieving their desired outcome, everybody starts maximizing that metric rather than doing the rest of their job—just as Campbell’s law predicts.”

“Campbell’s law: “The more any quantitative social indicator is used for social decision-making,” he wrote, “the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor.”

So this current system is going to break as we are not going to be able to keep up, no matter how much more complex it gets and the Quants will be there looking for small nooks and crannies to help the shareholders profit.  All of the overdone analytics in healthcare (outside of genomics and science as that is their business with big data) has made our health system worse.  On top of that we don’t even have HHS writing policy anymore, it’s done by the Center for America’s Progression and you’ll find people like Zeke Emanuel who thinks all should die at 75 over there.  He was a big contributor to the ACA and is not much more than a walking/talking commercial for United Healthcare. 

This is the real reason all the variables are coming at all of us right and left.  If you want to learn more about how this occurs, click here and visit the Killer Algorithms page which is full of videos from people smarter than me that will explain.  I chose the videos as they are mostly at the layman level so you won’t be overwhelmed but rather better educated on how what runs on servers 24/7 is running everything and as long as we continue to elect people in office who have no data mechanics logic, the insanity of what we are seeing now with Quants at one end and digital illiterates on the side of the government, it’s only going to get worse.  BD 

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.It is amazing how the discussion on the GP Co-Payment just runs and runs. Some more this week.Here are some of the more interesting articles I have spotted this 21st week since it was released. Clearly Ebola and the Government Response and the new Primary Health Networks got a lot of coverage in the press this week.The House of Reps returned a few days ago and the Senate comes back 27th October so we will see how we go!General.http://www.theage.com.au/federal-politics/political-news/bill-shorten-says-treasurer-joe-hockey-desperate-20141011-114utm.htmlBill Shorten says Treasurer Joe Hockey 'desperate'Date October 11, 2014 - 10:13PM Treasurer Joe Hockey is a desperate man, running out of time to justify his budget - but that doesn't explain why he's trying to tie Australia's intervention in Iraq to its passing, Opposition Leader Bill Shorten says.Mr Hockey made headlines this week when, while...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

Well if it’s not AARP and United wanting cheap code, or even Verizon, they do it too, here’s another opportunity to knock yourselves out and write some cheap code that will benefit Walgreens.  If you don’t win, you don’t get anything here either, but imageif it’s marginal and the Walgreens code department can use it even if you’re not the official winner, maybe they might throw a few dollars at you, who knows. 

AARP and United HealthCare Form “Longevity Network”–Time To Find Some More “Cheap Code” Looking For Millennials Still Living At Home Who Can Afford The Time To Write…Cash For Code Again

Walgreen has some other issues going on over there too as they just lost their CFO over some bad accounting algorithms and he’s now suing them and their VC investment head left as well as their VP of Merchandising too. 

Walgreens Loses CFO-Attacked By the KillerAlgorithms You Could Say As He Missed on the Pharmacy Earnings by Over a Billion

Just a little side note, Walgreens is also busy suing CVS over some mobile code too, so no wonder they want to line up some cheap code apps here:)  Whatever you do, don’t cheat if you get into this contest and use someone else’s code right now.  We know they need some more apps to probably collect some more data, preferably on us older folks because we have more of it. 

Walgreens Suing CVS, Rite Aid, Wants License and IP Damage Reimbursement, Patent Violations, Software Used For Refilling Prescriptions Via Mobile Phone Scanners…Not Getting Enough Data to Sell?

So there you go, one for “cash for cheap code” contest on the board.  They keep doing all of these and I wonder when the novelty is going to wear off and when the younger coders are going to demand some decent pay for this?  Also don’t forget that Walgreens now is partnering with WebMD to get some more of your data with rewards points next year.  You will have to log on to the WebMD page and upload data from widgets and trackers.    That sounds like the kind of stuff insurers want to get a hold of.   In some Walgreens stores you might have the pharmacist jump over the counter to sign you up for the YMCA or other Untied Healthcare programs as they get pay for performance money from United to do so.  BD

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Henry Ford Health System Innovations is supporting the Walgreens Balance Rewards App Challenge to find new mobile applications that encourage healthy behavior and improve disease management.

The challenge aims to drive healthy behavior through incentives, making it easier and more affordable for patients to manage their conditions, and for doctors and their preferred Walgreens pharmacy to better engage in a patient’s overall health and recovery.

