The hottest area in web search is image search and analysis. Needless to say, this will be a very important component of pathology informatics because of the evolving role of digital imaging in surgical pathology (see: "Eminence-Based" Surgical Pathology and the Digital Pathology Department; Image Analysis Using an iPhone Camera; Comparisons with Digital Pathology). Google scientists have achieved a breakthrough in image description using neural networks (see: Google’s Brain-Inspired Software Describes What It Sees in Complex Images). Below is an excerpt from the article describing the work:
Researchers at Google have created software that can use complete sentences to accurately describe scenes shown in photos....When shown a photo of a game of ultimate Frisbee, for example, the software responded with the description “A group of young people playing a game of frisbee.” The software can even count, giving answers such as “Two pizzas sitting on top of a stove top oven.”....Google’s researchers created the software through a kind of digital brain surgery, plugging together two neural networks developed separately for different tasks. One network had been trained to process images into a mathematical representation of their contents, in preparation for identifying objects. The other had been trained to generate full English sentences as part of automated translation software. When the networks are combined, the first can “look” at an image and then feed the mathematical description of what it “sees” into the second, which uses that information to generate a human-readable sentence. The combined network was trained to generate more accurate descriptions by showing it tens of thousands of images with descriptions written by humans....After that training process, the software was set loose on several large data sets of images from Flickr and other sources and asked to describe them. The accuracy of its descriptions was then judged with an automated test used to benchmark computer-vision software. Google’s software posted scores in the 60s on a 100-point scale. Humans doing the test typically score in 70s....That result suggests Google is far ahead of other researchers working to create scene-describing software.
When we get to the point of widely implemented digital pathology and image search, the surgical pathologist will never be redundant. Rather he or she will be empowered to operate more efficiently. We can draw an analogy between the current use of digital imaging in cytopathology and hematopathology. Here's a quote from an article about digital imaging in hematology (see: Digital imaging in hematology):
Digital imaging of Romanovsky-stained blood films can improve the work environment and alleviate some of the burdens associated with performing a WBC differential. With properly prepared and well-stained blood films, imaging technology can locate WBCs, capture images of the cells, perform a preliminary classification of cell type, and then display those images on a monitor. The advantages of this approach are immediately evident, since the technologist is freed from preparing slides and locating cells and can manipulate cells on the monitor to confirm or reclassify the identity of 100 (or more) WBCs. Metaphorically, the technologist becomes the editor, rather than having to author the book.
I think that we will see the following scenario evolving in the deployment of digital pathology in surgical pathology. Stained glass slides will undergo whole slide imaging and then a step in which the images are compared to those in an image archive seeking comparable cases. The surgical pathologist reading the case will then be directed to abnormal areas the slides with suggestions about what such cases have been diagnosed as previously. This is what my colleague Dr. Ulysses Balis has referred to as assisted, directed review. It may be the case that biopsies deemed totally normal by the search and analysis algorithms may be automatically signed out which is now the SOP for WBC differentials. However, any suggestion of abnormality in a slide will automatically require the attention of a pathologist.
Only readers of this site could enjoy this pharmacy sign. Thanks to HIPAA One for sharing the picture with me. Have a great weekend everyone! Stay Warm!
Maybe the pharmacy thought that HIPPA with two P’s stood for Patient Privacy. Of course, a quick search through posts on my site turn up 18 posts with HIPPA. So, this might be the pot calling the kettle black. I just enjoy the humor of humanity.
Well I thought we were trying to crack down on hydrocodone abuse and maybe the deterrent properties are the key here. In the last couple of years I seem to remember more of these types of products being approved or maybe I’m just imagining things? It comes from Purdue labs, one of the long time manufacturers of hydrocodone. Granted we need pain killers for short term after surgeries, etc. and some folks with long term use needed to where there’s not any other alternatives so they can’t go away. BD
Hysingla ER has properties that are expected to reduce, but not totally prevent, abuse of the drug when chewed and then taken orally, or crushed and snorted or injected. The tablet is difficult to crush, break or dissolve. It also forms a viscous hydrogel (thick gel) and cannot be easily prepared for injection. The FDA has determined that the physical and chemical properties of Hysingla ER are expected to make abuse by these routes difficult. However, abuse of Hysingla ER by these routes is still possible. It is important to note that taking too much Hysingla ER, whether by intentional abuse or by accident, can cause an overdose that may result in death.
I’m excited to tell you that we’ve officially announced the 2nd Annual Health IT Marketing and PR Conference happening May 7-8, 2015 in Las Vegas. We’ll do a full post in the future describing all the details, or you can check out the HITMC conference website for many of the details as well. It’s going to be the greatest gathering of healthcare marketing and PR executives that’s ever been done. People’s response to the first event has been amazing and I believe what we have planned for the second year will be even better. We hope we’ll see you there.
Here at EMR and HIPAA, we continue to grow and reach amazing new milestones. We just passed 10 Million pageviews on just EMR and HIPAA. We’ve done 2142 blog posts and you’ve contributed 9598 comments during that same time. Plus, I’m really excited that the Healthcare Scene blog network has over 29,500 Healthcare Scene email subscribers. I appreciate every reader that trusts us to provide thought leadership on the healthcare IT industry. We’ll keep doing everything we can to provide you value every day.
As part of our regular content, we’ve been working really hard on a number of amazing sponsored blog post series. They’ve been very well received by readers. I previously highlighted the content series that have been sponsored by Medical Management Corporation of America and The Breakaway Group. I’m sure that many of you have also enjoyed the recently started Cost Effective EHR Workflow Series that’s being sponsored by ClinicSpectrum. I’m looking forward to the amazing content these sponsored series provide readers.
