September 2,2014

Microsoft recently released a blog post on the company’s Security Blog that details three possible scenarios or views of the world and cyberspace in 2025. The three possible scenarios are; Peak, Plateau, and Canyon. Here’s how each scenario is defined...(read more)
Source: HealthBlog

In Where Does It Hurt, Athenahealth CEO Jonathan Bush explicitly calls out a number of businesses that are disrupting hospitals. Specifically, these businesses are performing a single function – e.g. labs, imaging, birthing, urgent care – at a much lower cost with higher quality than general-purpose hospitals. These modular businesses are disrupting hospitals by ruthlessly focusing all of their operations around a single service line to optimize quality and reduce costs. This stands in stark contrast to hospitals, which generally try to be all things to all people (the antithesis of entrepreneurship and general business practices).

I’ve previously outlined how healthcare providers are struggling as they shift to risk-bearing reimbursement models. They’re straddling two dramatically different business models as they try to transform their businesses from fee-for-service to risk-bearing. Inverting a business with thousands of employees and billions of dollars worth of assets and processes is nearly impossible. This is even more challenging in a highly uncertain and fast-changing regulatory environment.

But what if there was a better way?

In the Innovator’s Solution, author Clayton Christensen describes how multi-billion dollar companies such as Apple, IBM, Johnson and Johnson, and Intuit have disrupted themselves. When faced with disruptive changes in their respective businesses, these incumbents disrupted themselves by:

  • Funding a separate operating division with its own P&L
  • In physically removed location
  • With dedicated employees who have no responsibilities to the old business model.

This formula by no means guarantees success, but it creates an environment in which the disruptive division can potentially save the business as a whole, so long as the disrupting business has the operating freedom to disrupt the parent. Employees shouldn’t be bound to the processes, assets, and values of the old business model.

How can providers disrupt themselves?

How can providers, in particular large hospitals and health systems, adopt Christensen’s disruption framework? By funding their disruptors! This strategy drives value across a number of dimensions:

1) Hospital management will have the opportunity to learn about the operational expertise necessary to modularize their existing operations at a lower cost

2) Hospital management will have access to insider information about their own disruption that they would otherwise lack. They can in turn use this information to make smarter decisions about their own businesses, and potentially buy out the disruptees if they become too disruptive.

3) Drive inbound referrals from the periphery to the hubs

4) Generate a financial return

A practical example

My company, Pristine, recently spent some time learning about urgent care centers. We wanted to sell urgent care centers a lightweight telehealth platform so they could beam specialists and hospitalists into the urgent care center. This would allow the urgent care center to generate more revenue by avoiding “leakage” while also generating more revenue for the consulting specialist, guaranteeing more referral traffic to the host hospital, and providing the patient a more convenient experience. All parties would win. The idea was perfect in theory, except…

We discovered that non-hospital owned urgent care centers generally dislike hospitals, and are in fact too proud of the quality of care they provide to patients at much lower cost. These urgent care centers know that they’re disrupting hospitals, but are holding that against the hospitals as a reason not to align interests. Similarly, the hospitals view the urgent care centers as a competitive threat and have no desire to do business with them.

The more I think about this situation, the more I’m convinced that hospitals should invest in their disruptors. A financial tie will massage the hard feelings that exist and create an opportunity in which community resources can be most effectively coordinated across the continuum of care. As we move towards risk-based models, hospitals will need to drive patients to the most capitally efficient cost center that can diagnose and treat the patient.

What are your thoughts? Do you know of any major health systems investing in their disruptors? Or of any health systems that are outright trying to disrupt themselves by establishing modular service lines themselves? (Banner Health and University of Arizona are doing this to some extent!)



Question number 1 for our “20 Questions for Health IT” project. Read the details about the project at the link. Please comment on the topic below in the comments section or on twitter using the #20HIT tag. And please share with your friends and colleagues to encourage discussion!

From Chad Johnson:

In what ways will personal health information exchange change patient engagement through individual ownership of the health record?

You can’t change what you don’t control. Your finances, your car maintenance, your inbox… and your healthcare. When patients take the responsibility to store and to share their medical record with their current and future caregivers then they will feel more in control of the process and more likely to want to improve what the record says about their health. With the growth of Direct Project and apps that allow patient-to-provider communication, this is quickly becoming an option for patients.

But: How many of us want to take control of our health?

Categories: News and Views , All

The Association for Pathology Informatics (API) and Sunquest Information Systems will be offering a second series of free webinars focusing on timely topics in pathology informatics. The first series of six presentations, offered in 2013-2014, were well received with a total of nearly 500 participants. This new series will be composed of seven lectures and will explore pathology informatics as one of the key elements in the quest for greater efficiency and effectiveness of pathology and clinical lab operations. This efficiency/effectiveness goal is being driven largely by healthcare reform and the Affordable Care Act (ACA). Particularly important will be attention to the emerging areas of molecular testing and genomics. 