The contest encourages the integration of Walgreens’ Balance Rewards incentive program's application program interface. This will allow users to earn Balance Rewards points for making healthy lifestyle choices. These rewards can be redeemed at participating Walgreens for merchandise, both in-store and online.

Categories and awards in the contest are as follows:

*Walgreens Best Overall App Integration Award ($7,000)

*Henry Ford Health System Patient Engagement Award ($3,000)

*People’s Choice for Best App Integration Award ($3,000)

Third-party app developers can access contest details and submit an integrated app entry by visiting the challenge page through Nov. 28. Winners will be announced during the Walgreens session at the upcoming mHealth Summit in Washington D.C., Dec. 7-11.


October 22,2014


I can relate to the bad algorithms after being in the hospital myself with the pain drip machine falling offline andimage waking me up a lot.  Well that’s just my tiny world there but the hospital staff lives and breathes these things every day.  So my experience with the device above is only one tiny device compared to what goes off in a hospital.  This is a good study and well worth it to get some data on what’s going on.  This is not the first time this topic has been brought up either but I think it’s the first time there’s been “real” data to look at to see how bad it can be. 

Alarm Fatigue and Health IT interoperability Are Top 10 Challenges Today With Medical Engineering And Pushing Some to Technology and Occupational Burn Out

Every time an alarm goes off there’s a purpose to it and with 88% of the Arrhythmia Alarms being false positives, you and I and anyone else would tune them out as you know there’s good odds that it’s a fake alarm and it goes down the list of priorities to attend to, and shut it off. 

This study was done at USCF a big hospital and they have a lot of automation all over to include alarms.  A while back this video appears in the Boston Globe and it’s worth repeating to watch again. 

Is that screech enough to get your attention in the video, hold your ears.  The “toxic” alarms of course are the ones that require urgent attention and even the video they talk about the false positives.  They spend a lot of time chasing alarms and now we have a number to put to it.  Interfacing between devices and information systems is about the biggest problem and there’s more such as broken connectors and so on.  With more devices entering medical data, I again think the ONC would be miles ahead to be over at the FDA as EMRs and devices, just due to the way technology is rolling are growing together and that way they would have two points of view from safety and the records portions and I would think we would win there.   BD 

Newswise — Following the study of a hospital that logged more than 2.5 million patient monitoring alarms in just one month, researchers at UC San Francisco have, for the first time, comprehensively defined the detailed causes as well as potential solutions for the widespread issue of alarm fatigue in hospitals.

Their study is in the Oct. 22 issue of PLOS ONE and available online.

The issue of alarm fatigue has become so significant that The Joint Commission, a national organization that accredits hospitals, named it a National Patient Safety Goal. This goal requires hospitals to establish alarm safety as a priority, identify the most important alarms and establish policies to manage alarms by January 2016.

“There have been news stories about patient deaths due to hospital staff silencing cardiac monitor alarms and alerts from federal agencies warning about alarm fatigue,” said senior author Barbara Drew, PhD, RN, David Mortara Distinguished Professor in Physiological Nursing in the School of Nursing at UCSF. “However, there have been little data published on the topic to inform clinicians about what to do about the problem. Our study is the first to shed light on cardiac monitor alarm frequency, accuracy, false alarm causes and strategies to solve this important clinical problem.”

During that time period, a staggering 2,558,760 unique alarms were recorded, many caused by a complex interplay of inappropriate user settings, patients’ conditions and computer algorithm deficiencies. This includes a subset of 1,154,201 arrhythmia alarms, of which 88.8 percent were determined to be false positives caused by the algorithm deficiencies.


22 - 24 April 2015, Luxembourg.
Join Med-e-Tel 2015 - 13th edition - and actively participate in the educational and information program of presentations, workshops, demonstrations and interactive panel discussions on eHealth, Telemedicine and ICT applications in medicine, health and social care. Med-e-Tel is the official event of the International Society for Telemedicine & eHealth, the international federation of national associations who represent their country's Telemedicine and eHealth stakeholders.
Agfa HealthCareAgfa HealthCare announces that it has been successfully installing two new DX-G digitizers and seven CR 30-X computed radiography (CR) systems as part of a digital radiography update at Salisbury NHS Foundation Trust. The digitizers support both standard phosphor plates and needle-based detectors, providing state-of-the-art image quality for the next generation in digital radiography across a broad range of applications.

I recently heard Elliot Lewis, Dell’s Chief Security Architect, comment that “The average new viruses per day is about 5-10k appearing new each day.” To be honest, I wasn’t quite sure how to process that type of volume of viruses. It felt pretty unbelievable to me even though, I figured he was right.

