October 31,2014

I spotted this report last week:Fund managers wary of Orion price5:00 AM Wednesday Oct 22, 2014 Software developer ends speculation on IPO, but some possible investors worry it might set the bar too high. The ink is barely dry on the announcement of Orion Health's up to $150 million sharemarket listing and fund managers are already talking down the offer's price - even though it is yet to be revealed.After years of speculation, the Auckland developer of software systems used in hospitals yesterday confirmed it is aiming to float on the NZX and Australia's ASX late next month.The company is looking to raise between $120 million and $150 million through its initial public offer, which will fund growth in key markets such as the United States.An entity associated with chief executive Ian McCrae, who founded Orion in 1993 and remains the majority shareholder, is planning to sell $5 million of shares through the offer.Valuations of up to $900 million have been bandied about for Orion,...

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

October 30,2014

As cases of the Ebola disease emerge in Europe, the crisis is gaining increasing levels of media coverage. Certain types of coverage can foster fear and stigmatisation which leads to harmful consequences for the individuals, communities and countries involved. Therefore communication strategies that maximise opportunities and minimise risks are vital.

With the rapidly-growing demand for technologies that solve challenges for healthcare patients, professionals and institutions, many of the most innovative and disruptive solutions are coming not from large corporations, but small, scrappy startup companies.

With this trend has risen a group of startup “incubators” and “accelerators” specifically focused on healthcare technology entrepreneurs. These organizations serve as a launching pad for healthtech startups by facilitating high-value mentoring, collaboration and investor connections, plus basic needs like office infrastructure and seed funding.

For the startups, this gives them the time and resources to refine their technologies and services while finding investors and customers. Meanwhile the accelerators benefit by building local economies, solving healthcare challenges, and opening up highly-profitable opportunities for their backing investors

Below, we’ll introduce you to some of the leading incubators in the healthcare industry. These incubators have a proven track record in helping innovative young companies bring new ideas and services to consumers and businesses.

The Top-Six Healthcare Incubators and Accellerators


Rock Health – Rock Health invites early stage companies to work within the incubator and receive funding and mentorship from a variety of companies and health organizations. Rock Health notes that 18% of our economy is healthcare-based, but it’s one of the last industries to receive a tech makeover.  With more than 50 active startups in its portfolio, Rock Health is one of the most experienced healthcare incubators, especially for startups that focus on providing web services, mobile applications and SaaS solutions for healthcare providers and companies.


Health Wildcatters – Health Wildcatters is a mentorship-driven healthcare seed accelerator in Dallas; slightly different than an incubator. Though similar to incubators in their goals, accelerators typically acquire a small amount of equity in a startup, then work quickly to help a company achieve a short-term goal like raising money or launching a product. While incubators house companies for months or years, accelerators like Health Wildcatters work in weeks. Health Wildcatters focuses mainly on early-stage healthcare technology startups, including IT,

SaaS, digital health and mobile health companies. Companies receive an initial seed investment and a 12-week program in which Health Wildcatters works quickly to help the company build value and refine its product. The name “wildcatter” hearkens back to independent oil entrepreneurs who were willing to take risks in where they drilled. Health Wildcatters takes the same approach to finding companies. This entrepreneurial approach allows it to help more startups reach their goals.


StartUp Health –Chaired by TimeWarner CEO Jerry Levin, this incubator aims to fund 1,000 healthcare companies within the next decade to help transform the face of the healthcare industry. StartUp Health works to build sustainable growth in its companies over a three-year period. During the incubation period, StartUp Health matches companies with a network of more than 10,000 health professionals and business people focused on improving digital health and wellness.


The Iron Yard – With its first location in Asheville, NC, the Iron Yard is growing a network of incubators focused on growing new areas of technology like digital health, green tech and emerging technologies. Its digital health accelerator, located in Spartanburg, SC, is working to turn one of the nation’s oldest railroad junctions into a hub for digital health innovation. The Iron Yard offers startups $20,000 in seed capital and three months of mentorship and workshops from experts in design, development and financing. The Iron Yard also offers training in web development and programming to place graduates with the startup companies it supports.


Blueprint Health – Blueprint Health, located in New York City, is one of the largest incubators in any niche and offers an expansive network of healthcare mentors to assist healthcare entrepreneurs launch new ventures. Blueprint Health focuses on companies developing tech projects directly for hospitals, physicians and health plans rather than consumer-facing applications, which means deeper access to established customers. In 2013, Blueprint Health focused its efforts on mature startups companies. While many incubators assist early-stage companies, more than half of Blueprint’s mentees already had paying customers. With more than 12,000 sq. ft. of space and two classes per year, Blueprint Health is able to help more than 100 healthcare companies each year.