Since our last post recognizing companies who support the work we do, we’ve had all of these great companies renew their sponsorships:
Ambir – Advertising since 1/2010
Cerner – Advertising since 9/2011
Canon – Advertising since 10/2012
gMed – Advertising since 8/2013
Colocation America – Advertising since 10/2013
Modernizing Medicine – Advertising since 1/2014
I’m extremely proud of those advertisers who’ve supported us for such a long time. Hard for me to believe that Ambir, for example, is about to reach their 5 year mark advertising on EMR and HIPAA.
A big thanks also goes out to our new sponsors. If you enjoy the content we create, take a minute to check out these companies and see if they can help you in your business:
HIPAA Secure Now! – I’ve written regularly about the need to do a proper HIPAA Risk Assessment in order to avoid any HIPAA penalties and to meet the meaningful use requirements. While you can do the HIPAA risk assessment in house, there’s some real value in having someone outside your organization being the one doing the HIPAA Risk Assessment. Avoids a conflict of interest. If you’re looking for someone to help you with your MU risk assessment, check out what HIPAA Secure Now has to offer.
Blue Horseshoe Network – I think their ad says it all. “Just Call Justina” if you need support for your EHR Go-Live, EHR Training or EHR optimization support. I’ve had a chance to interact with Justina myself and she’s got a lot of energy and passion for the work she does. Check out what Justina and Blue Horseshoe Network can do to help you in your EHR efforts.
Canon – You’ll see that Canon was listed in our renewing advertisers, but I wanted to highlight them here as well since they just started a big email sponsorship campaign with us. Canon is doing a lot of work to bring their fully integrated scanning solutions to healthcare organizations. We appreciate their support of our site and now our email lists as well.
You can get more details on how to get your company added to this list of EMR and HIPAA supporters. Just drop us a note on our contact us page. We’re happy to talk with you and your company about our sponsored content, display ads, email marketing, and webinar options. I think you’ll be impressed by the fully integrated email, SEO, display, and social marketing campaigns we provide.
I reported recently that the Cleveland Clinic, an Epic EHR client, was developing its own EHR interconnectivity solution (see: "Don't Tell Judy Faulkner," Cleveland Clinic CEO Cosgrove Cautions Audience). At a health innovation conference, CEO Cosgrove commented "that EHR interconnectivity will be happening across the country in three or four years'" but cautioned the audience "not tell the Epic CEO Judy Faulkner" about this trend. Now comes news that Geisinger Health System, a Cerner client, is also working on an interconnectivity solution (see: Interoperability: Now Geisinger has an app for that). Details are provided in the excerpt below:
Geisinger Health System and xG Health Solutions, a company founded by Geisinger, have connected a software app to an electronic health record by employing a new draft standard developed by international standards organization Health Level Seven. Geisinger developed a rheumatology app to interact with its Epic EHR. Now, by using the new HL7 draft standards, Geisinger and xG Health Solutions have successfully exchanged clinical data in real-time within the Cerner EHR framework. Geisinger and xG Health Solutions anticipate enabling apps to work in a similar fashion with all EHRs. This new "app approach" to augmenting EHR functionality has the potential to transform the delivery of healthcare by giving providers access to analyses of information that resides outside and/or inside the EHR, as well as decision support, regardless of the underlying EHR platform, Geisinger officials say in announcing the feat....Geisinger expects to make apps like these available to other healthcare systems through xG Health Solutions, founded by Geisinger in 2013 to commercialize Geisinger innovations. Geisinger and xG Health Solutions used an approach developed with grant support from the Department of Health and Human Services' Office of the National Coordinator's Strategic Healthcare IT Advanced Research Projects, known as SHARP, specifically the open-source Substitutable Medical Apps, Reusable Technologies, or SMART Platform. This Web-based interoperable container and the corresponding HL-7 Fast Healthcare Interoperability Resources, or FHIR, interface can exchange information in real-time with any SMART-on-FHIR-enabled EHR."
Epic has been dragging its feet with regard to interconnectivity of its product with EHRs from other vendors but not among its own client base. In my opinion, the company has been pursuing this strategy both to provide a valued feature to its own clients and also to promote its software as a de facto interconnectivity standard. Such a goal was not inconceivable given Epic's popularity among large hospitals. What Epic apparently did not bank on was that the Cleveland Clinic was willing and able to enter the software market with its own solution. Geisinger, through its IT company xG Health Solutions, was following a similar path with regard to the Cerner EHR. Look for Epic perhaps to soften its position on interconnectivity with foreign systems in light of these changed circumstances. I don't think that it will relish the scenario of competing with one of its own major clients in software sales.
The following question was posed on Twitter at the Healthcare Leader (#hcldr) chat:
“Over the holidays, can we ‘talk turkey‘ about health with family and friends?”
Coincidentally, at a recent family gathering, we had been discussing our health, and spontaneously decided to check our blood pressure and glucose readings. Although most of us did not have high blood pressure, and were not in the range of prediabetes, it led to a lively discussion.
How could we better support each other in health? What new consumer technologies could help prevent the most chronic conditions for our family and loved ones in the year ahead?
Early adopters enjoy the newest technologies and bold predictions, like those from futurists at Exponential Med (#xMed). The skeptics dismiss innovations like wearable tech as just a fad, or just for fitness buffs and “Quantified Selfers.” Others see the implications of new health tech as threats to privacy – like collecting and sharing data with employers and insurance companies.