Today, I came across this amazing internet attack map by Norse which illustrates a small portion of the attacks that are happening on the internet in real time. I captured a screenshot of the map below, but you really need to check out the live map to get a feel for how many internet attacks are happening. It’s astounding to watch.

Norse - Internet Attack Map

For those tech nerds out there, here’s the technical description of what’s happening on the map:

Every second, Norse collects and analyzes live threat intelligence from darknets in hundreds of locations in over 40 countries. The attacks shown are based on a small subset of live flows against the Norse honeypot infrastructure, representing actual worldwide cyber attacks by bad actors. At a glance, one can see which countries are aggressors or targets at the moment, using which type of attacks (services-ports).

It’s worth noting that these are the attacks that are happening. Just because something is getting attacked doesn’t mean that the attack was successful. A large majority of the attacks aren’t successful. However, when you see the volume of attacks (and that map only shows a small portion of them) is so large, you only need a small number of them to be successful to wreak a lot of havoc.

If this type of visualization doesn’t make you stop and worry just a little bit, then you’re not human. There’s a lot of crazy stuff going on out there. It’s actually quite amazing that with all the crazy stuff that’s happening, the internet works as well as it does.

Hopefully this visualization will wake up a few healthcare organizations to be just a little more serious about their IT security.

I thought I would take a few rough notes for readers here. E & O E! Relevant Section -Outcome 7 - E-Health Started 08:34 pm. Lots of waffle on NICNAS and FSANZ. (Chemicals and Cosmetics!!) 8:58 pm Moved on to TGA. Refused to discuss medical cannabis….. Questions since June from all sorts of Senators. Australian Medical Devices are now more able to get easier conformity assessment if approved in EU or, I assume, US. Outcome 7 - Finished at 9:14pm. We know where e-Health is heading now - Into Oblivion! Sleep Well and what a farce - zero accountability! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

Here we go again, yet one more person in government suffering from “The Grays” and confusing virtual world values with the real world.  I love to use the broken Big Gulp example as everyone can relate to it as Bloomberg got soaked on his proof of concepts beliefs there and now we find out that Frieden came in and wrote policy for the broke Big Gulp model! Heck New York couldn’t win on that one with money and influence with Bloomberg being sucked in with the statistical models, and then this guy comes along and writes the policy for it.  Lot’s of fun and frustration when people don’t know when to quit and hold up the white flat with broken models today. It can be a lot of work writing policy for a “broken model” I might think:)  You end up sometimes with some very spurious correlations. 

By the way if you like satire, visit the page by the same name and create some of your own and you might be reminded of what you see in the news today with number crunches, oh those spurious correlations with data scientists working over time:)  Hey let’s find out the real run down on the per capita consumption of cheese as correlated to those who die getting tangled up in their bed sheets:) A very smart student from Harvard created the site.  You have to mathematically determine if correlations really exist and here’s a bunch of nonsense of when the folks don’t include the “why” with value. 

Spurious Correlations - Per Capita Consumption of Cheese As Correlated With Number of People Who Died Tangled Up In Their Bed Sheets! I Found Where All These Obscure Studies Originate:)

When it came to Ebola, there was a lot more policy to be written of course other than just getting rid of a larger cup.  Folks like this are are a danger and it goes all the way up to the White House, Obama and Biden, and the email bot that comes out of the White House too.  Again, I call it “The Grays” to where folks can tell what’s virtual and what’s the real world and further whether or not to use a “virtual” or “real world solution.  Well Ebola is the “real” world so nothing virtual was going to work here.  I wrote this post a while back on that topic based on what I have been observing in the world today.

Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…

The article here goes on to talk about some of the other focuses that Thomas Frieden had while he worked at the New York City Health Department so he took the easy things that work with PR, transfats, smoking and more, so according to this article this is where his best expertise was.  He didn’t do too well with the flu and ignored some requested policy in that area. 

So long and short of all of this, well maybe we had one more living in “The Grays” for too long and I’ll tag the Big Gulp campaign right to his tail with pushing Big Gulp and Bloomberg too:)  They just didn’t know when to stop shoving a broken model down the throats of consumers.  Data Scientists and Quants do get that way with their models and someone once in a while if they get off base has to come in and say “no” as they are not Gods.

