Scheduling is not a workflow one normally associates with medical device connectivity. In some applications, scheduling is handled by software separate from the connectivity solution. Sometimes, scheduling is not done at all. In other applications, as we shall see, scheduling is so much a part of the broader workflow, that it’s hard to recognize as a scheduling task. Two illustrative aspects of scheduling will be discussed, scheduling for diagnostic modalities and scheduling for routine patient care tasks. Because it’s less understood (and frankly more interesting) we will look at scheduling for routine patient care tasks first.
Patient care tasks encompass routine activities carried out by caregivers and/or aids. Examples of these routine tasks include vital signs collection, medication administration, bed turns (to avoid hospital acquired pressure ulcers, or HAPU), and respiratory circuit flushing (to avoid ventilator acquired pneumonia, VAP). These tasks must be completed at a predetermined frequency on a reliable basis or adverse events – including patient death – can result.
While the scheduling workflow diagnostic tests is very medical device centric (getting the patient to the device), patient care task scheduling is more patient centric (as in ensuring that certain patient care tasks are completed). The order for these routine tasks come from the ordering physician in numerous ways. Often the actual patient care task is implied by the physician order and must be interpreted by the caregiver. Some tasks are initiated based on operating policy that requires that patient’s be screened for things like HAPU, VAP or fall risk. Patients that meet the at-risk criteria then receive the routine care prescribed by the policy.
Identifying all the routine tasks associated with a given patient is not the hard part. The challenge is ensuring that these routine tasks actually get done, and completed within the specified time frame. The reason this is a challenge is because of the interrupt driven environment at the point of care. This adverse work environment is at the root of many patient safety challenges found at the point of care: medication administration errors, hospital acquired pressure ulcers, ventilator acquired pneumonia, fall prevention, failure to rescue, and more. Besides failure to rescue, everything on the preceding list succeeds or fails based on completing routine tasks.
The need to balance nursing vigilance, medical device alarm response, patient and family member requests, and reliably completing routine tasks is a tall order. Past efforts to improve this situation have focused mainly on trying to develop and apply information technology to transform the point of care into a more manageable and predictable environment. Sadly, there is no information technology in existence that can direct when a patient needs to use the toilet, when their pain becomes intolerable, or when a patient’s condition deteriorates generating a medical device alarm. Not surprisingly, attempts to reduce the interrupt driven nature of the point of care have failed.
While it is possible to somewhat improve improve workflow and nursing unit design to minimize interruptions, solutions that bring meaningful improvement to reliably completing routine tasks on schedule remain scarce.
Reliably completing routine tasks can be thought of as a connectivity solution. Let’s consider bed turns as a means to prevent HAPU. First the patient must be screened and identified as at-risk, and an appropriate prevention regime selected – this portion of the workflow is well understood and widely adopted. What’s missing for many point of care tasks is a solution that improves on the implementation of the previously selected patient care plan. In our HAPU example, the next requirement is a means to reliably know whether or not a patient has been turned within the prescribed time frame. Next, you need a means to prompt the caregiver to complete the required turn that doesn’t itself become another nuisance interruption that detracts from patient care. Finally, the data from this process – when the the actual turns occurred compared to when they were scheduled – is recorded and available for retrospective analysis.
The first example of a solution supporting a specific type of routine care has recently come to market. A similar framework and resulting product could be used to address a variety of activities at the point of care. Some of these routine tasks are more challenging to support with automation than others. A perfect example of a challenging application is medication administration, where initial solutions were shown to be inadequate.
A classic example of scheduling is found in diagnostic imaging, where complex algorithms are needed to match requests for specific diagnostic procedures with available diagnostic equipment/rooms and human resources. This scheduling must be done in a way that evenly disburses workload across on-duty techs and radiologists and also maximizes the utilization of fixed assets such as x-ray rooms, CTs, MRs and interventional radiology suites. These kinds of complex scheduling tasks are often automated using software separate from the connectivity solution – in this example, scheduling is typically found in the Radiology Information System rather than the PACS.
These classic scheduling requirements are common to many diagnostic departments and associated with diagnostic connectivity workflows. Smaller, lower volume diagnostic modalities such as endoscopy and the cath lab may have scheduling included in the same solution as medical device connectivity – either from the medical device manufacturer or a third party.
If there was a connectivity solution for dialysis, this would be an example of a therapeutic modality where patient flow and resource utilization is as important as with many diagnostic modalities. An application like this is simplified in that the dialysis therapy does not vary like different diagnostic imaging procedures, and the dialysis machines on a unit tend to be identical or at least very similar. This greater degree of uniformity means the scheduling process is much less complex.
In certain situations scheduling can morph into more of a workload optimization and fulfillment exercise, somewhat different from the typical prospective scheduling scenario. For example, orders for clinical lab tests are generated by providers on nursing units or in their offices. These orders are received by the lab information system (LIS) which then dispatches phlebotomists to collect specimens which will then be tested.