Some innovations do not take off with consumers, like Google Glass, but fare better in B2B applications, according to Dr. Rafael Grossmann. His foresight for Google Glass in medicine is still one of the best use cases for the technology.
Apple has pushed back the release of its new Watch. But in 2015, a number of smartwatches will have the ability to continuously collect biometric data. We can expect precise readings for heart rate, blood flow, respiration, and glucose all in one device, like the Samsung Simband. No one has a system for sharing this data “between” people yet.
A List of Consumer Health Tech – Beyond Fitness Trackers
Wearables and health apps are great for fitness and chronic disease, but now we can use this technology for everyone to prevent chronic conditions. New tools make information accessible to the consumer that previously had only been available when seeing a doctor.
Ignite a conversation about health with family as smart consumers, and maybe they can avoid becoming patients of chronic disease.
Heart disease is the leading cause of death in the United States. AliveCor lets you manage heart health by recording your own electrocardiogram, and immediately relaying if atrial fibrillation is detected. AliveCor can now also track medications, symptoms (palpitations and shortness of breath), habits (caffeine or alcohol consumption), and activities (exercise and sleep) while using the monitor and app. (AliveCor’s inventor, Dr. David Albert, is also an interesting person to follow on Twitter!)
Hypertension affects one in three adults in the U.S. But the “white coat effect” of high blood pressure readings is very real.
“Researchers concluded that repeated measurements taken at home may help give a more accurate picture of blood pressure control than a single reading in a doctor’s office.”
Researchers hope to learn more about the disease and correlations as people track their own blood pressure more regularly. Treating signs of high blood pressure early can make all the difference. Why not make it a habit to take family blood pressure readings?
Seasonal Affective Disorder, characterized by fall/winter major depression and spring/summer remission, affects up to one in ten people in some northern states. But SAD can even be found in Florida.
Interdisciplinary research is needed to advance scientific knowledge about SAD. Solar-powered SunSprite tracks sunlight impact and measures your UV exposure.
All signs point to Home-as-a-Platform. Amazon Echo just launched, and is already attracting a lot of controversy, not unlike the introduction of Google Glass. However, Echo could make life easier for the elderly and disabled with its voice recognition technology that is touted as superior to Apple’s Siri.
Training your brain can help you reduce stress, improve focus, and enjoy a better quality of life. Why not practice mindfulness with the whole family? The benefits of mindfulness have been proven through medical research, and can even change the brain after only eight weeks of practice.
MUSE cites research that 20 minutes of focused attention training for only 3 days in a row can measurably improve mood, as well as reduce pain, anxiety, and heart rate.
After the holiday dinner, gather everyone for a walk, and talk about how you can improve your family health and fitness. Get inspired, as I was, by this series of “films” by Dick’s Sporting Goods – stories about people who face real challenges, yet still manage to get out there and run.
I run to express the gratitude for the life that I have. – Alicia Shay
I have never seen anything like this and I’m not happy with either party. I can understand the battle a bit though as the Democratic Dupers have sucked in so much “junk science” that it has irritated the other side to be the party of no with almost any science. I get irritated with what I called the Sebelius Syndrome as you can’t find anyone that was more of a repeated “public duper”, not once but over and over and I can’t figure out for the life of me where in the heck she came up with some of her rationalizations and actions. She had some smart people and and dupers working for her, but I must say the dupers won, either that or she listened to neither and was left to her own duped perceptions.
Folks in tech used to just sit and roll at some of what she said and it wasn’t for the fact that it was really messing with some big systems, it might have actually been funny. One of the best ones though is the letter sent out telling all hospitals and they were billing liars, along with software vendors in the Health IT business. In that case she even went so far as to duped Holder into signing the letter too:)
What’s funny about this too is that just a couple months ago CMS found an insurer that billed up $70 billion in “said fraud” using a risk fiddler and soaked them over 5 years so all the billing fraud inquiries and investigations couldn’t even touch this number, so we had a case of Algo Duping deluxe, and again those wacky perceptions we had to listen for a number of years:)
So there’s the Democratic Dupers who believe all the stats and formulas insurers tell them, while they algorithmically cash in. Health insurers have armies of Quants that really know how to work “the virtual” value world and the dupers never questioned it. I go back to my first sales manager I had when I was young who told me “throw numbers at them and you’ll get your sale” and that what we have with the Democrats here. Even the White House aggravated me with using junk science numbers with Climate Control and I have no problem with it but it made me mad to see duper stats that nobody can predict, insulted my intelligence but I wrote it off as that came from the Democratic Dupers. I don’t mean any disrespect here but damn this stuff is getting thick and you sit and wonder how much more will they dupe on in? Don’t put 2300 less hospitalizations will take place with one year of Climate Control as nobody and I mean me or anyone else can predict that because we have this little element called “variables” out there.
The best I could figure on that one is that the geeks at the White House were mirroring what we see in the news every day and were following a dupe pattern as everyone could be duped right?
Here’s another matter, does either party realize “the machines” are running the Affordable Care Act? From what I read, and it might be part media too, they don’t get it and still think a big shout down or another “he said she said” deal in the news is going to make a difference?
So let’s cut the crap here and get the Democrats out of their virtual worlds of sucking any set of numbers you toss at them and maybe the GOP won’t be so mad all the time and hang way at the other side? You think? Again I can see the aggravation here as I’m a Democrat and I get mad a their dupes! It’s stupid and I know better and there’s folks out there a lot smarter than me that read this stuff too, so stop the dupes! The GOP can stop being party of the “NO”. The more the Democrats dupe on us, the madder the GOP get and nothing happens.