Below is the list of the seven lectures, each lasting about an hour, that will be included in this second series accompanied by the names of the faculty who will present them. I will be presenting the first of these lectures on Tuesday, September 9, at 1:00 p.m. EDT. Dates and times for the next six will be provided on Lab Soft News as they are become available.

  1. Information management in Pathology and Healthcare Reform: Responding to Cost Containment Pressures (Bruce Friedman; September 9, 2014, at 1:00 EDT)
  2. Deploying Analytic Software in Your Lab for Management Support (Dennis Winsten and Hal Weiner)
  3. Working with Clinicians to Improve Test Ordering and Result Interpretation (Jason Baron and Anand Dighe)
  4. Computational Pathology: IT Support for Basic Research in Pathology (Mike Becich)
  5. Diagnostic Information Systems and Enhanced IT Support for Cancer Genomics (Justin Starrin)
  6. What the Future Holds for Direct-to-Consumer Genomic Lab Testing  (Jill Hagenkord)
  7. How Digital Pathology Will Reshape Surgical Pathology (Steve Hewitt)

Registration for this first lecture and all of those following is simple. Point your browser to this registration  page (see: You're Invited to Attend the Second Pathology Informatics Webinar Series Presented by Sunquest and API) and provide your name, organization, and email address. You will then receive an invitation in response.

The premise underlying this first lecture is simple. Healthcare reform, most particularly the ACO, has placed pressure on pathology and the clinical labs to operate faster and deliver less expensive and higher quality results. One of the key elements in this response is through the deployment of pathology informatics tools to improve managerial and clinical efficiency. Specific details will be provided such as the deployment of analytic software packages that provide dashboards to analyze various aspects of lab operations. Attention will also be paid to the future of LISs which is critical in this era of maximum attention to EHRs.

This release appeared last week:New Online Forums to Support People Living with Mental IllnessSupport for people living with mental illness and their family, friends and carers is the focus of two new online forums launched by the Minister for Health, Peter Dutton.Page last updated: 27 August 2014PDF printable version of New Online Forums to Support People Living with Mental Illness - PDF 241 KB27 August 2014Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched in Canberra today by the Minister for Health, Peter Dutton.Minister Dutton said the SANE Australia Online Forums would help people by giving them trusted and anonymous access to reliable mental health information, advice and referrals.“While almost half of the Australian population will develop a mental illness at some point in their lives, only 46 per cent of this group will seek any form of support or treatment,” Minister Dutton said. “We know that...

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

September 1,2014

European Health Forum Gastein1 - 3 October 2014, Bad Hofgastein, Austria.
Six cutting-edge projects are in the running for the prestigious €10,000 European Health Award 2014, sponsored by the Austrian Federal Ministry of Health and FOPI, which brings together Austria's research-based pharmaceutical and biotechnology companies. The winner will be chosen by a panel of leading health experts, and announced during the 17th EHFG Conference, being held in the Gastein Valley.
Advanced Health & CareAdvanced Health & Care (Advanced) has announces extended, mobile functionality for Caresys, the company's widely used care home management software. Caresys Mobile will now be accessible via tablet computers, allowing care workers to evidence care provision at the point of delivery within the care home environment, as they carry out their day-to-day duties.

Cambridge HealthTech Institute (CHI) invited me to attend their Next Generation Point of Care Diagnostics Conference and I came away thoroughly impressed with the content, speakers, and organization. Since I chair several conferences a year I know how hard it is to pull off a good one so I’d like to thank CHI for a job well done. While I took the notes and attended the event, this post was written by HITSphere‘s Vik Subbu, our Digital Health editor that focuses on Bio IT and Pharma IT. Bio IT, Pharma IT, Health IT, and MedTech are all going to be merging over the next few years and Vik will be helping our audience understand those shifts and what they mean to Digital Health innovators. Here’s Vik’s recap of the conference:

Goals & Attendees

The goal of the event was to provide a progress update to the healthcare industry on the advances in next generation point-of-care (POC) diagnostics while highlighting the advent of innovative platforms and use of digital information systems to aid in the development of novel POC diagnostics. The conference was attended by industry experts from various disciplines ranging from academic institutions, non-profit computational and bioinformatics centers, venture capital, service providers, pharmaceutical, diagnostic and biotechnology companies.

Why does Point of Care Dx matter to Digital Health innovators?

The interactions and cross-fertilization of ideas among various disciplines in the diagnostic arena was the highlight of the conference. The ability to have real time interactions between academic researchers, clinicians, product developers and reimbursement specialists provided a ‘one stop’ venue for an attendee to obtain a holistic overview of both the promises and pitfalls in developing point-of-care diagnostics. The outcome of the conference should yield greater public-private collaborations involving novel platforms, available NGS datasets, and academic laboratories. Such partnerships will hopefully enable the industry to overcome product development and reimbursement barriers while paving the way for effective and streamlined approval process for next generation POC diagnostics. All of this will help integrate POC better into next generation Digital Health innovations.