A key part of the scheduling process is the initial capture of patient information. These patient demographics are captured along with the specific exam being ordered, the ordering physician and any special instructions regarding the patient or required time frame for the study. Some of this data, such as orders, may be available from other systems and can be pulled in without requiring the user to reenter that data. In some workflows, the order may follow the request to schedule the study. When this happens, there must be a validation step where the scheduled study and the ordered study are compared to ensure they are identical – and the ability to resolve any inconsistencies found.
Besides the obvious value of scheduling the study or some other patient encounter, scheduling data can indirectly support operations. For example, the schedule can drive when to push work lists or copies of orders to medical devices and/or techs to improve workflow. Scheduling data can also be used to determine optimal staffing levels for the scheduled workload. The scheduling of tasks can be part of a connectivity workflow, or a point of systems integration that feeds data into the connectivity workflow.
The foregoing scheduling workflows are mostly well understood. The software for supporting these kinds of scheduling tasks is mature and most of these markets have reached penetration and become replacement markets.
Routine tasks in patient care can be approached as scheduling challenges. Unlike with scheduling diagnostic tests, patient care task scheduling is more about the implementation of the tasks than the determination of when and where they should occur. There is a rich set of patient care tasks at the point of care that present persistent challenges to consistent implementation, resulting in adverse events and subsequent attention from the Joint Commission, AHRQ, CMS and others. It seems the industry – manufacturers and providers – are just now starting to come to grips with these routine clinical tasks.
Almost eight years ago, I posted a note on the tight link between longevity medicine and lab testing (see: Anti-Aging, Longevity Medicine, and Lab Testing). The two go hand-in-glove. The tests are used, in part, to determine the biologic age of the patient and then various regimens and remedies are used to theoretically slow down the aging process. Here's a paragraph from that note:
Just to frame the issue and get your attention, annual revenue from the anti-aging industry is estimated to be $56B -- this includes products such as anti-aging cream and botox injections. Need to find an anti-aging physician? No problem. Here is the link to the home page of the American Academy of Anti-Aging Medicine (A4M). It's not too late to attend the 14th Annual International Congress on Anti-Aging Medicine.
When I wrote this note, I was not surprised that there was a market for services that emphasize youth in U.S. society. However, I had not thought about longevity medicine afterwards until I came across another article indicating that PAML had launched a lab focused on age management medicine diagnostics (see: AION Laboratories to Deliver Age Management Diagnostics). Here is an excerpt from it:
AION Laboratories, specializing solely in Age Management Medicine diagnostics, has been established to provide a full spectrum of laboratory testing to age management physicians and clinics across the country, said Francisco R. Velàzquez, M.D.,...CEO of PAML...and AION Laboratories. AION’s aging-related tests allow physicians to use a single requisition to obtain a thorough laboratory assessment of each patient. AION utilizes robust diagnostic technology to detect risk factors and biomarkers associated with aging. The purpose is to provide answers based in science and to support physicians whose goal is to enhance both patient health and physical performance well beyond statistical expectations....The laboratory, based in Spokane, Washington, utilizes cutting-edge immunoassays, tandem mass spectrometry and DNA analysis. AION has also established partnerships with highly specialized laboratories for propriety tests that complement our services.Test panels include baseline assessments for males and females, thyroid, lipid, expanded lipid, chemistry, cardiovascular risk assessment, comprehensive cardiovascular, female and male hormone, expanded hormone for males and females, menopause, inflammatory, diabetes/metabolic testing and genetic testing.
Probably the most important addition to the test menu in recent years for age/longevity medicine has been genomic testing (see: Length of DNA Strands Can Predict Life Expectancy). I have the impression that this specialty area has been flying below the lab radar for a long time but PAML/AION now seems prepared to capitalize on it. However, I do have one question. Why does PAML need to develop a new laboratory to provide the necessary lab testing for practitioners in the area. I am sure that PAML must have provided most or all of these tests prior to the launch of the new lab. I think part of the answer to this question is provided in the AION Labs web site in the "about AION" section. Here is a cut-and-paste from it (see: Available Tests):
The wide-ranging panels available from AION enable us to be a single-source laboratory partner to discriminating practitioners....Our test menu—characterizing a full spectrum of risk factors and biomarkers for age-related conditions—includes thyroid, lipid, chemistry, cardiovascular, hormone, menopause, inflammatory, metabolic, and genetic testing. A growing population of men and women age 35 and older is clearly becoming more determined to prolong a healthy lifespan. By detecting the underlying causes of aging in individual cases, AION supports physicians creating personalized treatment programs designed to restore and rebalance bodies through middle age and beyond.
Clearly the longevity medicine practitioners are looking for a "single-source" lab to meet their diagnostic needs. I am sure that this will be lucrative but is there the possibility that chasing this market will tarnish the reputation of PAML? Probably not.