Healthbox –  Healthbox offers accelerator programs in Boston, Chicago, Tampa, London, Nashville and Salt Lake City that provide  digital health entrepreneurs with funding and access to a global network of healthcare investors and providers. Healthbox launched its first accelerator program in Chicago in 2012 and quickly grew to other states and the UK. It recently expanded its business programs with $7 million in funding and started a program that helps hospitals create their own in-house Healthbox accelerator programs that, in turn, help companies gain traction within their own medical communities. So far, Healthbox has invested in 56 active startups, supported by a network of more than 350 expert mentors.

About the Author: David Vogel is a blogger for Datapipe, a leading provider of HIPAA-compliant hosting and managed cloud hosting. Connect with David on Twitter (@DavidVogelDotCo) and Google+ (+David Vogel).


I think that it's safe to say that there has been little deployment of cloud apps by hospitals and health systems whereas they tend to be ubiquitous in other business sectors. Part of the problem is that healthcare trails all other industries by a decade or more in IT issues. It's also a highly regulated industry so some of its conservatism about IT is well deserved. There are plenty of reasons to reject new IT with HIPAA, for example, as an excuse. There is a rumor that Salesforce.com will soon try to offer cloud computing services to the healthcare industry (see: Salesforce.com Will Soon Reveal Its Next $1 Billion Initiative: Healthcare). Below is an excerpt from an article on this topic:

In fewer than 100 days, the Benioff Children's hospital will open in San Francisco, mostly thanks to a huge $200 million donation from Salesforce.com CEO Marc Benioff and his wife Lynne. The Benioffs have been working with the University of California at San Francisco (UCSF) on building this hospital since 2010. It turns out that all that exposure to the way hospitals do business has given Benioff ideas. His company is set to announce in November a new initiative to sell cloud services software to the healthcare industry....Healthcare software is an interesting, and lucrative, nut to crack. Hospitals, doctors offices and related industries will spend $31.3 billion on tech by 2017....But because of privacy laws like HIPAA, they can't buy any old cloud service to store documents, chat, or send data to their phones or tablets. These services have to get certified with special security controls and get certain government stamps of approval....It makes sense that the hospital that bears his name would be the first to use a new app called CareWeb Messenger....It will let doctors, nurses and patients chat on mobile devices while complying with HIPAA. Salesforce.com could try to sell it to other hospitals, although there's already a ton of competition in that market (HipaaChat, Doximity, for instance). It could also get into the electronic health care records business, following competitors like Microsoft and Oracle.

Here's a brief description of HipaaChat, mentioned in the excerpt above, and copied from its home page:

HipaaChat lets you send HIPAA-compliant text and photo messages. HipaaChat anything from orders, vitals, lab reports, images, referrals, prescriptions and discharge instructions. No need to call or wait on hold for information. If you’re a texter, you’ll love HipaaChat on iPhone or iPad.

I't not sure that hospital executives want to make it easier for nurses and doctors to text and chat on mobile devices when working. Some of these texts may be personal business and serve as a distraction (see: Distracted Diagnostics: Is This Really a Problem?).

I think I know a couple of the reasons that sophisticated companies like Google and Microsoft have failed to crack the healthcare market -- they overestimate the appeal of cutting-edge technology to hospital executives and their staffs and they also tend to underestimate the conservatism of these personnel. Obviously Benioff will have an edge in convincing a hospital to try his new app if its named after him. If he wants to crack the healthcare market more broadly, he needs to hire sales personnel that are used to dealing with hospital executives and can address their concerns and understand their culture.

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.It is amazing how the discussion on the GP Co-Payment just runs and runs. Some more this week.Here are some of the more interesting articles I have spotted this 22nd week since it was released. Clearly Ebola and the Government Response and the new Primary Health Networks got a lot of coverage and this continues.The House of Reps returned a week or so ago and the Senate comes back 27th October so we will see how we go! I note rumblings about a much different approach to the Budget in 2015!General.http://www.theaustralian.com.au/news/senate-rows-an-18bn-drag-on-budget-bottom-line/story-e6frg6n6-1227096595716Senate rows an $18bn drag on budget bottom line The Australian October 21, 2014 12:00AM David CroweAUSTRALIA must repair the federal budget and confront global risks, including falling commodity prices, according to a new alert from the Parliamentary Budget Office that sharpens the...

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

October 29,2014


CCHIT announced that it was ending 10 years of service.

Today, the Certification Commission for Health Information Technology (CCHIT) announced that it is winding down all operations beginning immediately. All customers and business colleagues have been notified, CCHIT staff is assisting in transitions, and all work will be ended by November 14, 2014.