The intimate setting and the organization of the parallel track discussions/presentations were well designed and covered key aspects of POC diagnostics. For one looking to learn the current and future directions of POC diagnostics, the conference provided a nice platform to learn, understand and meet key contacts to support their individual interests. Entrepreneurs and innovators focusing on bridging the “gap” between healthcare IT and diagnostics will find that there was a recurring theme that surfaced in many of the presentation but wasn’t really the focal point of any one specific presentation. That topic was data. There were many presentations that highlighted the “use of genomic data” or “the use of computational super tools to assimilate or generate vast amounts of data” or “  the need for better data standards to achieve meaningful results”. While these were great presentations, none of the speakers focused on the “HOW” piece (which is a huge opportunity for entrepreneurs). For example, “”how can one can gain broader insights from these datasets?”  or “how can we solve the issues of standardization of datasets?”. Perhaps, this was the homework assignment that we must complete in time for next year’s conference.

Top Ten Insights for Healthcare IT innovators:

  1. Next Generation Sequencing (NGS) will continue to play a vital role in  disease detection and biomarker identification
  2. The increasing availability of publicly available datasets from the FDA and academia will help guide the development of next generation POC diagnostics
  3. Point of care diagnostics for hospital acquired infectious diseases remains an unmet need
  4. Need for improving sensitivity and specificity of diagnostic assay platforms is acute
  5. Reimbursement discussions need to occur with payers from day one
  6. Early stage diagnostic companies can benefit from innovative business models and strategic partnerships
  7. Clinical samples are required to validating an assay or biomarker – yet finding these longitudinal samples remains a challenge
  8. Software tools and POC diagnostics have improved the identification of diseases and better patient outcomes…..but we have a long way to go
  9. Establishing better workflows, processes and teams can lead to better outcomes
  10. Integrating disparate datasets can yield better insights and patient outcomes
Here are a few I have come across the last week or so.Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General CommentThe review of the NBN and what will now apparently be delivered, as far as broadband is concerned, to a waiting populace. It is a compromise but seems as though it might just deliver some useful improvement reasonably quickly. As always it seems, time will tell!Otherwise the consultation period on the PCEHR Review concludes today and now we wait to discover what we all think. Hopefully will only take a few weeks and then the outcomes can become public - in my dreams I fear!Enjoy the browse.----- needed for teleHealth, say Labor MPs in open letter 28 August 2014 By  ...

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

August 31,2014

From today, in Veneto Region the traditional prescription will make room for the digital one. The prescription drug will no longer be delivered to patients by general practitioners on the traditional "red prescription", but through a memo printed on white paper. With this reminder citizens will, as usual, go to the pharmacy and pick up the prescribed medication.

Information – Entropy by Oliver Reichenstein

Will information technology affect our minds the same way the environment was affected by our analogue technology? Designers hold a key position in dealing with ever increasing data pollution. We are mostly focussed on speeding things up, on making sharing easier, faster, more accessible. But speed, usability, accessibility are not the main issue anymore.  The main issues are not technological, they are structural, processual. What we lack is clarity, correctness, depth, time. Are there counter-techniques we can employ to turn data into information, information into knowledge, knowledge into wisdom?

Oliver Reichenstein — Information Entropy (SmashingConf NYC 2014) from Smashing Magazine on Vimeo.

Categories: All , News and Views

Self-regulation of human brain activity using simultaneous real-time fMRI and EEG neurofeedback.

Zotev V1,Phillips R, Yuan H, Misaki M, Bodurka J. Neuroimage. 2014 Jan 15;85 Pt 3:985-95. doi: 10.1016/j.neuroimage.2013.04.126. Epub 2013 May 11.

Abstract. Neurofeedback is a promising approach for non-invasive modulation of human brain activity with applications for treatment of mental disorders and enhancement of brain performance. Neurofeedback techniques are commonly based on either electroencephalography (EEG) or real-time functional magnetic resonance imaging (rtfMRI). Advances in simultaneous EEG-fMRI have made it possible to combine the two approaches. Here we report the first implementation of simultaneous multimodal rtfMRI and EEG neurofeedback (rtfMRI-EEG-nf). It is based on a novel system for real-time integration of simultaneous rtfMRI and EEG data streams. We applied the rtfMRI-EEG-nf to training of emotional self-regulation in healthy subjects performing a positive emotion induction task based on retrieval of happy autobiographical memories. The participants were able to simultaneously regulate their BOLD fMRI activation in the left amygdala and frontal EEG power asymmetry in the high-beta band using the rtfMRI-EEG-nf. Our proof-of-concept results demonstrate the feasibility of simultaneous self-regulation of both hemodynamic (rtfMRI) and electrophysiological (EEG) activities of the human brain. They suggest potential applications of rtfMRI-EEG-nf in the development of novel cognitive neuroscience research paradigms and enhanced cognitive therapeutic approaches for major neuropsychiatric disorders, particularly depression.

Categories: All , News and Views

Biofeedback-based training for stress management in daily hassles: an intervention study.