A group of researchers have completed a study which found new links between patients’ genetic profile and specific diseases by mining EMR data, reports a story in iHealthBeat.
The research, which was conducted by the Electronic Medical Records and Genomics Network, a consortium of medical research institutions including the Mayo Clinic and Vanderbilt University School of Medicine, analyzed data from about 13,000 of EMRs.
The participants then grouped about 15,000 billing codes contained in the EMRs into 1,600 disease categories. Next, they looked for links to diseases in EMRs which contained DNA data.
The researchers, whose study was published in the journal Nature Biotechnology, found 63 new genetic links to diseases, ranging from skin cancer to anemia, iHealthBeat said.
The EMR study method, which is known as a phenome-wide association study, is a departure from the 13-year old genome-wide association model, which has been used to search for common mutations in the DNA of patients of people with the same diseases.
Co-author Joshua Denny, a biomedical informatics researcher at Vanderbilt, says that the newer method can help link seemingly unrelated symptoms, detect potentially harmful side effects of a drug, and help find new uses for drugs.
This is just the tip of the iceberg where translation medicine and EMRs are concerned. Using EMRs to conduct genomic research is becoming an increasingly popular exercise, cutting across a wide range of clinical disciplines.
And it’s not just institutional academic research houses getting into the act. For example, this summer a large northern Virginia hospital announced that it had struck a deal with a Massachusetts analytics firm to see if data mined from EMRs can better predict the risk of preterm live birth.
Now, genomics research is not for just any hospital — it’s obviously a major undertaking — but I think it’s likely more hospitals will get into the game. By this time next year I think there will be a crop of interesting new genomics projects mining EMRs. Although, it will be interesting to see how the 23andMe FDA battle impacts this as well.
I had the pleasure of meeting John Traeger in October at Corepoint Connect 13. John works with a number of hospitals and health systems in the Northwest to set up private HIEs and to connect to various forms of external HIE organizations. His keynote presentation on private HIEs had some interesting information I thought readers of this blog would appreciate. Feel free to leave any HIE questions for John in the comments.
The context in which we provide interfaces outside of hospital organizations is changing rapidly. There are many new regulatory and business requirements. The government and market pressures to form ACOs and HIEs have generated a high number of new participants and connections. These factors and others are creating a tsunami of interface work that is coming in at a rapid pace.
While there has been a considerable amount of work done on public, state and local HIEs, the private HIEs still outnumber them. Private HIEs are experiencing a considerable growth in demand for interfaces being driven by Integrated Healthcare Delivery organizations that want to capture physician “mindshare” and the patients that go along with the new care coordination model.
The integration of formerly independent organizations also frequently involves sharing new HIS system builds to make extending patient information and physician teamwork easier. These system conversions drive a considerable amount of interface work.
Frequently, the nature of the business relationships force the provider organizations to share only the minimum amount of patient data. Centralized data repositories have turned off some provider organizations from participating for this reason. HIEs that utilize this model are also experiencing high costs to manage an ever-growing data store and often have to charge high fees that put their business model at risk.
Private HIE data connections tend to be more comprehensive than public ones, with tighter integration between systems than just sharing CCD documents on a query/response model. This often involves standing up the “traditional” set of ADT, clinical results, lab and rad interfaces, depending on the nature of the relationship and entities involved (for example, specialty clinics vs. ambulatory care vs. rural hospitals, etc.).
Also, technology matters. One private HIE implementation I worked with had this long chain of handoffs making troubleshooting particularly difficult, especially when three of the components in the data flow are opaque to the participating organizations.
ACOs, public and private HIEs, and regulatory or market requirements are driving a massive growth in demand for community data sharing. Selecting the right strategy to keep pace with the demand and being agile enough to handle the evolving requirements is critical. A key technology strategy for success is to select a robust interface solution that makes interfaces quicker to deploy, easier to support, has less skilled resource risk, and delivers community connectivity quicker and more cost effectively. (See John’s white paper “13 Steps to Select the Right HL7 Interface Engine“)
The EHR incentive program has paid out $17 billion, with 85 percent of eligible hospitals attesting to Stage 1 MU.
Within Medicare’s 2014 physician fee schedule, CMS expands reimbursable telehealth services to include most rural communities up to “the fringes of metropolitan areas.”
In a recent Annals of Internal Medicine op-ed, the overlooked danger of charting in an EHR while interviewing a patient is equated to texting while driving. The authors argue that "using a cell phone while driving reduces the amount of brain activity devoted to driving by 37 percent. Multitasking is dangerous – cognitive scientists have shown that engaging in a secondary task disrupts primary task performance."
23andMe, a genome testing service provider that markets direct-to-consumer genetic tests, is hit with a class action lawsuit just a week after the FDA ordered the company to pull its tests from the market until its submits evidence that the tests are scientifically valid.