Alisa Ray made these comments in the announcement:

“We are concluding our operations with pride in what has been accomplished”, said Alisa Ray, CCHIT executive director. “For the past decade CCHIT has been the leader in certification services, supported by our loyal volunteers, the contribution of our boards of trustees and commissioners, and our dedicated staff. We have worked effectively in the private and public sectors to advance our mission of accelerating the adoption of robust, interoperable health information technology. We have served hundreds of health IT developers and provided valuable education to our healthcare provider stakeholders.”

“Though CCHIT attained self-sustainability as a private independent certification body and continued to thrive as an authorized ONC testing and certification body, the slowing of the pace of ONC 2014 Edition certification and the unreliable timing of future federal health IT program requirements made program and business planning for new services uncertain. CCHIT’s trustees decided that, in the current environment, operations should be carefully brought to a close”, said Ray.

The announcement also said that CCHIT would be donating its remaining assets to the HIMSS Foundation. Makes sense since HIMSS kind of gave them a partial home the past few months as they tried to save the jobs of the many who worked at CCHIT. Credit should go to Alisa Ray for all she did to try and give those who worked at CCHIT a soft landing.

Long, long time readers of this blog will remember my long blog posts talking about CCHIT and the lack of value that they provided the EHR industry. I believed then and even now that EHR certification was more of a tax on the industry than it was something that provided value to the market. They told me it provided some assurance to the purchaser of the EHR, but I never saw such assurances.

Once EHR certification was made part of meaningful use and the HITECH act, it basically made CCHIT irrelevant. Although, I still think that EHR certification in its current state doesn’t provide value to organizations and I’d love to see it go away. Sadly, there’s some legislation which is pushing the opposite direction.

While I disagreed with CCHIT’s approach to EHR certification and the value they provided, I do think there were good people who worked there that had good intentions even if we disagreed on the approach. I hope they all land somewhere great.

CernerCerner established a partnership with the Health Social Innovators programme to help healthcare start-ups develop their products and solutions into viable businesses. Health Social Innovators, a partnership between Healthbox, Numbers4Good, UCL Business, Trafford Housing Trust, Janssen Healthcare Innovation and established with support from the Cabinet Office under the Social Incubator Fund, launched its first accelerator programme for healthcare ventures with a social impact last week.
AllscriptsAllscripts (NASDAQ: MDRX) has introduced Sunrise Mobile Care™, a new mobile application for the Allscripts Sunrise EHR that delivers valuable medication, order and result information to the mobile devices of nurses and other clinicians.
This advertisement appeared a few days ago.Senior Policy AdvisorNEHTA-Sydney, Australia23 October, 2014Job descriptionStatus: Fixed term until June 2015 The Policy team at NEHTA are vital in developing and delivering consistent national policy frameworks which support eHealth into the future. The Policy team provide specialist advice on governance issues and key to the role is to engage with jurisdictional representatives. As Senior Policy Advisor you will provide specialist policy advice to key stakeholders internally and externally.  In this busy role you will work closely with other QA and product and implementations teams and assist with a variety of ehealth projects and initiatives.Desired Skills and ExperienceTo be successful in the role you will have extensive experience in resolution and mitigation of risks and issues and have the ability to develop sound, implementable recommendations for action. You will possess superior communication skills and must have...

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

October 28,2014

A study by an international team, including the University of Southampton, has shown population maps based on anonymous mobile phone call record data can be as accurate as those based on censuses. Their findings show maps made using mobile records are detailed, reliable and flexible enough to help inform infrastructure and emergency planners; particularly in low income countries, where recent population density information is often scarce.
Late last evening, Microsoft announced a new platform called Microsoft Health . Microsoft Health is designed to give people a holistic picture of their health, fitness, nutrition and work life to help them live healthier and achieve more. For the health...(read more)
Source: HealthBlog

I recently sat down with Walter Houlihan, Director of Health and Information Management and Clinical Documentation at Baystate Health, and Steve Bonney, EVP of Business Development and Strategy at RecordsOne to talk about the CDI (Clinical Documentation Improvement) program at Baystate Health. In the video below Walter and Steve talk about the savings that Baystate Health has received from their CDI program including how Walter has used dashboards, metrics and quality to convince senior management to increase Walter’s CDI staff from 4 FTEs to 10 FTEs so that they can review 100% of patients.

Steve and Walter also talk about how they use technology to make those 10 employees more efficient and make it possible for their CDI employees to work remotely.

How is your CDI program working? What technology are you using to make your CDI efforts more efficient? Have you had the success that Walter has had getting buy in from senior management?

Each year, malaria kills over 600,000 people, more than half of them children. In a study published today in PLOS ONE , researchers with the non-profit Innovations for Poverty Action (IPA) and Harvard University found that simple text message reminders to take malaria medication can help in the fight against the disease by boosting the rates at which patients complete their medication regimen.

In moving from healthcare to health, consumers and patients must be enabled to make healthier, more cost-effective choices.