Brain Behav. 2014 Jul;4(4):566-579

Authors: Kotozaki Y, Takeuchi H, Sekiguchi A, Yamamoto Y, Shinada T, Araki T, Takahashi K, Taki Y, Ogino T, Kiguchi M, Kawashima R

Abstract. BACKGROUND: The day-to-day causes of stress are called daily hassles. Daily hassles are correlated with ill health. Biofeedback (BF) is one of the tools used for acquiring stress-coping skills. However, the anatomical correlates of the effects of BF with long training periods remain unclear. In this study, we aimed to investigate this. METHODS: PARTICIPANTS WERE ASSIGNED RANDOMLY TO TWO GROUPS: the intervention group and the control group. Participants in the intervention group performed a biofeedback training (BFT) task (a combination task for heart rate and cerebral blood flow control) every day, for about 5 min once a day. The study outcomes included MRI, psychological tests (e.g., Positive and Negative Affect Schedule, Center for Epidemiologic Studies Depression Scale, and Brief Job Stress Questionnaire), and a stress marker (salivary cortisol levels) before (day 0) and after (day 28) the intervention. RESULTS: We observed significant improvements in the psychological test scores and salivary cortisol levels in the intervention group compared to the control group. Furthermore, voxel-based morphometric analysis revealed that compared to the control group, the intervention group had significantly increased regional gray matter (GM) volume in the right lateral orbitofrontal cortex, which is an anatomical cluster that includes mainly the left hippocampus, and the left subgenual anterior cingulate cortex. The GM regions are associated with the stress response, and, in general, these regions seem to be the most sensitive to the detrimental effects of stress. CONCLUSIONS: Our findings suggest that our BFT is effective against the GM structures vulnerable to stress.

Categories: All , News and Views

A new Northwestern Medicine study reports stimulating a particular region in the brain via non-invasive delivery of electrical current using magnetic pulses, called Transcranial Magnetic Stimulation, improves memory.

Categories: All , News and Views
Regular readers will be aware that over approximately the last 2 months Deloitte has been assisting DoH in consulting stakeholders on the PCEHR as produced by the Royle Committee the report of which was released in May.There is a link discussing all this here: a month ago we had the astonishingly botched release of an online survey for the public and others (vendors and clinicians) to respond to. You can read about all that here: here: was also an article I published a month ago pointing out that the options for the PCEHR Review were pretty limited. See here: we have had a leak of a NEHTA Report dated June 2014 which basically...

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

August 30,2014

Here are the results of the poll.Do You Believe The NEHTA Leadership Should Be Held Accountable For The Slow Progress In E-Health Over Almost The Last Decade? For Sure 48% (79) Possibly 34% (56) Neutral 6% (10) Probably Not 5% (8) No Way 4% (7) I Have No Idea 2% (3) Total votes: 163 This is a clear cut outcome. The readers of this blog largely believe NEHTA has failed and needs major change. Again, many, many thanks to the many that voted! 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 are a few I have come across last week. Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.----- Technology Gives Surgeons Unprecedented Views of Patients’ Bodies by George Putic When could a video game possibly save your life?  A new imaging technology, now being used at Methodist Hospital in Houston, Texas,  has direct links to video games.  It can provide detailed views of patients’ bodies -- helping surgeons plan and execute complicated operations with much more confidence. Those who think that developing video games software has no other purpose than entertainment should think again.  So says Dr. Brian Butler, a radiation oncologist at Houston Methodist hospital and...

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

August 29,2014


Given the number of breaches we’ve seen this Summer at healthcare institutions, I’ve just spent a ton of time recently on several engineering engagements looking at “HIPAA compliant” encryption (HIPAA compliance is in quotes since it’s generally meaningless). Since I’ve heard a number of developers say “we’re HIPAA compliant because we encrypt our data” I wanted to take a moment to unbundle that statement and make sure we all understand what that means. Cryptology in general and encryption specifically are difficult to accomplish; CISOs, CIOs, HIPAA compliance officers shouldn’t just believe vendors who say “we encrypt our data” without asking for elaboration in these areas:

  • Encryption status of data at rest in block storage (the file system that the apps, databases, VMs, are stored on)
  • Encryption status of data at rest in virtual machine block storage
  • Encryption status of data at rest in archived storage (backups)
  • Encryption status of data at rest in the Oracle/SQL*Server/DB2/MySQL/Postgre/(your vendor) databases (which sits on top of the file system)
  • Encryption status of data in transit from database to app server
  • Encryption status of data in transit from app server to proxy server (HTTP server)
  • Encryption status of data in transit from proxy server to end user’s client
  • Encryption status of data in transit from API servers to end user’s clients (iOS, Android, etc.)
  • Encryption status of server to server file transfers
  • Encryption key management in all of the above

When you look at encrypting data, it’s not just “in transit” or “at rest” but can be in transiting or resting in a variety of places.

If you care about security, ask for the details.


If you wonder where I’ve been, I’ve, for one thing, been blogging a bit for (very little) pay over at and writing a lengthy cover story for the September issue of Healthcare IT News.