I have been relatively unenthusiastic about ACOs, thinking that they are merely reconstituted HMOs (see: The Emerging Role of ACOs; How to Define and Reduce Unnecessary Services; Hospital Executives Search for the Formula for an Accountable Care Organization; ACOs Won't Work According to Clayton Christensen in the WSJ). I came across a recent article that discusses the same idea and suggests that both are highly dependent on cherry-picking healthy patients in order to succeed (see: Are ACOs Really Different from HMOs?), Below is an excerpt from this latter article:
Accountable care organizations are a "fad" and "not very different from the HMO model… [with] a few bells and whistles, but otherwise it's the same old incentive to do as little as possible and find the healthiest patients you can," says [Richard Amerling, MD], a director of the Association of American Physicians and Surgeons....Accountable care organizations (ACO) aim to completely revamp how healthcare is delivered in the United States, promising better quality and lower costs. But physicians who have heard these promises before are wondering if ACOs are just the new version of HMOs, the same lofty concept dressed up in a new way....HMOs also were touted as the revolutionary way to save healthcare in America, Amerling says. In that model, the physician served as a gatekeeper for the insurance companies to control access to high-level care, tests, and hospitalizations. Under a capitation arrangement, the physician was paid a set amount per patient to coordinate care, which Amerling says provided a strong incentive to restrict patient access to care. In addition, capitation provided a bonus to the physician if total spending on patients was kept below a certain amount. The plan worked well if the physician's patients were overwhelmingly healthy, which encouraged cherry picking of the most profitable patients. But eventually the very sick had to receive care, and that threw the whole system off....
The differences between the HMO and ACO models are purely cosmetic, he says. ACOs also will have strong incentives to cherry-pick the healthiest patients and limit access to expensive medical care, and eventually that strategy will fall apart just as it did with HMOs, he says.....There are a few bells and whistles, but otherwise it's the same old incentive to do as little as possible and find the healthiest patients you can. [H]is concerns are borne out by the experience of the Pioneer ACOs that recently reported their results. All of the 32 health systems in the Pioneer ACO program reported improved scores on quality measures such as cancer screenings and controlling blood pressure, but only 18 were able to lower costs for the Medicare patients they treated. Two hospitals reported losing money on the ACO program and seven notified CMS that they will switch to a different ACO because of the monetary strain. Two said they will dump the ACO model and find another approach with less financial risk.
The notion that ACOs are little different than HMOs has been raised in other articles. Here, however, are some quotes from one that takes the contrary point of view and highlights differences between the two (see: Why ACOs Are not HMOs and Other Important Questions). Here are two differences cited in this article:
The ACO is not a very new concept. It was a term that was coined by Elliott Fisher from Dartmouth Medical School, who is the director of Center for Health Policy and Clinical Practice. I hate to use the word HMO, but in a way, it’s almost like an HMO. It’s not really an HMO because it is actually a provider-led organization, not an insurance-led one. In an ACO, the participants agree to be accountable for a population of patients and have agreed to share, not just in terms care delivery, but also in terms of risk sharing: cost and utilization of services. The ACO attempts to increase access, promote higher quality, and reduce costs. And one hopes because of the organization’s direct responsibility its population of care, that it would achieve success in all three of those domains.
I think one of the key differences here is that HMOs have been putting up walls in terms of patient options, whereas ACOs are breaking down those walls. One of the major tenets of the Medicare program and the Medicare pilot is that the patient would not be forced to choose networks of doctors. They are supposed to have a choice.
So HMOs were insurance-led rather than a provider-led with physicians acting as the gatekeepers in the former model. However and relating to Amerling's point in the excerpt above, HMOs and ACOs share the need to reduce the delivery of services to patients to reduce costs. While this is theoretically possible by becoming more efficient, I think that only the most innovative provider organizations are clever enough to accomplish this goal. It's far easier to merely cherry-pick the patients who enroll in the ACOs and thus skew the covered population to the healthiest. As Amerling also emphasizes, only 18 of the 32 "pioneer" ACOs were able to accomplish this goal for the Medicare patients they treated.
One thing’s for sure about patient portals: They’re a hot commodity.
What’s less clear is how much good they’re doing for health care.
The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.
Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.
But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.
In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”
Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.
Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.
Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.
The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.
When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.
The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.
Identity and the Leader
I vividly recall, at age 17, jumping off the bus at the in-processing station of Ft. Dix, New Jersey, where a drill sergeant greeted me—screaming. By the third day, I was wearing a uniform, had a shaved head, and was organized into a squad and a platoon.
The drill sergeant shouted, “Look to your left, look to your right, and now look down at yourself. In nine weeks, one of you will not be here, because you do not have what it takes to be a United States warrior!” Gulp. He scared the crap out of me.