CDC Is the Latest Government Agency Caught Up In Virtual Values, Confusion With The Real World Problem of Ebola–“The Grays” Continue to Haunt Those Who Can’t Tell the Difference…

Seriously we need to either get these folks to spend more time in the “real” world and drop out of their virtual values when the addiction takes over or can them if it’s that bad.  Well I guess when we look at where he came from and where he got his basic training, did politics speak louder than the virus?  You decide.  BD 

The chief of the Centers For Disease Control has come in for much criticism for his response to the Ebola crisis, but his current ideas might not be so surprising in light of the many political crusades in the form of "health policies" in which Thomas Frieden has engaged.

As City Journal's Steven Malanga reports, CDC chief Frieden has spent the last decade crafting government policies to attack smoking, transfats, and other dubious "lifestyle diseases" instead of, for instance, focusing on bio terror threats like anthrax and Ebola, or crafting policy to treat heart problems and cancers.

In 2001, only months after the Twin Towers fell in New York and during the same time Americans were on guard against anthrax, Frieden interviewed for the position of New York City Health Commissioner.

In that interview he was asked what his priority would be if he got the job. Instead of worrying about terrorism, bio terror, heart conditions, food borne illness from local restaurants, or cancer, Frieden said that his big priority would be to attack the tobacco companies.

Once he took on the NYC health position, Frieden began to initiate polices that offered increasingly "outrageous solutions to health problems based on few facts," Malanga wrote.

These dubious political campaigns were the soul of Frieden's tenure as NYC Health Commissioner and led to other health policies, such as Mayor Bloomberg's ban on large sodas


This alert was sent out today. I am told many system providers (not just Genie) are affected. Potential issue with PCEHR overviewsWe have been alerted by the Department of Health about a potential risk identified within the PCEHR system. This is impacting the way a small number of documents can be viewed in an eHealth record. This issue results in some Medicare, prescription and dispense documents presenting in the Document List but not appearing in the Medicare Overview or the Prescription and Dispense View. A permanent solution for this issue has been identified and will be implemented in December 2014 by the Department of Health. In the meantime, please do not rely on the Medicare Overview or Prescription and Dispense View within the Genie PCEHR-viewer to necessarily provide a complete list of information from a patient's eHealth record. It is recommended that you use the Document List to view all documents. Here is the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
To watch go to the following link: http://www.aph.gov.au/ Then select the Watch Parliament Tab and click on Senate Estimates / Community Affairs Hearing. Enjoy! David. Late Update - Committee is running very, very late. D.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

October 21,2014

HIMSS Europe6 - 7 November 2014 , Amsterdam, The Netherlands.
This year, the second annual HIMSS Amsterdam event will be taking place at the Hotel Okura. The 2013 conference, presented by HIMSS Europe, was the first HIMSS event in The Netherlands and brought together nearly 400 healthcare IT leaders from across Europe.
CarestreamMSC Cruises has become the first cruise line to offer a 24/7, multilingual pediatric telemedicine service on board its entire fleet thanks to an agreement with the renowned Instituto Giannina Gaslini Children's Hospital in Genoa, Italy.

EHR interoperability has been a hot topic lately and I have posted a number of notes about it. Here's a couple of the latest (see: What Will Motivate Hospital CEOs to Seek HIT Interoperability?Revisiting EHR Interoperability; Standardized Content and Vendor Strategy). The major EHR vendors have been unable or unwilling to provide broad interoperability solutions, particularly between their systems and "foreign" systems by which is meant systems from competing vendors. A new and perhaps unexpected player has emerged to provide an interoperability solution -- e-prescribing giant Surescripts (see: E-Prescribing Giant Surescripts Emerges As A Player In Push For Interoperability). Below is an excerpt from the article about this news:

With health care providers scrambling to meet a government deadline this year to electronically send and receive patient information, an unlikely actor has emerged to facilitate that transaction. As the country’s largest electronic prescribing network, processing 1 billion prescriptions last year, Surescripts has amassed information on more than 200 million patients—from phone numbers to birthdate. Capitalizing on its network, it started four years ago offering health care providers the ability to exchange clinical messages using government-sanctioned standards. The service, slow to take off, has quadrupled since March, with health care providers exchanging nearly 1 million clinical messages in August. Jeff Miller who heads clinical network services, says that number is rapidly rising. Surescripts has signed up 130 health systems, including Geisinger Health System, Mount Sinai Health System, and St. Joseph’s Hospital Health Center....Becomes The second phase of meaningful use calls for health care providers to transmit a patient summary electronically in order to qualify for financial incentives. Instead of fax or phone, a doctor at Mount Sinai can now forward to another physician on a different electronic health record a patient’s discharge instructions, medications list, and diagnoses, among other things. Mount Sinai uses electronic health records from multiple vendors....Giving Surescripts a major boost is Epic. The dominant electronic health record connects to Surescripts’ clinical messaging service, and many of Surescripts’ clients are on Epic. Other major vendors that use Surescripts include Siemens (now part of Cerner) and Meditech. Surescripts says it added 1,000 hospitals to its network this year. The more it adds, the more likely it makes its clinical messaging service indispensable.