The Healthcare IT News piece actually breaks down into a fairly short lead story and several sidebars, which aren’t all that evident from the traditional Web version. (The digital edition has everything.) For the sake of convenience, here are links to all elements of the cover package:

Main story: “Patient safety in the balance: Questions mount about EHRs and a wide range of patient safety concerns”


The issue also contains a reprint of my May 2012 blog post, written just a week after my father’s death: “Medical errors hit home.”

Happy reading, and happy Labor Day weekend.


As most of you know, I’ve been regularly trying to feature other Health IT and EHR bloggers out there. A lot of them are creating some really great content and I’m always happy when there are more smart people joining in on the healthcare IT conversation. I hope you enjoy discovering some new blogs that might help you in your work.

Meaningful Health IT News – This is Neil Versel’s healthcare IT blog. Neil is the most prolific healthcare IT journalist out there having written for pretty much every healthcare IT publication over the past couple decades. I’ve mentioned before that Neil’s blog was one of the first ones I looked to when I started writing a blog. I modeled some of the things I do after him. I figured he was a real journalist and I wasn’t, so I should learn from him. I should disclose that Neil’s blog is part of the Healthcare Scene network of blogs. I’m lucky to be able to work with someone like Neil. I only wish he had more time to write on his blog.

Data 4 U – This is a new health IT blog by Lynn Zahner, a former obstetrician/gynecologist, who’s transforming into a health IT professional. Looking at even just the first 3 posts I’m excited to see what Lynn will bring next. It’s always great to have a clinician’s perspective on healthcare IT. I hope Lynn’s able to keep it up.

Kat’s Space – Kat’s blog is a new find for me. She’s a RN and digital marketing interested in tech and social media. It’s too bad I hadn’t found her before now. Sounds like we’d get along really well. She’s also a Google Glass explorer and so she provides some really interesting insights into the Glass and wearable technology space.

Accountable Health – I think we can all use a great accountable health blog. In fact, we can likely use more than one to try and figure out what’s happening with ACOs and other accountable care programs that are in the works. This blog is written by Fred Goldstein. Fred has a unique view of the accountable care world since he’s the Founder of the Population Health Alliance. I think Fred’s blog is one to watch if you care about where healthcare reimbursement is headed.


#20HITSeptember arrives next Monday, signifying for most the end of summer, which means families with children are starting to settle back into a steady schedule and routine that allows for more consistent time to focus on work, on learning, and on reaching the end of 2014 on a positive note.

Here at we have always operated under the principal of “Engaging conversations on healthcare and technology.” We work to accomplish this through our blog posts that span the wide swath of healthcare technology and through social media interaction that is more conversational and collaborative as opposed to a preacher with a bullhorn.

Our collaborative approach is best illustrated through our weekly #HITsm Tweetchats, which involve thoughtful discussions on topics that seemingly cover each “silo” of healthcare technology. If we’re not learning from each other through technology then we’re not social, we’re not curious, and we’re probably not very interesting, in my opinion.

It is with this collaborative and learning spirit that I am pleased to announce a new project I’ve dubbed “20 Questions for Health IT.”

We hope this project, which covers the entire month of September, will take the interaction of our social media discussions one step deeper and allow more time to discuss 20 different topics currently influencing the health IT industry.

Beginning Tuesday, Sept. 2., we will begin publishing one health IT topic per day from 20 different individuals with a deep understanding of the topic. The author of each question was generous enough to stick her or his neck out and pose a short answer to the question in the hopes it will encourage further discussion in the comments section and also on Twitter using the #20HIT tag.

So stay tuned next week as we launch into a month-long discussion that hopefully will educate and just maybe lead to a breakthrough idea that will evolve into something bigger.

20 Questions for Health IT Schedule

Special thanks to each contributor

Sept. 2. Chad Johnson
Sept. 3. Don Fluckinger
Sept. 4. Michelle Ronan Noteboom
Sept. 5. Bernadette Keefe, MD
Sept. 8. Leonard Kish
Sept. 9. Greg Meyer
Sept. 10. Nick van Terheyden, MD
Sept. 11. Hubert Zajicek, MD
Sept. 12. Angela Dunn
Sept. 15. Rob Brull
Sept. 16. Mandi Bishop
Sept. 17. David Muntz
Sept. 18. Grahame Grieve & Rasu Shrestha, MD (Two for National Health IT Week)
Sept. 19. Scott Mace
Sept. 22. Jon Mertz
Sept. 23. Jenn Dennard
Sept. 24. Steven Posnack
Sept. 25. Vince Kuraitis
Sept. 26. Brian Eastwood