We have healthcare models at CMS failing right and left and need to be redone and it’s all those over quantitated formulas that United Healthcare mentored over there for years and they don’t work anymore, just like the quantitative formulas for hedge funds, they’re not working anymore and everyone’s on this quest for some magical algorithms and they won’t find them to make big money like they used to.
We have way too many folks confusing virtual world values with the real world, so much to the point to where doctors are just about choked at the neck with all of this and nobody’s getting any better care but the Health IT bills are going up. Some of that needed to be weeded out so we have “relative” data and not just data that can be sold to make money.
Watch this video from Paul Wilmott and think “population health” and relate it to what’s he’s saying with all this big data and you’ll see how hard it is with all the numbers to “really” find a pot of gold as how would you find a relationship with such a huge number of patients? This is where this so called “science” fails as queries with small data might do just as well. Science need to dig around in big data like this as well as the folks in genomics but it’s way over done with giving patient care and thinking there’s some big scientific breakthrough to arrive with running the business of healthcare.
Scientists do their share of cheating too and mess with risk fiddlers and P Values as well to tweak “statistical significance” and add that on to this the Democratic Dupers and the GOP perceptions and then we really have a mess:) When the models get too complex for some non linear work, Quants and Data Scientists guess, especially if their job’s on the line. With all the complexities out there today, I might think we have a bit of guessing going on out there in healthcare, science and the financial world.
I’d like to see the day return to where I didn’t have to read through and pick off the dupes out there and the spurious correlations that people confuse for “real news” on some little number crunch that people mistake for science, that’s not science, it’s number crunch. So can these two parties get their heads together and start looking at the “real” world here so both parties can create laws that are not based on flawed and fake numbers?
Can the GOP quit saying “No” to everything and being a skeptic about anything? We do need good numbers and we are not getting that now as the sides are so far apart and it does nothing for the country. There’s sites besides mine that just rip on folks and their virtual world perceptions and yet they still keep doing it as again they have been confusing virtual values with the real world when they don’t belong and can’t tell the difference anymore.. You have to also remember the business world likes that confusion as it means profits as they will work both sides as needed.
We don’t need any more Bloomberg Big Gulp failed models and see how he was duped in and all the money and power couldn’t shove a broken model down the throats, literally of consumers. BD
If you think Epic Systems, which doesn’t issue press releases and infrequently shares much with the press, is tough for the media, you should try Meditech. I’ve never gotten a response from anyone there and never written any actual news about the company. Until now.
Today, this tweet appeared:
— Christina Noel (@Christina_Noel) November 19, 2014
So there you have it: Meditech is at a conference in Ireland today. That’s the most news I’ve ever had on that EHR vendor.
Trends and fads come and go. When they stick, it’s clear they address a consumer need, whether it’s a service, promise, or hope. Here at The Breakaway Group, A Xerox Company (TBG), we operate within a proven methodology that includes metrics, and it’s exciting to those of us who can’t get enough of good data. Most people find metrics interesting, especially when they understand how it relates to them, and the results are something they can control. Metrics are powerful.
To understand the power of data in shaping behaviors, consider the popularity of the self-monitoring fitness tracker or wearable technology. Even as their accuracy is scrutinized, sales in 2014 are predicted to land somewhere in the $14 billion range.1 Do mobile fitness trackers actually help people change their activity habits? Could doctors actually use the data to help their patients? Can companies be built on the concept of improving health with a wearable device? Not conclusively.2 Does a dedicated athlete need this kind of information? Some think not.3
So what is driving the growth of the fitness tracker market and what are these devices offering that creates millions of dedicated users? The answer is real-time data, personalized goals and feedback, and a sense of control; in other words, empowerment.
In the 70s and 80s, my grandparents spoke about their doctor as though he were infallible. They didn’t doubt, question, or even note what he prescribed, but took his advice and dealt with the outcomes. If healing didn’t progress as planned, my grandmother blamed herself, as though she’d failed him.
Jump ahead a few decades when more emphasis is being placed on collaboration. We expect our physicians to work with us, rather than dictate our treatment decisions.4 Section 3506 of the Affordable Care Act, the Program to Facilitate Shared Decision Making, states that the U.S. Department of Health and Human Services is “required to establish a program that develops, tests and disseminates certificated patient decision aids.”5 The intent is to provide patients and caregivers educational materials that will help improve communication about treatment options and decisions.6
Patient portals are important tools in helping to build this foundation of shared information. The portals house and track patient health data on web-based platforms, enabling patients and physicians to easily collaborate on the patient’s health management.7 Use of patient portals is a Meaningful Use Stage 2 objective.
The first measure of meeting this objective states that more than half the patients seen during a specified Electronic Health Record reporting period must have online access to their records. The second measure puts the spotlight on the patient and their use of that web-based information. MU Stage 2 requires that more than 5% of a provider’s patients must have viewed, downloaded, or transmitted their information to another provider in order for the provider to qualify for financial incentives from the Federal government.8
Empowered consumers want information immediately, whether it’s a restaurant review, number of steps taken in the last hour, how many calories they’ve burned, or their most recent checkup results. We like to weigh the input, make a decision, and then take action. Learning and information intake, no matter the topic, is expected to happen fast.
Metrics show us where we stand and how far we’ve come, which empowers us to keep going or make a change, and then measure again. We’re in an age of wanting to know but also wanting to know what to do next. The wearable device market has met a very real need of consumers. Whether or not fitness trackers make us healthier, whether or not our doctors know what to do with the information, or if this is information an athlete would really use, these devices can serve the purpose of putting many people in control of their own health, one measurable step at a time.