I posted a note two years ago that suggested that this could happen (see: Surescripts May Capture the Health Information Network (HIN) Business). Here's a quote from the Surescripts web page that provides more information about the Surescripts interoperability solution (see: What Is the Current State of Interoperability? – Part One).

Surescripts....will demonstrate how Surescripts’ Record Locator & Exchange (RLE) service can connect other EHR systems and HIE networks. This new offering from Surescripts will locate patient records stored in disparate locations, support electronic patient consent, and facilitate the exchange of information with the requesting care provider’s EHR, adding significant value in a streamlined process.  With RLE, care providers receive comprehensive information about a patient with appropriate consent at the right time, in the right setting, and with the right context, improving care while saving time and money.  

How was Surescripts able to pull all of this off with the EHR companies, who should have deployed broad interoperability solutions, twiddling their thumbs? As noted above and despite government pressure, the major EHR vendors did not want to provide interoperability solutions with competing EHRs. Surescripts was in the e-prescribing business and therefore had a deep understanding of how to interface with hospital EHRs in order to transmit drug prescription data to pharmacies. The company then exploited a new business opportunity by serving as a third-party to enable inter-hospital EHR communication. It looks like Epic is playing ball with Surescripts, at least for now, in terms of supporting its clinical messaging service. However and at least to me, there's something a little looney about an e-prescribing company providing this service.


I’ve been writing about the need to do a HIPAA Risk Assessment since it was included as part of meaningful use. Many organizations have been really confused by this requirement and no doubt it will be an issue for many organizations that get a meaningful use audit. It’s a little ironic since this really isn’t anything that wasn’t already part of the HIPAA security rule. Although, that illustrates how well we’re doing at complying with the HIPAA security rule.

It seems that CMS has taken note of this confusion around the HIPAA risk assessment as well. Today, they sent out some more guidance, tools and resources to hopefully help organizations better understand the Security Risk Analysis requirement. Here’s a portion of that email that provides some important clarification:

A security risk analysis needs to be conducted or reviewed during each program year for Stage 1 and Stage 2. These steps may be completed outside OR during the EHR reporting period timeframe, but must take place no earlier than the start of the reporting year and no later than the end of the reporting year.

For example, an eligible professional who is reporting for a 90-day EHR reporting period in 2014 may complete the appropriate security risk analysis requirements outside of this 90-day period as long as it is completed between January 1st and December 31st in 2014. Fore more information, read this FAQ.

Please note:
*Conducting a security risk analysis is required when certified EHR technology is adopted in the first reporting year.
*In subsequent reporting years, or when changes to the practice or electronic systems occur, a review must be conducted.

CMS also created this Security Risk Analysis Tipsheet that has a lot of good information including these myths and facts which address many of the issues I’ve seen and heard:
CMS HIPAA Security Risk Analysis Myths and Facts

Finally, it’s worth reminding people that the HIPAA Security Risk Analysis is not just for your tech systems. Check out this overview of security areas and example measures to secure them to see what I mean:
CMS HIPAA Security Risk Analysis Overview

Have you done your HIPAA Risk Assessment for your organization?


First, do no harm.

Four simple words that are synonymous with healthcare. It’s a principle that everyone in the industry – not just physicians – should adhere to.

So shame on us all for our part in allowing an EHR vendor to shut off a practice’s access to their patients’ medical records and for recklessly putting patients at risk.

Background: Full Circle Health Care in Maine purchased an EHR from HealthPort in 2010. Originally the maintenance fees were $300 a month. A few months later CompuGroup Medical purchased HealthPort and increased the maintenance fees to $2,000 a month. The practice protested the price increase and claimed CompuGroup failed to deliver hardware upgrades that had been paid for. The parties spent several months arguing and for 10 months the practice did not pay its maintenance bills. Finally in July, CompuGroup shut off the practice’s access to its medical records.