Dates subject to change


Categories: News and Views , All

August 28,2014


I have blogged before about the shrinking residency and job opportunities in radiology (see: Job Prospects Dimming for Residents in Radiology; Defining the Underlying Problems; Radiology Jobs Trend Downward; Blame Technology and Reimbursement). Also see this: Job Prospects Are Dimming for Radiology Trainees. This seems to be the result of a number of factors including: (1) incumbent radiologists are able to work more efficiently due to RIS/PACS support; (2) some radiologists have reportedly postponed their retirement due to the financial downturn in 2008; (3) teleradiology enabled some radiologists to find part-time or full-time positions working from home; (4) teleradiology has also enabled some hospitals to outsource their radiology departments to "nighthawk" firms (see: Dayhawk Radiology and the Decline of the General Radiologist). Below is an excerpt from a recent article on this topic (see: Radiologists Having a Hard Time Finding Residency As Teleradiology Takes Over “Day” Jobs):

Radiologists and orthopedic surgeons are still at the top of the doctor occupation chain but those jobs too are facing reimbursement cuts. In [one hospital], which is losing money, ...[radiology residents]... were given their pink slips. The hospital is ending the residency program and is going with Teleradiology that reads images remotely. So these students need to look elsewhere to finish their post graduate training. The next obstacle is getting a job as if this hospital is relying more on remote image reading....Medicare too has made cuts with radiology reimbursements in order to shift more over to primary care, which is not a bad thing, except when you have the remote services coming in and replacing them instead of less income....Anesthesiologists, facing competition from nurse anesthetists and California just passed a law to allow more use with nurses with anesthesia. Dermatology and Ophthalmology are the only two entities that are seeing an increase or staying level....For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work.....Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline....On Internet forums, younger radiology residents agonize about whether it is too late to switch tracks....Though outsourcing to India grabbed headlines, the big growth in teleradiology was domestic. Now the nighthawk companies, staffed by recent radiology graduates, are competing for the daytime work, too. One hospital, McLaren Macomb, in suburban Detroit, instead offered several residents slots in its “unfunded program,” in which most radiology residents essentially pay for their own positions through donations, typically from a spouse or parents: $65,000 a year to cover a $42,000 salary and $2,000 for expenses. 

There is some irony in the fact that the field of radiology, as a ROAD medical specialty (see above), is attractive to medical students for reasons of lifestyle. However, the better hours and more sedentary demands of the specialty also enabled some older radiologists to remain in their positions past the usual retirement age. One radiologist told me that he was working twice as hard to maintain the same income and that his RIS/PACS systems have enabled him to do this.

When writing this note, my mind was drawn to the field of interventional radiology that has been booming for years. I think that this continues to be the case. There is one cloud on this horizon, however, for radiologists. As intravascular approaches to certain lesions such as abdominal aneurysms becomes more common (see: Endovascular Grafts for Abdominal Aortic Aneurysms), some surgeons will be also be learning these techniques. For example, the Integrated Pathway of the American Association of Thoracic Surgery includes a rotation in interventional radiology. 

GoogleGoogle has announced Google Fit: an open platform for developers to more easily build fitness apps. According to the official blog post, Google Fit provides a single set of APIs for apps and device manufacturers to store and access activity data from fitness apps and sensors on Android and other devices (like wearables, heart rate monitors or connected scales).
CodeMonkeeBy Rok Vrbica, CEO of CodeMonkee.
PHR (personal health record) is a health record where health data of a patient is maintained by the patient. Majority of today’s solutions are web-based applications. While mobile apps are focused mainly on a single problem, web solutions are comprehensive PHRs.

A few weeks ago, I wrote about engaged patients and how they had lower healthcare costs and better health outcomes. While there is no one official definition of patient engagement, I see engaged patients as those who are interested in their health outcomes and who actively participate in their care by working with their healthcare providers to create goals.

Most healthcare professionals can attest that not all patients are necessarily engaged in their care. Some patients are very interested in achieving goals and outcomes and others don’t seem at all interested in participating in their care. How do we get those in the second group to become more participatory and invested in their care? Interactive patient care might be one way to get them on board.

Interactive patient care is a means of providing education to patients through technology like mobile devices and televisions. Interactive patient care allows patients to be active participants in their care rather than just passive recipients of information and instructions.

A June 2014 article in Healthcare Finance News, gives an example of interactive patient care at work. Boston’s South Shore Hospital and Brigham and Women’s Hospital created a pilot project that used a mobile application to connect with cardiac rehabilitation patients. The app allowed patients to check daily to-do lists, to log exercise, to remind themselves to take medications, and to interact directly with clinicians. The project appears to have improved patient engagement and interaction. In the article, South Shore nurse manager Karen LaFond explained that while cardiac rehabilitation programs have been shown to decrease mortality rates, many patients don’t take part in them. However, patient retention and compliance with cardiac rehabilitation care plans have significantly improved when using mobile applications.

Another example of interactive patient care is GetWell Network’s pediatric tool GetWell Town.It was developed to help patients and families learn and play during their hospital stay. GetWell Town can be accessed at the patient’s bedside through an iPad or television and offers age-appropriate entertainment, education and other content. The system covers information on topics like asthma, diabetes and various procedures. The GetWell website describes the presentation of information as “colorful and interactive.” It certainly grabbed the attention of my 3-year-old who saw the website over my shoulder as I was typing this and asked, “Can we play that?”