A large part of success may be determined by how we develop incentives to bring attention and pull to those choices. One of the leaders in this area, who’s been driving successful consumer engagement through incentives for over a decade, is Michael Dermer, Chief Innovation Officer at Welltok. I had the pleasure of sitting down with Michael a few weeks ago to talk about what we can do to help people make the right choices for health.

Here is part one of my Interview with Michael Dermer, the Chief Incentive Officer at Welltok, developer of CafeWell, a leading health optimization platform, that rewards participants for leading healthier lives.. In Part II will discuss a bit more about Apple and how to get different populations engaged.

LK: As we move from health care to health (projections are that half of payments will be value-based by 2022, according to Leavitt Partners), tell us how you got into the health incentive business, a little of the IncentOne story (Michael Dermer’s previous company that was acquired by Welltok just over a year ago), and why it’s so important to this Copernican moment, where patients move to the center of the universe of health care.

Michael Dermer

Michael Dermer

MD: If you go back 10 or 15 years ago, I was a corporate lawyer in New York and just randomly stumbled upon the incentive business and ultimately the health care business. I had seen statistics that said for women who follow their prenatal care, their costs are (generally) the costs of the tests and the delivery claims. But for those who don’t follow their prenatal care, the risk to themselves and the increased risk to infants can cost the healthcare system literally millions of dollars.

That just really struck me that the medical profession knew what behaviors they wanted consumers/patients and even providers to take, but weren’t very good at getting people to do what are often simple, proven things (to reduce health risks) even in situations where the intrinsic motivations are seemingly very high.

In every other industry other than healthcare, incentives and rewards were and are a foundational way to accomplish that. So, in the mid 2000’s with IncentOne, we said, if it all comes down to consumer and provider behavior, then incentives aren’t just a one-off, $25 reward for a health risk assessment, for example, they’re a foundational asset that should be a cornerstone to your consumer and provider engagement strategy.

Back then incentives were kind of like witchcraft and people would say we’re never going to pay people to do things they should be doing already. So it’s been a really interesting ride to see how things have evolved to where incentives have become a cornerstone tool (to health) and the success we’ve achieved with IncentOne and now with Welltok.

LK: So tell us about some of the incentives you’ve used, how things have changed in the incentive business, and what’s coming in the near future.

MD: If you go back, consumer-based incentives, delivered via self-insured employers and some health plans, were really basic: complete a health risk assessment, sign on to a portal, maybe go see your PCP, biometric screening, etc. As more and more wellness programs became prevalent in both employer and health plan communities, they started to do more around smoking cessation and online coaching. So if you look at it holistically, as the different health assets were being deployed by anyone who bore the risk, more and more of those behaviors started to be rewarded.

Fast forward today, think of telemedicine to transparency tools, to wrapping them around digital devices and apps in addition to all the traditional things around biometrics and outcomes. We have a real extension to providers with things like e-prescribing and the ACO infrastructure. What do we get from changing the behavior of providers?

So it’s been a constant evolution. Once people say “we know what the behaviors are, we know what impacts the system” then it becomes an evolution from the basic things like screenings and primary care to how to redirect people from the ER if they have the sniffles to a more appropriate care center (and much more specific decisions points). I think we now have over 6,000 behaviors we’ve rewarded over the years.

LK: So with things like telemedicine, you’re saying, “Hey, call in instead of going to the clinic and we’ll reward you for that?”

MD: Yes.

LK: What kinds of rewards do you offer for those kinds of things?

MD: Our view of the world is that different players in the healthcare continuum would want to use different dollar values and offer different types of rewards. So we always look at those two things differently.

Our first part is, how much do you actually give someone? If you give someone $50 to do a screening, you’ll get a lot more participation than if you offer $50 to run a marathon. So our first part, was what’s the dollar value? And the second part, what are all the different rewards? So from an administration perspective, that means everything from cash to HSA and HRA contributions, premium credits, gift cards, debit cards, that whole continuum of rewards that’s used in the most prevalent way. In our view of the world, the rewards that approach cash have the best results, and it’s the amount that you’re giving someone relative to the value of the behavior that is the true art and science behind all of this.

LK: Do we always get those lines to cross, between the behavior and the reward? Does it always make sense?

MD: That’s really the rub at the end of the day. So if you take things, a simple example, like you sprain your ankle and you need an MRI, and you need to decide where to have it done. At one place it’s $600 and one is $1,800, that’s simple and it’s easy to create appropriate incentives to steer people to a different service center in that instance. When you get a little deeper into long-term behavior change, that’s more complicated.

You know stopping smoking and managing nutrition and weight have longer-term benefits, but are harder [to change]. So it’s a matter of managing the benefit and the value of the behavior. It’s hard to get someone in Medicaid to stop smoking, but it’s not so hard to get them to go to a primary care doc for $50.