But looking around myself, I determined I was better than at least one or two of my fellow trainees. Yep, I would be OK.
A couple of weeks after I graduated as Private Marx, I entered freshman orientation at Colorado State University as a poster child for insecurity. I have no recollection of who spoke that day, but I do remember him saying that 80,000+ students had graduated in the past 100 years. I pondered the odds and decided that surely there were other bozos who made it, so I, too could succeed.
Since childhood, the comparison method had been a pervasive mindset. My identity had been in what I was rather than who I was. And I had based my success on what I could create rather than why I had been created. I floundered under that junior-high mentality of “I am significant because you are less significant.”
This warped attitude gave me a false confidence in the workplace. I compared myself to my peers and to those above me. Sometimes I would try to learn from others who were stronger and smarter than I, but more often than not I would pounce on their weaknesses to climb over them and up the career ladder. Sure, my skills and talents have helped boost my success, but I was also counterfeiting my identity and confidence based on others’ deficiencies and weaknesses.
Leaving that mindset behind, I’ve been searching for the real me and trying to live as the genuine Ed—insecurity surrendering to conviction.
After qualifying for the USA national championship Duathlon (run-bike-run) as an average athlete, I had just hoped to finish the darned race. Qualifying for a spot on Team USA was not only about to become a dream come true, but also a test of my desire to be the genuine Ed.
At first, I suffered second thoughts based on my insecurities. The odds for success were not in my favor. In fact, competing at this elite level, I would likely end up embarrassing myself. But there I was already comparing myself again. Yet this was my only shot to compete with the gifted.
When I arrived in Tucson and began the registration process, I started doing what most athletes do—comparing myself to others. That guy has less body fat. Another athlete was clean-shaven all over. The guy next to him had a $10,000 bike. The woman in the corner was sponsored … And pretty soon I stood there mentally defeated with the race a mere two days away. I was still basing my success on how I compared to others, not on who I was.
Damn that warped thinking! I stopped it and chose to walk in the opposite spirit. I decided that what I had—a strong heart, a decent bike, and an OK albeit hairy body—was sufficient. I chose to look forward and not to my right or left. The outcome wasn’t in my hands anyway. As an athlete, what mattered was, how will my stats in this performance compare to my stats in the previous races? Was I improving? Forget the guy racing next to me. If I was meant to represent Team USA at the 2014 World Championships, then that would happen.
Identity is a tricky thing. What is it? How is it formed? How does it impact who we are and our performance? Most of the time, I base my identity on how I believe I compare to others. I suspect most of us are mis-wired to think this way.
I don’t claim to have it figured out; I already proved that. My true identity is squaring who I was made to be and living congruent with this truth. I’m still working on it, but as I approach 50, I’m finally getting close. If these ideas help nudge you in the right direction, I will have accomplished my goal for this post.
Some self-reflection ideas:
Who are you really? And are you happy with you?
To view my full reflections in depth, leave a comment with a request and I’ll send you “Identity and the Leader” Part 2.
Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.
Hearst Corporation acquires an 85 percent stake in Homecare Homebase, the #1 KLAS rated home health and hospice software vendor.
Martin Health System (FL) will deploy a new biometric patient identification solution from RightPatient that uses iris scanning to positively identify patients. MHS executives expect that the new system will help stop patient identity fraud, eliminate the creation of duplicate medical records, and reduce billing errors.
KLAS forms an imaging advisory board to lead a new project focused on imaging-based research.
Adventist (CA) will go live with Cerner across 50 clinics this week, completing a network-wide install.
Medical researchers are turning to new ways to fund their work in light of cuts at the NIH due to the sequester and chronic cost-cutting by the agency. I recently blogged about a project at the University of Michigan called MCubed in which individuals outside of the University are encouraged to fund seed projects at the University to the tune of $75,000 (see: Fund Your Own Seed Research Project at the University of Michigan). For MCubed, the funders must have a research question in mind to ask and then are able to tap into the UM faculty resources to get answers. Another approach is being tried at the University of Minnesota by a surgeon/researcher; he is pursuing crowdfunding to support his cancer treatment research (see: Impatient with NIH, cancer researcher turns to crowdfunding), Below is an excerpt that provides more details about this approach:
Dr. Daniel Saltzman says he can prove that bacteria that ordinarily cause food poisoning in people can be modified for use as guided missiles to deliver cancer-killing payloads into tumors. But he needs $500,000 for some preliminary work, and despite his project’s potential, he’s not holding his breath for funding from the National Institutes of Health (NIH), the nation’s leading source of biomedical research grants. So Saltzman has teamed up with an entrepreneur in the television industry and Twin Cities advertising and public relations professionals to make an unusual direct appeal to the public. In the process, he’s helping to bring so-called crowdsourcing to the field of medical research....To convince people of his work’s promise, Saltzman and his partner have built a website branding his research “Project Stealth,” created an eye-catching plush toy to represent the salmonella bacterium, made a video featuring Saltzman and a golden retriever named Buddy, and turned to private fundraising events and crowdfunding avenues like Razoo.com. Saltzman, who has raised about $32,000 since launching Project Stealth in mid-October, acknowledges that the approach is unusual. But he says that, with federal research funds getting tighter every year, he had little choice....