The details as to why the fees jumped so much and whether CompuGroup had the legal right to do so are a little unclear. What is clear is that multiple parties are at fault for allowing such a mess to occur.

Let’s start with the government, which created the HITECH program and promised thousands of dollars for providers willing to adopt and meaningfully use EHRs. Though the objectives were admirable, CMS failed to adequately address all the “what if” scenarios in its rush to move the program forward. The legislation and final rule provide no guidelines for protecting patient records in the event of a vendor/provider disagreement, financial hardship, or business discontinuance. Undoubtedly we’ll see plenty more disputes like this one in the coming years.

Tdo no harmhe practice also gets a share of the blame. The owner should have invested in legal advice before signing a $72,000 contract for something as critical as an EHR system. Did she skip this step in her haste to achieve Meaningful Use and earn incentive payments? Furthermore, even if she disputed the increase in maintenance pricing, shouldn’t she, at a minimum, have continued paying the $400 a month fee she believed was the correct amount? Perhaps the vendor would have been more willing to come to an acceptable agreement if she hadn’t stopped paying altogether.

CompuGroup, of course, looks like the really bad guy here. The multi-national company has annual revenues of about $600 million. Did they really need to pull the plug on this practice over a piddling $40,000? The company’s general counsel says the situation is similar to an electric company shutting off power when a customer fails to pay. Perhaps, but many municipalities and some states have laws that prohibit the discontinuance of services under certain conditions, such as in extreme cold weather or when a child or sick person is in residence. In other words, there are laws to protect consumers against potentially harmful actions. (See: EHRs And The Law: When Interoperability Isn’t a Choice)

Which brings us to the seemingly forgotten patient, who arguably is – or should be – the owner of his or her own record. We do have federal and state laws that give patients the right to access and inspect their medical records. Perhaps the practice’s 4,000 patients should all send CompuGroup a written request for a copy of their records. Maybe an attorney who is smarter than me should look into that.

Until the mess is settled, we have a practice seeing patients without the benefit of medication and allergy lists, details on previous treatments, or lab and test results. And everyone involved is hoping that no patients are harmed.

Whether our role in healthcare is policy maker, technology developer, provider, or HIT geek, we really need to do better.

Categories: News and Views , All

In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn’t available for an interview in time for that report, but he was last week, so I got him for a new podcast.

Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. “Suboptimal system design could lead even careful users to make mistakes,” Silverstein said in this interview.

During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity and Responsibility in Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.

Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.

1:10 How this interest came about
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR’s role in Texas Health Presbyterian Hospital’s initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 “Postmarket surveillance” of “medical meta-devices”
18:50 EHRs now more like “command and control” systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 “Critical thinking always, or your patient’s dead”
25:05 Lack of health/medical experience among “disruptors”
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of “experimental” technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT “bubble”
36:10 Good health IT vs. bad health IT


October 20,2014


On October 17, 2014, I posted a note discussing the usefulness of a reverse feed of clinical data from the EHR to the LIS (see: Reverse Feed" of Clinical Data from EHR to the LIS -- Will This Ever Happen?). I commented that I had first heard about the "reverse feed" from Dr. Ulysses Balis who is the Director of Pathology Informatics at the University of Michigan Medical School. He submitted an interesting comment to my note which I am now elevating to the level of a note. --BAF

Indeed, I proposed on the fundamental need for reverse feeds (and also reverse-federation, specifically) from the EHR back to the LIS as far back as 2007. This need is made obvious, when one considers the present state, where pathologists and laboratorians are being compelled to sift through one or more clinical systems, in addition to the LIS, in order to review all the underlying diagnostic data needed to make a full and complete report or diagnosis. In the absence of having convenient access to such information, the outcome is both predicable and obvious: reports are generated where the clinical information in foreign/disparate information systems has not been reviewed [by the pathologists generating surgical pathology reports], sometimes leading to glaring errors and inconsistencies (e.g. a bone biopsy not being clinically correlated with the radiographic impression, which itself might be the primary pathognomonic body of evidence) because the pathologist didn't bother to look up the case in the EHR or RIS.

At [the University of Michigan], we are actively developing workflow models that are purpose-built around reverse EHR-to-LIS interfaces and plan to use one such interface from the EHR to enable a pathologist's cockpit for the evaluation of medical liver biopsies. Other exemplars will hopefully come into being in logical succession. In time, as the number of use-cases grow and as the need becomes obvious to all, from a workflow perspective, the hope is that this construct will become commonplace. An important distinction of this type of interface, as opposed to a traditional LIS outbound results interface, is that the incoming clinical data from the EHR to the LIS is ephemeral. As soon as the pathologist or laboratorian is finished in their review of such clinical data, it is discarded. This is done to ensure that the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise. Should the lab need subsequent access to clinical data, the reverse feed can again be utilized to refresh the view, with it always guaranteed to contain the most up-to-date data.