1 Harrop, D., Das, R., & Chansin G. (2014) . Wearable technology 2014-2024: Technologies, markets, forecasts. Retrieved from http://www.idtechex.com/research/reports/wearable-technology-2014-2024-technologies-markets-forecasts-000379.asp
2 Hixon, T. (2014) . Are health and fitness wearables running out of gas? Retrieved from http://www.forbes.com/sites/toddhixon/2014/04/24/are-health-and-fitness-wearables-running-out-of-gas/
3 Real athletes don’t need wearable tech. (2014) . Retrieved from http://www.outsideonline.com/outdoor-gear/gear-shed/tech-talk/Real-Athletes-Dont-Need-Wearable-Tech.html
4 Chen, P. (2012) . Afraid to speak up at the doctor’s office. Retrieved from http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_r=0
5 Informed Medical Decisions Foundation. (2011-2014) . Affordable care act. Retrieved from http://www.informedmedicaldecisions.org/shared-decision-making-policy/federal-legislation/affordable-care-act/
6 HealthcareITNews. (2014) . Patient pjortals. Retrieved from http://www.healthcareitnews.com/directory/patient-portals
7 Bajarin, T. (2014) . Where wearable health gadgets are headed. Retrieved from http://time.com/2938202/health-fitness-gadgets/
8 HealthIT.gov. (2014) . Patient ability to electronically view, download & transmit (VDT) health information. Retrieved from http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures-2/patient-ability-electronically-view-download-transmit-vdt-health-information
Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.
I few days ago I posted with information from the insurer themselves that doctors will be compensated at a rate slightly above what Medicaid pays, so I’m sure that’s what’s going on here as it’s all contracts and price. Other United Healthcare polices via employers and I’m guessing Medicare Advantage plans are still ok and accepted. Insurance carriers have had a busy year with hiring armies of quants and have zeroed in on the restrictive parameters of policies they will offer and making more of them carry a very high deductible which is basically coverage for a major event for most.
We did get away from pre-existing conditions with the ACA law but now the insurer modelers have just moved that segmentation over to narrow networks to model with.
“Also there’s another reason for all of this and that has to do with the “Secret Scoring of America’s Doctors” to where the armies of Quants that have been hired by insurers use pure analytics of some type to determine risk, costs, etc. and knock them off the network. The link below has more on the number of quants that have been hired by insurers. They want us as doctors and patients to move like algos and the result is flawed data. “
As a matter of fact the data at times with insurers due to frequent model changes that are also hard on us, we have cases like this in Maryland, where United bid and won a contract but then the left quant didn’t know what the right quant was doing and the doctors in the area had already been fired so they lost the contract as they nobody to see patients. This is how the constant shuffling of insurance data, they do on purpose for profits is shuffling out to consumers.
So again, those buying a United Healthcare policy via an insurance exchange in Maryland, looks like you are out of luck for Hopkins and their doctors. BD
Hopkins, one of the biggest systems in the state, is not excluded from all of the insurer's plans or by the other carriers on the exchange, created under the Affordable Care Act for people who don't get their insurance through their employers.
"We believe patients have the right to make informed decisions regarding their health care," said Patricia M.C. Brown, senior vice president of managed care and population health for Johns Hopkins Medicine. "Unless this limitation is clearly communicated, consumers who consider plans based on price alone may not realize they are restricting their access to the quality care and expertise that Johns Hopkins provides."
UnitedHealthcare is also still negotiating with the University of Maryland Medical System.
Other carriers may yet exclude some other health systems, though officials from CareFirst BlueCross BlueShield, the state's dominant carrier, said its networks were not narrowed for exchange policies and include about 45,000 providers.
What’s the matter with people anymore with being stuck in stat rat world? Do they think an obese person is going to look at this as something positive? With as bad as companies have been today with little concern for the people they employ at times (and this is not all employers) do they think this is a positive to motivate people to lose weight? The key to losing weight is not the expense of an obese person, it’s hitting the right key note to get the person motivated to lose weight for themselves and then everyone wins and you don’t need stupid websites like this. When a person loses weight for their own self esteem, that’s the best by all means. I wrote a while back too about another sick bunch that likes to sit around and map the obese in the US. Well it’s not like they are hiding anywhere and it takes one glance to recognize one who is obese so why all the infographics? It’s because the people who do them are suffer from narcissism and want you to see their “beautiful” work and the obese who are mapped, well they could be mapping anything really as it doesn’t matter.
Actually the head of CDC was the same one who dreamed up the Bloomberg Big Gulp failed model too so again people do things by example and if you remember, look at all we went through over that failed proof of concept. Bloomberg and Frieden didn’t know when to stop. I put this Obesity site right in there with being another failed Bloomberg failed proof of concept.
Attraction is the means to motivate someone to lose weight and there are much better ways to accomplish that versus segmentation like this. The obesity calculator is gone and from what I am reading it’s a standard BMI that you can find by the groves anywhere. That’s ok but when you start directing this type of segmentation to employers, it becomes a different story. As a matter of fact, I absolutely hate the term “human capital” and wish folks would just reduce it to one word “human” as that’s what we are talking about here.
It’s to the point to where people who are not obese look at those who are with minus dollar signs in their eyes and that’s not right as the obese need a little compassion and a reason to care, not this. We have way many lost today in virtual world values this is the prime example right here. Heck look at the example the White House produces and this one got my attention as again folks confusing virtual values with real world values. Now go take a look at the fatties in Congress and nobody’s on their case are they?