So, one part is how much you give them and the second part is how much it’s worth. There are lots of behaviors that have near-term benefit, the hope is that then leads to some intrinsic motivations and longer-term behavior change, but it ultimately comes down to how much you’re saving.

LK: Is the goal that these extrinsic rewards eventually become intrinsic rewards?

MD: They work hand in hand, neither will get the job done by themselves. I don’t think we’ll ever see a day where we don’t need extrinsic rewards. With all the changes in health care, you see them everywhere. If you work for a large, self-insured employer, they’re becoming commonplace. But extrinsic rewards don’t work on their own either, so what you want to do is use extrinsic for one-and-done kinds of activities, like choosing a place to have an MRI done, and then unlock more intrinsic motivations.

You’ll hear lot of stories like someone says, “Yeah, I never really exercised and never really thought about it, but I did a 10,000 step program, in response to an incentive, and something clicked.” Or a family member got them to join a competition and something clicked because they were part of a competition together. All of these things become arrows in your incentive quiver.

I’ll also say, when you look at the numbers, there’s no starker example than prenatal care. The idea of not following prenatal care may seem pretty foreign, but it’s commonplace even with so much intrinsic motivation, so we need to deploy extrinsic with intrinsic to optimize where you end up.

LK: So, let’s look at how much it takes to drive these incentives. You’ve collected a lot of data for more than a decade. Do have a good idea where to start? If you look at, say, airline miles, they’re worth maybe somewhere between a penny or a nickel. How do you know what it will take to drive a specific behavior?

MD: The reason I mentioned before that things need to be closer to cash is that you don’t want people to have to do those kinds of conversions. It’s just dollars. You’re getting real dollars. What we can do now that we have been doing this for over a decade, is we know what dollar value it takes to motivate around a certain behavior.

Our methodology is, we look at behavior in five different categories from simple things, like doing a health risk assessment, all the way up to changing lifestyle on the other end of the spectrum. And with all our data, we know how much reward will get you how much behavior change.

LK: How do you get people started on these programs? How do you get them in front of those that need to hear about them?

MD: If you think about the major sponsors, health plans, employers, now even more government agencies, reward and incentive messages are integrated into those offerings. So, if an employer is going to spend $1,000 on rewards, it becomes part of their health and wellness brand and communications, and the same goes for health plans. While health plans have been a little more tactical up until now, we’re not too far away from every health plan having a reward program just like credit cards, airlines and hotels. In the near future, we’ll see reward programs become a pretty core part of why consumers engage (with health plans), and it’s already becoming a core part of the communications strategy.

LK: In this new model that we’re heading toward, moving from healthcare to health, it seems like the core pieces are in three buckets: 1) there’s big data and analytics; 2) there’s measurement, health, sensors and home monitoring; and 3) then there’s incentives. It really seems like what Welltok and you are doing is really pulling all these components together on a common technology platform. How do all these pieces fit together, are we headed toward a behavioral health currency of some sort?

MD: It’s really interesting the way you describe it, because people used to say it’s preventative, or now it’s transparency, but we look at as all of the above. We say it’s a universe of behaviors, and they each might have immediate, intermediate, or long-term incentive applications.

One of the analogies from outside health care is Citibank. Citibank for years, like many large financial institutions, used to have these disjointed incentive programs. You’d get, say, a $200 television for opening an account, $50 for sitting down with a small business manager, and 1% back for using your credit card. Now that’s all rolled into a program called Citi ThankYou Rewards where everything you do with Citibank is rolled into one rewards program.

Another example is children with asthma. Parents might take their kids to the ER four times a year, but if they just had a fast-acting inhaler prescribed, they’d be safer and better off and it would save the system thousands and thousands of dollars.

So, with the list of different examples and risk factors, different associated behaviors, and all the assets that the health plan and employers are delivering is endless. So, I think we’ll soon see a continuum where it all comes together and starts to look a lot like ThankYou rewards, but for healthcare.


Thanks to Michael Dermer! Stay tuned for Part II on how to approach different patient populations and what the Apple Watch may mean for health care incentives and payments.