Over the past decade, inflation has eroded more than 20 percent of the buying power of NIH grants for scientists studying genomics, neurology, cancer, heart disease and countless other health issues. With so many competing projects, NIH has reduced the percentage of requests it has funded. Such novel fundraising methods raise concerns because they don’t go through the conventional peer-review process, said Arthur Caplan, a medical ethicist at New York University’s Langone Medical Center. And when they rely on celebrities, as some do, they can draw money for reasons other than scientific merit, he said....Caplan’s only concern was why the project hadn’t drawn NIH or foundation funding given its promising results in animals.....The idea of crowdfunding Saltzmans’ work came from Max Duckler, a semiretired entrepreneur who in 1993 founded CaptionMax, a closed-captioning service for television. Duckler has a degree in biology and a lifelong fascination with medicine. He attended a fundraiser where he bid to spend a day with a surgeon. He won, shadowed Saltzman on six surgeries, and learned about the cancer research. Duckler said he was disturbed to find that Saltzman and his lab workers were worried whether they could afford to spend $600 to buy special research mice.
We are obviously moving from a highly controlled, peer-reviewed research funding environment to one that differs in many respects. On the one hand, I applaud the efforts of individuals like Dr. Saltzman who seems to have a flair for marketing and promotion of his research. However, does the lack of NIH funding suggest a lack of merit for the research? Not necessarily because NIH funds are diminishing, as noted above, and it's often difficult for younger researchers to get a toehold in the NIH funding hierarchy. It's to Dr. Saltzman's credit that he has gotten the attention of an entrepreneur named Max Duckler who is working on Saltzman's behalf. Although the NIH peer-review system is tried and true, it tends to favor accepted research hypotheses and researchers with well-known mentors. Medical researchers have always been required to be entrepreneurial in the sense that they have to continuously hustle for funding. Some of these new funding approaches can only stimulate this entrepreneurship. Hopefully, all of this will result in better research outcomes.
We all know that October 1, 2014 is the date when ICD-10 will go live in the US (if you didn’t know that shame on you, but you know now). There have been plenty of rumblings that ICD-10 is going to be delayed…again. In fact, I even hypothesized that the Healthcare.gov debacle could prompt HHS to delay ICD-10 again.
While I think that there are plenty of reasons why they could choose to delay ICD-10, I now think that there’s no way HHS is going to delay ICD-10 (meaningful use may be another story). There’s so much momentum behind ICD-10 and with the previous delays, I think HHS will go forward with ICD-10 regardless of whatever reasons people come up with for delay.
Is your organization ready for ICD-10? What do you think about the possibilities of a delay? I’m interested to know your views in the comments, but for those too shy to comment I’ve embedded a poll below where you can rate delay or not on a scale from 1 to 5.
In a more complex question to answer, I’m also interested to know if readers think their IT and EHR vendors will be ready for ICD-10. Vote in the poll below.
Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.
Hearst Corporation will acquire 85 percent of Homecare Homebase, the #1 KLAS-ranked software provider for the homecare and hospice market. Hearst’s other healthcare IT companies include First Databank, Map of Medicine, MCG, and Zynx Health.
From N2InformaticsRN: “Re: CAP Consulting. The College of American Pathologists is dissolving CAP Consulting, its informatics consulting practice. This is the group that was doing exceptional work in terminology and standards with a deep understanding of the information needs and challenges faced by providers across the health care delivery and laboratory spectrum. More recently they developed an effective framework to assess and tackle health information management. The team has unique skill sets and helped us ensure ontological correctness by developing a terminology roadmap. It will be interesting to see who picks these folks up or whether they form a consulting group on their own.” Unverified. We have a call scheduled for Wednesday with CAP Consulting to learn more.
Welcome to new HIStalk Platinum Sponsor Physician Technology Partners. The physician-owned and led consulting company offers provider-to-provider services that make Epic-using physicians more productive. Its physician champions hold ASAP and EpicCare Ambulatory certifications. PTP’s six-phase approach to building to optimize for quicker ROI includes strategic planning, implementation, build and validation, training, go-live support, and optimization. They’ve done it for customers that include Ohio State, UCSF, Sutter, Exempla, Texas Children’s, Providence, University of Miami, and a bunch more names you would know. PTP’s expertise also includes making Dragon speech recognition work optimally in an Epic environment. Thanks to Physician Technology Partners for supporting HIStalk.