The CDC already has their Work Place Health Promotion page and that’s enough and they go over board too with a “work place scorecard” and more over there too. Heck if I were an employer, the reading is fine but I wouldn’t want to put any more information about my company on the CDC site. They claim their data is “science based” but I didn’t have time to read it all but doubt all of it is, more or less some of it is just number crunching and stats. There’s more stuff and resources over there to read and again how many employers will use and read it? I’m talking beyond healthcare information to be specific to the Healthy Worksite.
Again the information is ok but it will be misleading for some as well as again they want you to share and share and share more data, and I’m out of that ball game and again I don’t any employers are going to dig into that either and we have folks that just went over the edge a bit here. I can barely stand to be in a CVS or Walgreens store anymore as all of this is just in my face constantly and I can’t browse and shop like I used too and those may be just the stores near me but I started going to Rite Aid for that reason as I get tackled over and over for flu shots and I even get that a bit in the grocery store where I go which has a pharmacy in it. When things are slow they have the pharmacist handing out coupons…yuk.
So again we had some folks living just a bit too virtual and didn’t even think how this site would be accepted in “the real world”. You have give people some space and get out of their faces and quit selling our data right and left as well. BD
Called Lean Works!, the federal program drew recent criticism from some nutritionists and advocates for overweight Americans who claimed the site and its obesity calculator fueled workplace discrimination and perhaps even led some companies to fire fat people. NBC News first reported those concerns Nov. 2.
Brittany Behm, a spokesperson for the U.S. Centers for Disease Control and Prevention, said via email that content once posted at Lean Works! “is under review,” adding: “The calculator is also under review and will be potentially updated with new information, technology.”
A big question surrounding Cerner’s $1.3 billion acquisition of Siemens Health Services has been answered: John Glaser, head of the health IT division of Siemens AG, will join Cerner as a senior vice president, concentrating on “driving technology and product strategies, interoperability and government policy development,” according to a post on the Cerner blog.
Glaser wrote about his experience at the recent Cerner Health Conference in Kansas City, Mo. “For me, the conference, its energy and vision of patient-centered care and health, cemented my decision to become part of the Cerner organization once the transition is effective,” he said.
“At CHC, the message that resounded most clearly was, “It’s all about the patient.” When our industry talks about the HITECH Act, the drive toward electronic health records (EHR), and about greater efficiency and effectiveness, it’s usually from the perspective of helping the clinician and the organization. But, in the end, those clinicians, those organizations and those of us in the industry, know that it is about the patient,” Glaser continued [emphasis in original].
As Cerner President Zane Burke told me a few weeks ago, the acquisition is still on track to close in late winter or early spring. Still unknown is the fate of other Siemens Health Services executives and thousands of employees.
The people at DataMotion, cloud based HISP providers, sent me the following infographic covering the HIPAA data breaches. It’s a good reminder of the potential for data breaches in healthcare. As Marc Probst recently suggested, we should be focusing as much attention on things like security as we are on meaningful use since the penalties for a HIPAA violation are more than the meaningful use penalties.
I have posted a number of previous notes about integrated diagnostics and integrated diagnostic centers (see: Integrated Diagnostics and Its Relationship to Digital Pathology: A Strategic Analysis; Revisiting Integrated Diagnostics and the Integrated Diagnostic Report; Diagnostic Delay Time (DDT) and Integrated Diagnostics; A Call for the Development of Integrated Diagnostic Centers). The basic concept of integrated diagnostics is to aggregate pathology and radiology results for specific patients in order to: (1) decrease the time to diagnosis by providing guidance about the most efficient path to arrive at a diagnosis and (2) enable the analysis and interpretation of interim test results by which the time to diagnosis is also reduced by reporting "next step" recommendations. In order to pursue the goal of integrated diagnostics in a hospital, very close collaboration between pathology and radiology is necessary. I have suggested in the past that perhaps these two specialities could merge to form a new medical speciality of Diagnostic Medicine (see: Ten Reasons for Merging Pathology/Lab Medicine with Radiology). This latter note was posted in 2006. In the intervening eight years, I have come to understand that the creation of such a new speciality is highly unlikely.
The pursuit of the broad goal of integrated diagnostics in support of cancer diagnoses in a hospital requires the development of integrated diagnostic servers (IDSs) under the control of pathology and radiology. Under this scenario and when radiology or pathology departments first identify patients being worked up for a suspected but undiagnosed malignant lesion, a file will be created for that patient on the IDS and all subsequent pathology and radiology results for that patient will be copied to the server from the LIS, RIS, and PACS. This IDS is thus be a component of a larger, proposed federated, service-oriented IT architecture (SOA) in pathology and radiology.
Installed on the IDS will be a complex set of heuristics, business rules, and algorithms developed within pathology and radiology that will analyze all available diagnostic information for each presumptive cancer patient and then recommend the next set of tests and radiology procedures that are necessary to arrive at a diagnosis in the least amount of time. Usually, these IDS recommendations are forwarded to the patient's clinician. Under a reflex testing testing option if and when ordered by the patient's treating physician, additional test and procedures orders can be ordered automatically by the IDS. This reflex testing option speeds up the time-to-diagnosis by reducing the number of test ordering cycles. I discussed an early form of the IDS reports now operating in pathology at Pitt in a previous note about their so-called comprehensive theranostic summary (CTS) (see: The Comprehensive Theranostic Summary (CTS): A "Must Have" for Surgical Pathology).