Ul raises an important point with regard to a proposed interface at the University of Michigan from the EHR to the LIS. He indicates that the clinical data copied to the LIS will be ephemeral. By this he means that it would be discarded after review in pathology so that the EHR would remain as the single source of truth (SSOT) for all clinical information. Here's a definition of SSOT from the Wikepedia (see: Single Source of Truth):

In Information Systems design and theory Single Source Of Truth (SSOT) refers to the practice of structuring information models and associated schemata such that every data element is stored exactly once (e.g., in no more than a single row of a single table). Any possible linkages to this data element (possibly in other areas of the relational schema or even in distant federated databases) are by reference only. Thus, when any such data element is updated, this update propagates to the enterprise at large, without the possibility of a duplicate value somewhere in the distant enterprise not being updated (because there would be no duplicate values that needed updating).

When test results are transferred to from the LIS to another system such as the EHR, the process is always prone to errors. Some of these errors will be caught during the periodic validation of the LIS-EHR interface but such validation is never foolproof. Ul Balis has referred to the HL-7 interface between two systems as a data shredder (see: The EMR as a Data Shredder: Implications of a Single-Source-of-Truth Policy). As one example, formatting errors are common in the transfer of microbiology test results that are often in tabular format.

The most important interface for the LIS is the one to the EHR because this latter database is usually the only source of lab test results for hospital clinicians. This interface should only be validated by lab professionals because only they are trained to understand lab data in terms of accuracy and correct formatting. Let's assume that, in addition to the EHR, a hospital has a clinical data repository or warehouse that contains lab data. Such a database can not be used for patient care unless the lab data stored there is supplied by the LIS with the interface validated by pathology personnel. Ul understands this SSOT principle because he states, with regard to the reverse feed to the LIS, that "the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise." Another important reason for mandating that the clinical data that is copied from the EHR to pathology is ephemeral, as Ul point out, is that clinical data that is acquired later may be modified or updated.


I’ve been interested in the new “wearables” segment for a while. I reached out to Cameron Graham, the managing editor at TechnologyAdvice where he oversees market research for emerging technology, to give us some evidence-driven advice about wearables that entrepreneurs, innovators, healthcare providers, and payers can use for decision making. Specifically, what does the current research show and what are the actionable insights for how to incentivize patients to use them and figure out why patients might pay for them? Cameron thinks that wearable health technology could help improve patient outcome monitoring, if insurance companies and providers work together. He elaborated:

Wearable health technology (or mHealth as some call it) is one of the emerging frontiers in medicine. Fitness tracking devices could allow the healthcare industry to better measure patient outcomes, monitor patient populations for emerging trends, and give preventative healthcare advice based on quantitative measurements (such as daily step counts or heart-rate). We surveyed 979 US adults about their fitness tracking habits, in order to determine current the usage rate for this technology. We then further surveyed 419 of those adults, who identified as non-trackers, about what incentives would convince them to use wearable health monitors. Here are some of our takeaways for vendors and providers:

1. The wearable health market remains small, but is growing steadily

In order to gauge how many adults are currently generating personal health data that would be useful in either patient treatment or preventative medicine, we asked a random, nationwide sample of adults whether they currently tracked their weight, diet, or exercise using a fitness tracking device or smartphone app.

74.9 percent of respondents indicated they did not track any of those variables using either a fitness tracker or smartphone app. 25.1 percent reported tracking such stats.

Out of the roughly one quarter of adults who do track their fitness, 14.1 percent said they used a smartphone app, and 11 percent said they used a fitness tracker. There is currently little data on such demographics, although the Pew Internet Research Project conducted a survey in 2012 looking at similar trends. In their report, they noted that seven percent of adults tracked health indicators using an app. Combining these results, we can see that the market for health tracking applications has approximately doubled over the last two years.

As more consumers adopt such technology, and rely on it for monitoring their health, providers need to become involved in the discussion. There is limited data that can be draw from a sample of just 25 percent of a patient population. If providers can encourage adoption among a majority of their patients however, they will gain greater insight into current health habits, and be able to provide more tailored advice.