Play, while not always technology based, is the ultimate form of interactivity and one physician is combining technology with old school play to combat childhood obesity. Dr. Robert Zarr’s, a Washington, D.C.-based pediatrician, approach to managing obesity was featured on NPR in July. To get children to increase their activity, he writes prescriptions for daily play and activity. To make the prescriptions more specific, he has mapped out all of the district’s 380 parks and developed a searchable database that can be linked to patients’ medical records.

Think about ways we can make health promotion fun. Wouldn’t having a cooking contest along the lines of Chopped (where you are provided mystery ingredients and have to create a great tasting dish) for diabetic patients be more interesting than just handing them a piece of paper that tells them to keep their carbs under a certain number per day? It might inspire them to get creative and have fun in their own kitchens coming up with recipes that meet dietary requirements. And that would help them better adhere to their diets.

Interactivity, and not just technological interactivity, may be the secret to getting patients engaged. Doing is infinitely more interesting than being talked at or just handed information. That’s why we do science experiments in school. Theory is one thing but seeing an idea in action, and being a part of that action, makes the concepts so much more concrete. Making the action fun just adds to the chances of success. That’s why nursery rhymes and the ABC song have been used as learning tools for decades.

My generation was raised on video games, even if it was Galaga and Ms. Pac-Man. My daughter’s generation is being raised on smart phone apps and tablet computers. We like technology that can provide us with fun and feedback. And no matter what age you are – from 80 to 8 – when learning is fun, no matter what form it takes, the information tends to stick and this leads to better health outcomes.

Categories: News and Views , All
One of the most compelling arguments for storing digital data in the cloud is medical imaging. It is estimated that data from medical imaging (digital x-rays, CT, MRI, PET scans, etc.) already accounts for about 30 percent of the world’s total data storage...(read more)
Source: HealthBlog

August 27,2014

Your faithful HealthBlawger will be out and about at a number of conferences and events this fall, speaking, moderating . . . and immoderately disrupting. I hope to see you at one or more of these. See descriptions below for...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg

The following is a guest blog post by Art Gross, Founder of HIPAA Secure Now!.
Art Gross Headshot
Ask any medical professional about their biggest concern for protecting patient information and they will probably tell you about the threat of a random audit conducted by the Office of Civil Rights (OCR). OCR is tasked with enforcing HIPAA regulations and has the ability to hand out fines up to $1.5 million per violation for a HIPAA breach and failing to comply with HIPAA regulations.

With recent fines of $4.8 million handed out to New York and Presbyterian Hospital and $1.7 million fine to Concentra Health Services, physicians have good reason to worry.  These massive fines were levied not as the result of a random audit, but for the mandatory reporting of patient data breaches to the Department of Health and Human Services (HHS), and the investigation that followed.  So physicians need to reconsider where their real concerns should lie.

Ponemon Study

The 2013 Cost of a Data Breach Study by the Ponemon Institute calculated lost or stolen patient records at $233 per record. Let’s take a look at how quickly the cost of a HIPAA breach can add up:

# of Records Breached Cost
1 $233
10 $2,330
100 $23,300
1,000 $233,000




The cost of the recent Community Health Systems 4.5 million patient records breach could cost more than $1 billion!

Whether a medical provider loses 1,000 or 10,000 patient records the financial impact could easily set back the organization or even put it out of business.  But the “hidden cost” of a HIPAA breach that shouldn’t be overlooked is the damage to the provider’s reputation, lost trust from patients and the resulting sharp decline in revenues.

Lost patient records sparks negative publicity.  Take Phoenix Cardiac Surgery (PCS) for example. The Arizona medical practice with five physicians got slapped with a $100,000 fine for a HIPAA breach in 2012. A current search on Google returns the practice’s website plus 28 links to negative news stories related to the HIPAA fine. The consequences? A patient searching a referred cardiac surgeon from PCS finds the negative publicity and decides to continue searching for another surgeon. Or, an existing patient of PCS decides to look for another medical practice that takes every measure to safeguard his privacy.

Other Cost Factors

Beyond revenue loss and a damaged reputation are the direct overhead costs associated with a breach. The cost of discovering and stopping a breach may involve IT services, forensic investigative services to determine which systems and patients were affected, and legal counsel if patients file a lawsuit. There are also hard costs associated with notifying patients affected by the breach, including time spent to pull together their contact information, mailing out notifications and providing toll-free inbound phone numbers to handle complaints. Most organizations also provide identity and credit monitoring services for affected patients. All of these expenses add up, not to mention the cost of lost productivity due to the diverted attention of employees tasked with managing these processes.

Today it’s not uncommon for laptops, tablets and USB drives with patient records to disappear.  Or, for crime rings to hack into EHR systems to steal patient information and commit tax fraud, and for meth dealers to steal patient identities to obtain prescriptions.  If a large hospital system can lose 4.5 million patient records think how easy it is for a hacker to grab thousands of patient records from smaller medical practices and turn them into cash. The threat of a HIPAA breach has never been greater and all organizations should take heed.