Only pathologists and radiologists will have sufficient knowledge of tests and imaging procedures to create these heuristics, business rules, and algorithms. Because of the very rapid advances in the understanding of cancer genomics and cancer biomarkers, they also may change on a monthly basis. They also need to be constantly tested and validated in a hospital environment with the goal of shortening the time to diagnosis. I anticipate that the deployment of of IDSs will also reduce the cost of cancer diagnoses because of the elimination of unnecessary, irrelevant, and redundant testing. As soon as it can be demonstrated that IDSs result in faster, cheaper, and better cancer diagnoses, these heuristics, business rules, and algorithms will become extremely valuable intellectual property.
There is almost no likelihood that integrated diagnostics, as described here, can ever be accomplished by EHRs (see: Genomics-Based EHR: Is This a Realistic Expectation?; Predictions for the Post-EHR IT Era; Business Continuity Challenges; The -Omics Cloud: A Healthcare IT Solution Already Developed for Genomics Research). These systems are too large and unwieldy and are also designed primarily to replicate the paper medical records and generate bills. Also, they will be unable to allocate the necessary computing power to run the complex and ever-changing heuristics, business rules, and algorithms described here. Moreover, EHR vendors don't have ready access to the diagnostic expertise required for their development nor can they install new software with the short turnaround-times that will be necessary to test and validate them.
I will be providing more details about the proposed IDS to the members of the International Society for Strategic Studies in Radiology (ISSSR) on December 4, 2014, that will convene as part of the upcoming RSNA conference in Chicago. Because of the complexity and challenges of the development of IDSs, I will also address other aspects of them in upcoming blog notes. I also invite any readers of Lab Soft News to comment on this idea.
When it hits the mark, satire is sometimes mistaken for truth. For example, when this “article” Nurses Now Required to Chart What and When They are Charting was making the rounds on Facebook I saw more than a few comments from nurses who mistook it as real news. “As if we don’t have enough to do,” and “Like computerized charting isn’t bad enough,” were some of their opinions on it.
The piece jokes that nurses will have to chart that they are charting: “Nurses are required to additionally document, ‘I am currently charting that I documented the prior statement: rang call light for PRN pain medication, dispersed 1000mg acetaminophen.'”
How could something that sounds so silly be mistaken as a legitimate news article? Because good satire contains a bit of truth. In this case, the reality it’s alluding to is nurses’ frustration with EHRs.
According to survey results released in October by Black Book Market Research, 92% of nurses were dissatisfied with inpatient EHR systems. They reported the technology has disrupted workflow and productivity and negatively affected their jobs. Lest you think this is just another case of front line staff being resistant to change, hospital administrators validated these statements. Some 84% of administrators at not-for-profit hospitals and 97% of administrators at for-profit hospitals confirmed that EHRs’ impact on nurses’ workloads were not considered highly enough when selecting an EHR system.
Here’s more specifics on the nurses’ responses regarding EHRs:
Achieving Meaningful Use has been a motivating factor spurring facilities to adopt EHRs, and according to the ONC it improves quality, safety, patient engagement, and care coordination. But are these goals really being met? The nurses’ responses aren’t exactly a resounding endorsement from the professionals giving the bulk of hands-on patient care.
So what can be done to improve nurses’ experiences with EHRs?
First off, bedside nurses need to be included in the decision making process when selecting an EHR system. It’s not enough for nursing administrators or managers to be the only nursing representatives evaluating the options. They may understand financial and business reasons surrounding EHRs, but they don’t have a handle on nurses’ day-to-day workflow and how EHRs may affect patient care. Those using the technology to provide patient care 24/7 need to have a say.
Speaking of finances, 88% of nurses blame financial administrators and CIOs for selecting low-performing systems based on pricing and incentives and for cutting corners at the expense of care quality. Yes, being fiscally responsible is important but sometimes you get what you pay for. I’ve seen the results of this firsthand and it’s not pretty.
One employer had an unbearable EHR system. Part of the problem was nurses’ workflow had not been considered when implementing the system. But another issue was the organization had not paid extra to have the system customized for its specific needs. Because of this, nurses faced excess amounts of charting just to get through screens and fields that were irrelevant.
There must also be continued evaluation of the system. You can’t just launch an EHR and be done with it. There needs to be follow-up to see how it is performing and how it is or is not interrupting nurses’ workflows. There needs to be hard data collected regarding time spent charting versus time spent providing patient care so an honest evaluation can be made. Patient outcomes and experiences also need to be assessed to see how the technology is affecting those situations.
Finally, issues brought to light by nurses need to be fixed in a timely manner. Sadly, respondents to the survey did not have kind words for their IT colleagues. In addition to being slow to resolve problems, 69% of nurses in for-profit inpatient settings reported their IT department as “incompetent” when describing the level of expertise their organization’s in-house staff has working with the selected EHR software.
The results of the survey may sound harsh and critical of EHR and IT, but it’s essential that the nurses’ message be heard. All the patient satisfaction measures, quality improvements, safety initiatives that are now being championed will be worthless if workflow and patient care are impeded to the point that patient outcomes are being negatively affected. It’s time to start listening to what nurses using EHR systems are saying before there is a crisis involving patient outcomes.
Should more types of health data figure into electronic health records?
On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...
|educational attainment, stress, depression|
physical activity, stress
social isolation, intimate partner violence (for women of reproductive age)
|financial resource strain,|
neighborhood median household income
The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
No doubt social media has become an integral part of many of our lives. We use it in our personal lives and if we don’t use it personally, our children are using it all the time. With nearly 800 million daily active users on Facebook and nearly 300 million monthly active users on Twitter, most medical practices are asking how they could benefit from having their practice participate in social media.
Before I begin with the specific benefits of social media use, I should define how I’m using the term social media. In this case, I’ll be talking about social media in the broadest context. Certainly this would include platforms like Facebook, Twitter, LinkedIn, Instagram and Google+. However, I also include healthcare focused websites like Health Grades, Angie’s List, ZocDoc, Yelp, and many more in this list. Each of these websites or mobile apps has a social aspect to them which allows the practice to engage with patients online.
Now let’s take a look at some of the benefits your practice can receive from your participation in social media.
Be Part of the Discussion – The reality of the internet is that your practice is being discussed online whether you participate or not. Many of the social media sites listed above have already created your profile and patients are talking about their experience at your practice. While you may wish that this wasn’t the case, it’s something that you can’t stop.
Given that you can’t stop patients from posting information about their visit to your office, it really benefits your practice to keep an eye on what’s being said about your practice on these social media sites. If someone posts something nice, that’s an opportunity for your practice to show some gratitude for their kindness. If someone posts something negative, that’s an opportunity for you to show some compassion even when difficult situations arise.
When a negative physician review is shown compassion, understanding, and a willingness to help, it turns a negative into a positive for your practice. Now instead of driving patients away from your practice, a sincere interest in helping the disgruntled patient will drive new patients to your practice who realize that you care about your patients. Of course, if you’re not taking part in social media, that negative comment will remain and discourage patients from ever visiting your office.
First Impressions – One of the first impressions many patients get about your practice is on your website and your social media presence. While it’s not the end all be all for how patients select a doctor, being an active participant in social media shows potential new patients that you’re a progressive organization that stays on top of the latest trends. If you’re not on social media and/or your website looks like it came out of the 90’s, many patients will wonder how well your practice keeps up with more important areas like clinical skills. Right or wrong, we draw these connections between a practice’s online presence and their ability to stay up with the latest medicine.
Engage Current Patients – Social media is a great way for your organization to engage with your current patients. One of the largest sources of new patient referrals comes from existing patients. A simple follow on Twitter or Like on Facebook creates a powerful connection between your practice and your patients. That connection then serves as a reminder to your patients of the services you provide. You’ll be surprised at the serendipity of social media. Your social media post on back pain can often arrive in the same stream as one of your patient’s friend’s complaint of back pain. Now you just gave your previous patient a simple way to refer their friend to you.
Promote High Margin Services – This doesn’t apply to all specialties, but many specialties have high margin services they can offer patients on a repeat basis. Other specialties can remind their patients of annual visits. Social media is a simple, scalable way to inform and remind patients of these high margin services. With the right set of followers, a simple tweet that says “Women, take care of yourself! Don’t forget to get your annual pap smear.” can be a really effective way to drive more patients to your practice.
Local Social Media – One challenge medical practices face is that the majority of their patient population is local. Social media and the internet by its very nature is a national and international tool. However, with the integration of GPS into every phone and location enabled web browsers, the websites and tools to target local people are amazing. Do a simple Twitter search for “back pain” and add your location and you’ll find a captive audience of people with back pain near you. Here’s a simple example I found in NYC. Once you find these potential patients, you can easily follow or engage with their tweet.
Learn from Others – While much of this list has been about driving more high quality patients to your practice, social media can also be an excellent way for doctors, practice managers, billing staff, etc to learn from their peers. You can find a community of peers on social media that are focused on pretty much any element of a medical practice. Many of them are posting amazing content which can help you learn how to do your job better. Plus, as you engage with your peers on social media, you create relationships which can be leveraged to get answers to difficult questions. Not to mention, you’ll receive the satisfaction of helping other people and developing deep friendships with amazing people. Social media is a font of knowledge just waiting for you to tap into it.
In the next post in our series, I’ll look at the tools, techniques, and social media platforms you should use to help you realize the benefits mentioned above. Are there other social media benefits I missed on my list? I’d love to hear how you’re using social media in your practice and the benefits you’ve received from it.
Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.
Never before have healthcare professionals operated in a time of such rapid technological change—and faced the great uncertainty of today’s complex industry regulations. Unfortunately, it’s not a trend we see ending anytime soon. It’s getting harder and harder to even understand what the government is asking us to do, let alone satisfy those requirements. Does data collection have to mean data distraction—taking the focus off of what matters most to each physician: the patient?
At our annual User Summit last month, big data was the big topic of discussion. While our users recognize there can be very real benefits to elements of meaningful use, there is a lot of friction surrounding its integration into medical practices. It often feels like the data we are being asked to capture—the data that is supposed to make everything more productive—interferes with what we are trying to accomplish. Physicians can find themselves required to ask questions that make no sense, that take up valuable office visit time, and that possibly cast a little doubt in the patient’s eye. Where is the ROI on that?
Medical professionals need more, because that’s what MU is asking of them. HCIT companies have to provide more than technology—they have to provide expert guidance to help navigate the MU waters. Together, technology and expertise can help physicians satisfy government regulations while also achieving their industry and business goals. From strategic planning through product execution, we must provide more predictable solutions. This goes beyond “certified solutions”—this is about creating working solutions that allow medical professionals to be compliant without interfering with their practice goals.
It all comes down to ECR: Efficiency . . . Care . . . and Revenue. The right HCIT solutions will:
We heard it loud and clear at our User Summit: increased data requirements cannot be accomplished at the expense of patient care. EHR solutions aren’t real solutions if they slow you down—they have to capture data with minimum interference while ensuring maximum productivity.
At SRS we’re working even harder to help our clients navigate government and industry demands and translate them into meaningful products that will satisfy more than MU: they’ll satisfy your patients. And they’ll satisfy you.