2. Physicians can play a large role in encouraging tracking but there are are few incentives in place for them to do so

Looking into what incentives could convince non-tracking adults to use such devices, we found great potential for healthcare providers to encourage tracking habits among their patients. It appears patients want their physicians involved more in monitoring but our healthcare system doesn’t have the right incentives or payment structures available to compensate providers.

48.2 percent of adults said they would use a wearable fitness tracker if their physician provided one. While this may be financially unrealistic for smaller practices, wearable activity trackers (like the FitBit or Jawbone UP) will likely become cheaper as more sophisticated, multi-purpose devices enter the market, such as the forthcoming Apple Watch.

If physicians were able to get half of the three-quarters of non-tracking adults to start measuring their fitness with wearable devices, it would create huge amounts of patient-generated data for the healthcare industry to analyze.

The infrastructure for handling this data is largely in place. The most popular electronic health record provider, Epic Systems, recently announced a partnership with Apple that will allow hospitals to easily integrate wearable data through Apple’s HealthKit platform into patient portals and records.

Promoting the use of such devices should now be a goal for physicians looking to gain greater insight into their patient population. The question would be why Physicians would do this without additional compensation either directly from their patients or indirectly through insurers.

3. Insurance companies and providers need to form partnerships

While a significant portion of adults would use physician-provided devices, health insurance companies may be the ultimate key to promoting widespread fitness tracker adoption.

A total of 57.1 percent of respondents said they would be more likely (or much more likely) to wear a fitness a tracker if they could receive lower health insurance premiums. In fact, this was a more compelling incentive than the possibility of receiving better healthcare advice from their physician (just 44.3 percent of respondents said that would make them more likely to use a tracker).

By agreeing to use a fitness tracker, insurance customers would become eligible for special discounts, perhaps for walking a set number of steps each day, or raising their heartbeat for a certain period of time. Discounts could be given out directly or through an employer.

Some companies are already experimenting with such systems. Humana insurance has a new Vitality program that allows employees to opt-in to fitness tracking in exchange for possible discounts. Car insurance companies have also found success by offering lower rates for safe-driving, as measured through in-car tracking devices.

If providers want to encourage fitness and health tracking among their patients, they should evaluate the possibility of providing devices to their patients, either for free or at a reduced cost. At the very least, they should make patients aware of the benefits of such devices, and encourage them to automatically share such data through their patient portal.

Long term, providers will likely need to collaborate with insurance companies in order to establish a data sharing system for such information, which can allow for physicians to better monitor their patient population, and provide more accurate, tailored diagnoses. A universal patient record system would be ideal, although given current interoperability standards, an insurance-provider arrangement is more likely.


Last week I had the chance to attend the Craneware Summit in Las Vegas. It was a really interesting event where I had the chance to meet and talk with a wide variety of people from across the spectrum of healthcare. I love getting these added perspectives.

One of the sessions I attended was an E&M session which provided some really interesting insights into the life of an E&M coder and how they look at things. There’s a lot more to their job, but I tweeted these comments because they made me laugh and illustrated part of the challenge they face in a new EMR world.

I thought these immediate responses to the question were interesting. They came from a crowd of HIM and coding professionals. Overall, they were quite supportive of EMR it seemed.

Many doctors don’t understand this. That’s why so many coders still have jobs.

Too funny.

Said like a true coder.


Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All

Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All

October 18,2014


Via Medgadget

locked in detection New Technique Helps Diagnose Consciousness in Locked in Patients

Brain networks in two behaviourally-similar vegetative patients (left and middle), but one of whom imagined playing tennis (middle panel), alongside a healthy adult (right panel). Credit: Srivas Chennu

People locked into a vegetative state due to disease or injury are a major mystery for medical science. Some may be fully unconscious, while others remain aware of what’s going on around them but can’t speak or move to show it. Now scientists at Cambridge have reported in journal PLOS Computational Biology on a new technique that can help identify locked-in people that can still hear and retain their consciousness.

Some details from the study abstract:

We devised a novel topographical metric, termed modular span, which showed that the alpha network modules in patients were also spatially circumscribed, lacking the structured long-distance interactions commonly observed in the healthy controls. Importantly however, these differences between graph-theoretic metrics were partially reversed in delta and theta band networks, which were also significantly more similar to each other in patients than controls. Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

Study in PLOS Computational Biology: Spectral Signatures of Reorganised Brain Networks in Disorders of Consciousness


Categories: All , News and Views

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