Risk Assessment as a First Step

Healthcare organizations, particularly smaller medical practices, should perform a HIPAA risk assessment to look at where patient information is stored and accessed, and how the organization protects that information. It examines the risks of a breach and recommends steps to lower them. Without performing a risk assessment an organization may be lulled into a false sense of security, mistakenly believing they won’t suffer the consequences of a HIPAA breach.  At $233 per lost or stolen record that could be a costly miscalculation.

About Art Gross

Art Gross co-founded Entegration, Inc. in 2000 and serves as President and CEO. As Entegration’s medical clients adopted EHR technology Gross recognized the need to help them protect patient data and comply with complex HIPAA security regulations. Leveraging his experience supporting medical practices, in-depth knowledge of HIPAA compliance and security, and IT technology, Gross started his second company HIPAA Secure Now! to focus on the unique IT requirements of medical practices.  Email Art at

Full Disclosure: HIPAA Secure Now! is an advertiser on EMR and HIPAA.

August 26,2014


During my early years in pathology informatics, I was constantly reminded of the challenge of two hospitals merging with different LISs. The problem was usually resolved in one of two ways. The first was that the two merged hospitals continued to operate the their two different LISs but with some makeshift attempt to view lab results across the two institutions. The second and more common approach was to rip out one of the LISs and replace it with the brand running in the other. All of these previous problems of IT integration are now compounded in this era of complex and expensive EHRs. Here's an article discussing how M&A costs can be boosted significantly by IT integration demands (see: Hospital M&A Cost Boosted Significantly By Health IT Integration). Below is an excerpt from it:

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially.....[T]he cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated...[O]ther experts feel that PwC is understating the case...[One of them said that] IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” ...[he said] “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.” Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics.... And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above? On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process.

What are the reasons why two hospitals in the same city or region decide to merge? It's often a case of the stronger system absorbing the weaker one (see: Some Hospitals Experiencing Financial Distress and Even Bankruptcy). Of course, lurking in the background of all potential hospital mergers is always the notion that substantial savings can be achieved. Such savings, at least in the past, were anticipated with the creation of single IT and HR units. Consolidated labs were often also under consideration. However, this article (and past experience on my part) suggests that the anticipated IT savings are often illusory. This point is well illustrated by the excerpt above.

Added to this IT stew is the challenge of converting the previous LIS or EHR database of the abandoned systems to the systems used by the dominant hospital partner in the merger. I know of one company, Ellkay, that specializes in such structured conversions. Below an interesting quote from the home page of another data migration company, Informatica. Of course, hiring consultants to supervise data migration activities will only add to the hospital merger costs discussed above.

Gartner has reported that 80 percent of data migration projects fail to meet expectations, running over time and budget. This is in large part due to common misconceptions about the migration data, including electronic health record data: it complies with a standardized format; users have captured it in expected fields; and it's all valid and of high quality. But the reality is, complex patient, member, and provider data exist in various formats, anticipated data is missing, and data quality is inconsistent. When healthcare organizations hand-code or write one-off processes to migrate legacy data from electronic health records and applications, they are doing so to move millions of pieces of data, likely spot-checking only a small subset. As a result, data are moved into a new application with minimal review.


About 10 months ago, we added Healthcare IT Central to the Healthcare Scene family of healthcare IT websites. It’s been a really amazing addition to the network and I’ve been amazed at the thousands of people that have been able to find health IT jobs thanks to Healthcare IT Central. I love blogging because you get the direct interaction with readers, but there’s a really amazing feeling that comes when you play some small role in helping someone find a job.

The other great part about the addition of Healthcare IT Central is the related Healthcare IT Today career blog. If you’re not reading that site, we just added it to our Healthcare Scene email subscription lists so you can receive the latest posts in your email inbox.

Just to give you a little flavor of the type of content we’ve been posting on Healthcare IT Today, we asked the questions, “Has There Been an EHR Consulting Slow Down?” and “Who’s More Satisfied – Full Time Health IT Professionals or Health IT Consultants?” Plus, we even posted really interesting data like a look at the Epic Salary and Bonus structure. Then, since it is a healthcare IT career website, we cover things like LinkedIn tips and LinkedIn as a professional or personal profile.

If you’re someone looking for a healthcare IT job or looking for a better healthcare IT job, we have hundreds of health IT jobs available. You might also check out Cordea Consulting, ESD, and Greythorn that recently posted jobs with us.

If those jobs aren’t your style we have other jobs like this Sales Account Executive at EHR vendor, gMed, or these system analyst jobs at Hathaway-Sycamores Child Family Services and Pentucket Medical.

If you’re an employer looking for amazing healthcare IT professionals, you can register for the site and post your jobs or search our database of over 12,000 active health IT resumes.

Hopefully some of these health IT career resources are helpful to readers of EMR and HIPAA. One thing that’s universal in healthcare is the need to find a job or hire the right talent. Hopefully we’re doing are part to help both sides of the coin.

Follow Us: