October 23,2014


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Categories and awards in the contest are as follows:

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

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

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

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


October 22,2014


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

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

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

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

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

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

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

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

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

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


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

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

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

Norse - Internet Attack Map

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

October 21,2014

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

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

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

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

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

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


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

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

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

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

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

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

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

Have you done your HIPAA Risk Assessment for your organization?


First, do no harm.

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

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

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

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

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

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

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

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

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

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

Categories: News and Views , All
Gough, For getting rid of conscription (yes I was sucked in), providing major changes to health and education (yes I really benefited) and getting rid of the death penalty - many thanks! We won't see his likes again I believe. The meanness we now see in public policy just shows how badly we are presently led - IMVHO. We can care and fund things - but no one wants to try! Pity about that. David.

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

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

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

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

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

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


October 20,2014

PhilipsRoyal Philips (NYSE: PHG, AEX: PHIA) has reported Q3 sales of EUR 5.5 billion and operational results of EUR 536 million. Healthcare comparable sales grew by 1% year-on-year. The EBITA margin, excluding restructuring costs and various charges, was 12%, a decrease of 2.6 percentage points year-on-year.

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

3. Insurance companies and providers need to form partnerships

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

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

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

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

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

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


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

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

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

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

Too funny.

Said like a true coder.


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

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

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

staffing humor 1

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

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

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

staffing humor 5

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

Categories: Influential , All

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

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

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

staffing humor 1

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

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

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

staffing humor 5

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

Categories: Influential , All

October 18,2014


Via Medgadget

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

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

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

Some details from the study abstract:

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

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


Categories: All , News and Views
Call for Articles for a Special Section of Semiotica, the Journal of the International Association for Semiotic Studies on the theme of “Social Representations, ICTs and Community Empowerment”.

This special section will provide an overview of the use of Social Representations Theory (SRT) (Moscovici, 1961), for empowering local communities, with a specific focus on the role of Information and Communication Technologies (ICTs), such as the Internet, desktop and mobile devices, radios, etc.

Interested researchers are invited to submit an abstract proposal (word file) of about 500 words via e-mail.

Abstracts should be accompanied by the following information about each of the authors:
  • Name
  • Position
  • Affiliation
  • Contact Information
The deadline for abstracts submission is November 21st, 2014.

Inquiries and submissions can be forwarded electronically to:

Dr. Sara Vannini
Università della Svizzera italiana, (USI Lugano, Switzerland)
sara.vannini AT usi.ch

More information can be found here:

Thank you so much for your help!

Sara Vannini, PhD
Visiting Researcher - TASCHA
Executive Director - NewMinE Lab
PostDoctoral Researcher - BeCHANGE Research Group
sara.vannini.usi AT gmail.com
website: http://www.saravannini.com

My source: ciresearchers AT vancouvercommunity.net

Additional link [pj]: Wikipedia - Social representation
Categories: News and Views , All

October 17,2014


In a pathology informatics webinar delivered yesterday by Dr. Mike Becich and presented by API and Sunquest  (see: Free Informatics Webinar Tomorrow: IT Support for Pathology Research), I posed the question whether he knew of any cases of a "reverse feed" of clinical information from an EHR to an LIS. Ul Balis was the first informaticist who had used the term "reverse feed" in my presence but I am not sure if he originated it. A feed of clinical information to the LIS will be absolutely necessary for pathology to fulfill its evolving mission in molecular diagnostics and cancer genomics because it enables pathologists to refine their diagnoses and generate therapeutic recommendations. Pathologists obviously have manual access to the EHR but the volume of such data demanded by molecular and genomic pathology requires an electronic interface back to the LIS.

Dr. Becich said that he knew of no instances of reverse feeds of clinical information from the EHR to the LIS in any hospital. In my opinion, there are a number of reasons why such a reverse feed will never be allowed by EHR vendors. Here are some of the reasons for my statement:

  • The LIS, RIS, and PACS systems are viewed as "ancillary systems" with the sole purpose of sending diagnostic data to the EHR with which the clinicians interact. For an EHR vendor, there would be no rationale or justification for such a "reverse feed" to the LIS from a competitive or business point of view. They would never articulate such an argument, however. Instead they would say that there is no need for such an interface given the integrated nature of the EHR database. They would omit the fact that there are few available tools to perform "deep phenotyping" studies on the EHR. Below is a definition of deep phenotyping for precision medicine (see: Deep Phenotyping for Precision Medicine)
    • Deep phenotyping can be defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described....The comprehensive discovery of such subclasses, as well as the translation of this knowledge into clinical care, will depend critically upon computational resources to capture, store, and exchange phenotypic data, and upon sophisticated algorithms to integrate it with genomic variation, omics profiles, and other clinical information. 
  • An EHR vendor like Epic offers an enterprise-wide-solution with its own LIS and RIS. The company would thus not be inclined to participate in any process that enhances the functionality of a best-of-breed LISs like Sunquest, Soft, or Cerner and, in so doing, enhance their perceived value.
  • An EHR vendor will assume that any algorithms used for deep phenotyping would run on its own system. Although such processing would be very desirable, I don't personally think we will see the development of such algorithms in the foreseeable future for EHRs. Although EHRs store massive amounts of clinical data, they are destined to function primarily as archives of clinical data without advanced data processing features.

Dr. Becich went on to state that very sophisticated data integration and analysis (i.e., deep phenotyping) is now occurring within the Department of Pathology at Pitt. The clinical data that the department of pathology requires to support its clinical and research mission is obtained from medical center's clinical data warehouse or repository which is populated with data by the EHR (including lab data) and to which the LIS is interfaced.  At the end of the day, this may well be the best architecture for hospitals and medical schools because it spares the EHR the cycle burden of supporting interfaces back to the ancillary systems like the LIS and RIS. The downside of such an architecture is that the creation of a clinical data warehouse will probably be limited to the larger academic medical centers that are able to justify the expense by its research mission and the funds generated from it. Smaller hospitals will thus be deprived of the opportunity to integrate pathology test results with the relevant clinical data.



Categories: All , News and Views

The people at online physician community, QuantiaMD, recently sent me a list of the top 3 “Crazy ICD-10 Codes” that they got from their community. It was quite interesting to learn that when they asked their community for these codes, they yielded double the participation the company typically sees. No doubt, physicians have globbed on to these funny and crazy ICD-10 codes. I’ll be honest. I’ve gotten plenty of laughs over some of the funny ICD-10 codes as well. Seriously, you can’t make some of this stuff up. Here’s a look at the top 3 crazy ICD-10 codes they received (and some awesome color commentary from the nominators):

1. W16.221 – Fall into bucket of water, causing drowning and submersion. I didn’t realize mopping the floor was so dangerous!
2. 7. Z63.1 – Problems in relationship with in-laws. Really, Who does not?
3. V9733xD – Sucked into jet engine, subsequent encounter. Oops I did it again.

While these codes are amazing and in many respects ridiculous, they’re so over the top that they’ve branded ICD-10 as a complete joke. For every legitimate story about the value of ICD-10 there have probably been 10 stories talking about the funny and crazy ICD-10 codes. You can imagine which story goes viral. Are you going to share the story that talks about improvement in patient care or the one that makes you laugh? How come the story about their being no ICD-9 code for Ebola hasn’t gone viral (Yes, ICD-10 has a code for Ebola)?

Unfortunately, I don’t think the proponents of ICD-10 have done a great job making sure that the dialog on the benefits of ICD-10 is out there as well. Yes, it’s an uphill battle, but most things of worth require a fight and can easily get drowned out by humor and minutiae if you give up. If ICD-10 really is that valuable, then it’s well worth the fight.

My fear is that it might be too late for ICD-10. Changing the ICD-10 brand that has been labeled as a joke is going to be nearly impossible to change. However, there are some key people on the side of ICD-10. CMS for starters. If you can get the law passed, then the ICD-10 branding won’t matter.

One thing I do know is that doing nothing means we’ll get more and more articles about Funny ICD-10 codes and little coverage of why ICD-10 needs to be implemented. I encourage those who see the value in ICD-10 to make sure their telling that part of the story. If you don’t have your own platform to share that part of the story, I’ll be happy to offer mine. Just drop me a note on my contact us page.

October 16,2014


I’m thinking I need to start a new healthcare reality TV show called “Healthcare Data Hoarders.” We’ll go into healthcare institutions (after signing our HIPAA lives away), and take a look through all the data a healthcare organization is storing away.

My guess is that we wouldn’t have to look very far to find some really amazing healthcare data hoarders. The healthcare data hoarding I see happening in comes in two folds: legacy systems and data warehouses.

Legacy Systems – You know the systems I’m talking about. They’re the ones stored under a desk in the back of radiology. The software is no longer being updated. In fact, the software vendor is often not even around anymore. However, for some reason you think you’re going to need the data off that system that’s 30 years old and only one person in your entire organization knows how to access the legacy software. Yes, I realize there are laws that require healthcare organizations to “hoard” data to some extent. However, many of these legacy systems are well past those legal data retention requirements.

Data Warehouses – These come in all shapes and sizes and for this hoarding article let me suggest that an EHR is kind of a data warehouse (yes, I’m using a really broad definition). Much like a physical hoarder, I see a lot of organizations in healthcare that are gathering virtual piles of data for which they have no use and will likely never find a way to use it. Historically, a data warehouse manager’s job is to try and collect, normalize, and aggregate all of the healthcare organizations data into one repository. Yes, the data warehouse manager is really the Chief Healthcare Data Hoarder. Gather and protect and and all data you can find.

While I love the idea that we’re collecting data that can hopefully make healthcare better, just collecting data doesn’t do anything to improve healthcare. In fact, it can often retard efforts to leverage healthcare data to improve health. The problem is that the healthcare data that can be leveraged for good is buried under all of this useless data. It takes so much effort to sift through the junk data that people just stop before they even get started.

Are you collecting data and not doing anything with it? I challenge you to remedy that situation.

Is your healthcare organization a healthcare data hoarder?

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