Categories: News and Views , All
This post from Dr Edwin Kruys appeared last week.The Australian PCEHR: Success or failure?24/10/2014 Edwin Kruys Call me naive, but I was hoping that somewhere in Australia IT-people would be working day and night to fix the PCEHR, based on the abundant feedback from doctors and consumers. I had a rude awakening when I read this article in Australian Doctor Magazine: PCEHR: Patients may see test results before GP.Sorry? Diagnostic imaging & pathology results may be uploaded to someone’s eHealth record, before they have been reviewed by or discussed with the requesting doctor? This doesn’t sound like an improvement. Worse, it flies in the face of the 2014 PCEHR review recommendations to make the system ‘more usable, and able to deliver meaningful use.’So where are we at with the PCEHR? I asked four leaders in the field about their thoughts: Has it been a success or a failure? Can it still be improved and if so, how?Let’s get the basics right first: Frank JonesDr Frank Jones,...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
The terms of reference for the short review were: Terms of Reference are: review and assess the extent to which NEHTA delivers for Victoria on its intended objectives as documented in relevant national agreements, strategies and agendas; review and assess the efficiency and effectiveness of NEHTA for Victoria, in general, including identifying areas of risk in the national agenda (e.g. duplication of effort, unnecessary burden); assess possible new governance arrangements for the national E-Health agenda in light of the findings of the Commonwealth review of the PCHER; assess the net benefits to Victoria, particularly in light of its state contribution to the funding NEHTA, to participating in the national E-Health agenda through NEHTA. Here is what I wrote: ----- Core Points On The Over 9 Years Of NEHTA. NEHTA was founded 5 July, 2005 1. NEHTA has consumed well over $650M - with a good 40% spent on consultants - over the last 9 years. They have used their market dominance to...

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

October 27,2014


Everywhere I turn I’m reading articles and tweets that talk about the shift of healthcare towards the patient. All the EHR vendors are touting various patient focused features. Supposedly, a new engaged patient is getting involved in their healthcare and doctors are having to focus much more on the patient that they’ve ever done before. The drum beat of patient focus is being beat in so many places.

Is this really happening or is this just the topic du jour?

Some might argue that things like meaningful use’s patient engagement requirements are pushing this movement forward. However, those who have worked to meet those requirements know very well that meeting the meaningful use patient engagement measures doesn’t look very much like true patient engagement. The concept was interesting, but the actual implementation leaves a lot to be desired.

I have recently seen some patients start to care a little bit more about their health than they did before. This is driven largely by the high deductible plans. It’s amazing how getting people to pay for their care will change their attitude. Although, even then it hasn’t made people want to care about their healthcare. It’s just made them more informed on the price of the healthcare they receive.

Has the healthcare system really turned towards the patient? Are we any more focused on the patient now than we’ve ever been before? I don’t think we are. For all the talk, I haven’t seen much action and I can’t think of something that’s really going to dramatically change things.

I’d love to hear if people disagree. Do you see a shift of focus towards the patient? Have we always been focused on the patient, and so it’s not really a shift at all? Are there things we should be doing to encourage a shift to the patient?


Hospitals can be chaotic environments both for patients and staff such as physicians and nurses. This high-tension environment is exacerbated by interruptions by alarms from physiologic monitoring devices and alerts  from EHRs. Here is an excerpt from an article about alarms (see: Hospitals rank alarm fatigue as top patient safety concern):

Nineteen out of 20 hospitals surveyed rank alarm fatigue as a top patient safety concern, according to the results of a [recent] national survey....Alarm fatigue occurs when clinicians become desensitized to the constant noise of alarms or overwhelmed by the sounds and turn alarms down or off [of patient physiologic monitoring devices]. The problem has become so widespread that last month The Joint Commission...now requires accredited hospitals and critical access hospitals to improve their systems....The findings [of the survey] show hospital staff are exposed to an average of 350 alarms per bed, per day based on a sample from an intensive care unit at the Johns Hopkins Hospital in Baltimore....To reduce alarm fatigue and better manage alarms,...hospitals must develop a systemic approach that considers staffing patterns, care models, architectural layouts, patient populations and staff responsibilities....One way hospitals can combat the problem is to follow the lead of Boston Medical Center (BMC), which has reduced its weekly audible cardiac alarm rate by 89 percent simply by adjusting monitor alarms for bradycardia, tachycardia and heart rate limits

Here is an excerpt about the EHR alerts: (see: How EHR Alerts Benefit Physicians and Patients)

There has been a lot of discussion in the Health Information Technology (HIT) community lately regarding the number of [prescription and clinical-decision support] alerts physicians receive through electronic health records (EHR) systems. Discussions focus on the possibility of alert fatigue, which is caused by physicians’ frustration at receiving numerous alerts through EHR systems, sometimes leading to warnings being ignored....

For me, the best general advice about how to manage alarm/alert fatigue is the following from the first quote above: develop a systemic approach that considers staffing patterns, care models, architectural layouts, patient populations and staff responsibilities. This makes perfect sense but the advice is too general; what's needed is specific guidance about exactly what can be done to solve the problem. One of the best specific solutions is the adoption of so-called smart alarms and alerts that can differentiate between, say, a technical problem versus a change in a patient's medical condition, particularly one that places the patient at serious risk (see: Hospitals Mobilize To Tackle Alarm Fatigue). 

As a physician with 20 years of patient care behind me, I know all too well how important mobility is to clinical workflow. Whether healthcare professionals are working in the hospital, clinic, ancillary care facility or elsewhere, they are always on...(read more)
Source: HealthBlog

October 26,2014


I’ve written a number of articles and a few video interviews on job opportunities in digital health recently and have received a steady stream of questions since then. Given healthcare IT professionals can make $90,000 or more annually, there has been growing interest in the industry. To help separate fact from fiction and dive a little deeper in to the realities of these opportunities, I reached out to Beth Kelly, a freelance writer from Chicago, IL to summarize the projected outlook for specialized positions within the field of health IT. Careers in healthcare IT are appealing whether your preference lies within the computer or medical sciences; what’s clear though is to succeed you’ll need to have your passion fit somewhere between both.  As positions in the industry are constantly evolving, the ability to adapt to new technology is also crucial — whatever is “cool” today will be different tomorrow. As healthcare providers and physicians strive to  implement new technology systems, the expertise of HIT professionals will guide the industry into the future so knowing the Outcome Driven Innovation (OID) and JTBD of clinical professionals will be a differentiator for those who possess such skills. The market for health care information technology continues to show enormous growth potential – with no signs of slowing down any time soon. Here’s what Beth thinks the outlook is:

General Qualifications and Useful Certifications

It’s clear that the expanding field of healthcare IT affords plenty of opportunities. But of course, making the move into this field isn’t as simple as picking up the phone and interviewing. Qualifications are important — in a recent salary survey report completed by HealthITJobs.com, it was noted that certified workers are on average making $10,000+ more than those without certifications.  If you are an IT worker currently, CISSP, CCNA, and PMP are a few technical certifications that are in high demand in Healthcare IT. But beyond the classroom, health IT requires a unique set of skills, and not all of them are related to technology. In healthcare, the right applicant needs to understand more than codes and processes. Many hiring managers look for applicants with “soft skills” who are willing to work in a highly collaborative environment. Applicants for HIT positions need to be aware that in a hospital environment, their position is not the star of the show. Ultimately the healthcare world revolves around the patient, and IT roles provide supportive care. In many cases when hiring, institutions prefer applications with a combination of IT and clinical skills.

Optimizing opportunities afforded by the changing healthcare landscape requires a lot of hard work and insight into the diverse nature of the healthcare IT job market. Whether you are transitioning to IT from a clinician position, or you have an IT background already but are new to healthcare, challenges are inevitable. But in an increasingly digital world, where people use technology in more ways perhaps than they even realize, an HIT skill set is almost guaranteed to pay off.

The healthcare sector of IT is as diverse as the industry itself. There are numerous areas in which to specialize; the following domains being several of the most promising.

Mobile Healthcare

Looking purely at the numbers, Americans are inseparable from their phones. And with nearly one third of all mobile applications being health related, the opportunity to access and utilize vast amounts of health data is there, also. As Silicon Valley tech companies take a greater interest in mobile health devices, advances in analytic software now make it possible to capture illuminating data about our daily lives. The sum of this information is aimed to transform medicine. Even as privacy concerns loom, the ubiquity of smartphones and tablets promises career opportunities in the realm of HIT.

Joseph Hobbs, CIO at Community Hospital at Anderson located in Anderson, Indiana, had this to say about mobile technologies: “This is a huge topic for any organization. Whether it is a mobile cart, a tablet or a smartphone, you need to give caregivers access at their fingertips. The [other] challenge in healthcare is that it’s not a one-size-fits-all initiative. Beyond just finding a solution for all you then have to worry about security and application presentation to all of these types of devices.”

Many health professionals agree that the data from medical devices and data from modern EHR solutions should be integrated. When mobile devices are capable of being linked to EHR, physicians can provide patients with appointment alerts and medication reminders, as well as additional medical assistance. In the remote patient monitoring space, cell service provider Verizon represents the Converged Health Management solution, one of the first products that hopes to bridge the gap between monitoring devices and EHRs. Partnering with Ideal Life, a medical device company, Verizon’s platform is capable of measuring blood pressure, oxygen saturation, glucose levels and weight.

The market for mobile healthcare apps promises many new opportunities for with room tremendous growth and earning potential. According to German market research firm research2guidance, the worldwide market for mobile health applications and their corresponding services reached $2.4 billion in revenue in 2013 and will grow to $26 billion by the end of 2017.

Mobile apps are becoming increasingly significant in the healthcare community, their influence extending throughout both the medical and insurance industries. Mobile app developer positions are in extremely high demand. With medical health app growth ahead of the general mobile market, there are tremendous number of opportunities for people interested in these positions. According to the U.S. Bureau of Labor and Statistics, from the years 2010-2020, there is a projected growth rate of 57.4% for software application developers. For software systems developers, there is a projected growth rate of 71.7%. It’s estimated that overall employment in the industry will continue to grow rapidly.

Clinical Informatics

Clinical analytics are a top priority for two reasons: data mined by those with analytic skill can be used to understand population health, helping better identify infectious disease outbreaks and other population health trends, and can also be used to help a hospital’s bottom line. Big data allows providers to better see how their resources are spent, and where they can trim the fat. The recent deal between Apple and IBM only promises to fuel the market for data analyst positions.

In the current market, an advanced degree in health informatics is very useful. Because of the move toward electronic health records, hospitals and health systems need qualified people to undertake complex projects. A degree opens the door to working for a hospital, a health system, a vendor that sells electronic records or computer software or as a professional consultant. From 2010 to 2020, the U.S. bureau of Labor has said that employment of computer systems analysts in computer systems design and related services will grow 43 percent. Businesses will typically hire them to reorganize IT departments to operate more efficiently.

HIPAA, Meaningful Use and ICD-10 Project Managers

Now that both HIPAA and HITECH are being fully enforced, affected entities can be audited for compliance at any time. At Stage 2 of the HITECH act a certain percentage of provider’s patients must use and interact with patient portals. Navigating HIPAA privacy regulations and the proprietary nature of the portal software is a convoluted process. And the transition from ICD-9-CM to ICE-10-CM is a hefty task as well; ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories.  ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories. In the transition to greater coding specificity, hospitals typically look for someone who has worked as a coder and in health information management roles.

As health organizations strive toward integrating ICD-10 throughout every aspect of their business, there is an enormous need for medical coding and billing specialists capable of working with the updated diagnostic coding system. ICD-10 skills will put you in the front running for an in-demand position such as project manager, ICD-10 coding specialist, or even ICD-10 educator.

Skills in HIPAA Compliance qualify you for a high level HIPAA Privacy Officer position, a role that typically pays over $60,000 annually. Meaningful Use Director positions, a recent addition to the healthcare landscape, can pay anywhere between $35-80,000 each year.

Privacy and Data Breach Prevention Specialists

Health Information privacy specialists are in extremely high demand. EHR applications, particularly when accessed on mobile devices, require enhanced security access and monitoring. Data breaches are expensive, embarrassing, and damaging to to health groups, but many physicians still neglect to encrypt the patient information they’ve stored on various devices. Healthcare organizations need to take security seriously, and bring on IT professionals to ensure they are doing everything they can to reduce instances of identity theft.

Information security spending is expecting to increase nationwide, especially within industries that deal with sensitive information such as hospitals. New security measures are added and reconfigured constantly, and as a result the demand for privacy and data protection specialists is always high. Job growth for this title is projected to grow upwards of 25% within the next 5-10 years.

Pharmaceutical companies, naturally interested in joining the digital health movement as well, have found it more difficult to gain traction. A 2013 Deloitte survey found that, while people trust doctors and medical professionals the most, they trust companies like WedMD next and then internet search results. Big pharma companies come in dead last. Healthcare organizations and pharma companies are competing, not within their respective sectors, but against one another. Digital pharma is only now beginning to take off. According to M2i2′s Chief Medical Information and Innovation Officer Sachin Jain in a May interview, “the ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business, and as we do that, I think we realize that data and technology and HIT is going to be a critical enabler.”

Getting started in healthcare IT is not as intimidating as it may seem. For new job seekers, however, it is important to research the different types of positions available and where you may be most helpful. Additionally, for those without a background in health, learning clinical workflows and the other processes that go into healthcare is imperative. Experience, if it’s outside the realm of healthcare, can be transferable, but you will need to be sure to tailor your resume and cover letter around the language of the health industry. If possible, volunteer in a hospital or similar healthcare IT setting to obtain hands-on experience.

Unlike humans, which can handle diversity, computers hate variations. Hospitals and physicians have experienced workflow disruptions and productivity loss as they adopt more advanced EHR systems. Health IT workers, cogs in the digital health machine, fulfill hybrid roles that blend the skills of clinicians and traditional IT workers. As the nature of the healthcare industry continues to evolve, the future for healthcare IT continues to look very bright.

October 24,2014


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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

October 23,2014


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

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

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

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

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


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

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

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

Medical analysts are the new data darlings of baseball operations.

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

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

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

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

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

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

Baseball is a Data Driven Industry

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

Video, Biomechanics, and Data

Matisse VerDuyn Fastest Bat Speed 101 MPH


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

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

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

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

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

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

Tracking Body Movements

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

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

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

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

296Baseball28They Might Be (Tech) Giants

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

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

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

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

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

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

Healthy Eating: Let Them Eat Kale

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

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

Now, let’s play ball!

Categories: News and Views , All

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

Categories and awards in the contest are as follows:

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

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

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

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


October 22,2014


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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


October 21,2014


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

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

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

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

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


First, do no harm.

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

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

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

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

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

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

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

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

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

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

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