I have an interesting challenge with HIStalkapalooza. Jonathan Bush has a conflict and, for the first time since the inaugural HIStalkapalooza in 2008, we may need to find someone else to present the HISsies awards (travesty, I know.) I need someone who has commanding stage presence, a wicked sense of humor, and a cynical view of healthcare IT (extra points for being able to swig large-format bottles of high-gravity beer while uttering a non-stop stream of one-liners during the otherwise august proceedings.) Let me know if you’ve seen anyone who can approximate JB’s on-stage magic since otherwise Inga’s going to have to get up there and she will be terrified.
Post-acute care software provider Brightree acquires MedAct LLC, a developer of home medical equipment and DME software solutions.
Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.
Shareable Ink closes $10.7 million in Series C financing and names former Allscripts CEO Glen Tullman to its board.
Lexmark will consolidate four acquired businesses — Pacsgear, Saperion, Twistage, and Acuo Technologies — under its Perceptive Software subsidiary.
AnMed Health (SC) will implement technology from Iatric Systems to integrate multiple hospital and departmental systems.
The Metropolitan Chicago Healthcare Council selects HIE technology from Sandlot Solutions.
Children’s National Medical Center (DC) will deploy Streamline Health’s OpportunityAnyWare business analytics software suite.
Kristina Greene (Proxicom) joins Lucca Consulting Group as RVP.
Acusis names Richard Simonetti (Horiba Medical) VP of strategic business solutions.
Kareo hires Amyra Rand (HireRight) as VP of sales.
Perigen appoints Chip Long (Merge Healthcare) SVP of growth and development.
RCM service provider MedData appoints Paul Holland (QuadraMed) VP of sales and Carl Naso (Aleris International) corporate controller.
Stephen Bernard (Accretive Health) joins Connance as VP of professional services.
Valence Health names Nathan Gunn, MD (Verisk Health) VP of population health and Dan Blake (AirStrip Technologies) SVP of software product development.
KLAS names six members to its first-ever imaging advisory board: Mark Christensen (Intermountain Healthcare), Karen McGraner (Exempla St. Joseph Hospital Denver), Eugene V. Pomerantsev (Massachusetts General Hospital), Peter S. Rahko (University of Wisconsin Hospital), Pablo Ros (University Hospitals HS Cleveland), and Brian Wetzel (Our Lady of Lourdes Memorial Hospital Binghamton.)
Announcements and Implementations
Pro-Laudo, a teleradiology practice in Brazil, implements eRAD PACS with integrated reporting and speech recognition.
PeaceHealth Medical Group in Longview, WA goes live on Epic.
Hospitals and skilled nursing facilities in California’s Santa Clara county will deploy CareInSync’s Carebook platform to coordinate care transitions.
Cheyenne Regional Medical Center (WY) converts patient information and data from seven legacy systems into a single platform integrated with Epic using Hyland Software’s OnBase ECM solution.
More than 50 Adventist Health/Central Valley Network (CA) facilities go live this week on Cerner.
Martin Health System (FL) deploys the RightPatient iris biometrics patient identification system from M2SYS Healthcare Solutions.
Providence Health & Services (WA) opens a clinic without a waiting room in its first go-live of RTLS from Versus Technology.
UCLA Health System (CA) opens the Lockheed Marking UCLA TeleHealth Suite and Lockheed Martin Outpatient Recovery Suites for Wounded Warriors of Operation Mend, which were made possible by a $4 million gift from Lockheed Martin.
GE Healthcare launches Centricity 360, an online clinical collaboration tool that provides real-time sharing of data.
3M Health Information Systems releases 3M ChartScriptMD Software for Radiology, a reporting application that allows radiologists to create, sign, and distribute complete reports and communicate diagnostic findings from a single, integrated system.
Congratulations to Tampa General Hospital (FL), which VP/CMIO Richard Paula tells me has earned HIMSS EMRAM Level 7 with its $90 million Epic system.
Innovation and Research
Researchers from NORC at the University of Chicago will study how Cerner employees respond to cost transparency tools from Change Healthcare. The RWJF-funded study will assess the impact of price, quality, and engagement approaches on consumer choice of healthcare.
Researchers at the University of Pittsburgh create a publicly searchable digital database of infectious diseases cases dating back 125 years.
The Leapfrog Group publishes its annual list of top hospitals based on quality of care.
Carolinas HealthCare System launches analytics capabilities that integrate data for evidenced-based health management, individualized patient care, and predictive modeling. The health system’s in-house analytics group built the data analytics models and are using de-identified clinical and financial information from 10.5 million patient encounters. I interviewed SVP/CIO Craig RIchardville in September.
Happtique certifies 19 health and medical apps, which requires them to meet privacy, security, and operability standards and pass clinical content testing.
WEDI, EHNAC, and DirectTrust partner to promote and accelerate the adoption of a national accreditation program for information “trusted agent” service providers.
The New York Times highlights the insanity of US hospital charges, including pricing that is often arbitrary; wide variations in pricing for the same service across different facilities and regions; and, heavily inflated prices for routine supplies and services. For example, the average cost of treating a cut finger in an ER ranges from $790 in New England to $1,377 in the Pacific. Also noted: the hefty incomes of many executives in non-profit health systems, including 28 Sutter Medical Center officials who each make more than $1 million a year.
A tone-deaf boy in Denver suffers a concussion playing lacrosse, recovers, and develops the ability to play 13 instruments. His physician theorizes that the musical talent was “latent in his brain and somehow was uncovered by his brain rewiring after the injury.” Sort of gives new meaning to the term, “one-hit wonder.”
Crain’s Chicago Business points out that despite the hoopla around the 34 hospitals MetroChicago HIE has announced as members, it has failed so far to sign at least three of the biggest ones: Northwestern, University of Chicago Medicine, and NorthShore.
Weird News Andy finds himself thankful for piercings after reading this story, which describes a joystick-like device implanted as tongue piercing that allows paralyzed people drive their wheelchairs by flicking their tongues.
WNA may have a new competitor, as a reader provided this toothsome morsel of prose. A Swedish prisoner escapes two days before his scheduled release to have a tooth fixed, having been denied service by the prison dentist. He has the tooth removed and then returns to his cell. The prison gives him an oral warning and extends his stay by 24 hours to make up his time.
Deborah Kohn checks in with a high-level reaction to RSNA.
Based on my observations of RSNA 2013’s multitude of imaging informatics products, radiology (and other image-generating “ology” or department) PACS continue to be “deconstructed”.
For example, the “A” in PACS (for Archiving) remains the focus of many Vendor Neutral Archive (VNA) system products. No noteworthy independent (of PACS vendors) VNA products are being introduced this year, and most of the PACS vendor VNA products are trying to catch up to the independents by highlighting new functionality. This year’s newer focus centers on enterprise viewers, which consolidate provider organizations’ large number of disparate clinical system viewers, such as those of the multi-modality PACS (DICOM), Enterprise Content Management (non-DICOM), and even EHR system viewers.
Also moving to the enterprise level are the image share / image exchange capabilities, which include the taking-along of key clinical content down/uploaded from/into the EHR. An impressive Johns Hopkins Medicine work-in-progress at IHE’s Image Sharing Demonstration included Face Time/Skype-like (yet HIPAA secure) video conferencing for consultations and/or second opinions. The remote providers collaborated on diagnostic-quality views of DICOM images with side-by-side, structured EHR data and unstructured text reports – all in one view at the click of a button.
In summary, traditional PACS functionality continues to be siphoned off into other, more robust and often enterprise components, leaving traditional PACS as the important workflow engines for the modalities.
“Happy dreams, Mama.”
That’s the last thing my daughter says to me before bedtime. I like it because it seems more tangible and emotional than the standard, “Sweet dreams.” Also, it ensures I’m not kept awake because I have this classic Eurythmics song stuck in my head.
Eighties music aside, it seems many Americans aren’t dreaming much these days. According to the Centers for Disease Control and Prevention, 50 to 70 million Americans have a sleep or wakefulness disorder.
Factors that contribute to sleep disturbances include medication, illness, and stress. So do two things common to the health care industry – shift work (particularly night shift) and technology. Both are messing with our circadian rhythms.
Circadian rhythms are basically a human being’s internal clock. They run on a 24-hour cycle and tell us when it’s time to wake, sleep and release particular hormones like cortisol and melatonin.
The circadian biological clock is controlled by a group of cells in the hypothalamus that respond to light and dark signals. When light travels to this group of cells, it’s signalling the body that it’s time to be awake. The other parts of the brain that control hormones, body temperature and other functions that play a role in making us feel sleepy or awake also kick in.
This is the perfect set-up for the day shift. When they get up in the morning to go to work, they are exposed to light and the brain sends signals to raise body temperature and produce hormones like cortisol. Unfortunately, the bright sunshiny day also greets the soon-to-be clocking out night shift. Even though they’ve been up all night, their body is jolted by the same shot of sunshine as the day shift. But here it is detrimental to their sleep habits. It’s telling them, “Get up! Get moving! It’s time to start the day,” when what they really need is sleep.
Light from technology is affecting users in the same way natural light affects night shift workers. The blue light emitted from your tablet as you play Angry Birds before bed is particularly powerful in suppressing melatonin production — the hormone needed to induce sleep. The blue light that most of our devices emit works on melatonin in the same way. Again our bodies are being told, “Get up! Get moving! It’s time to start the day!” even though it’s 11pm.
Sleep disturbances and sleep disorders can have serious impact on people’s health. According to research, working the night shift is going to kill us. A 2003 review lists peptic ulcers, cardiovascular disease, cancer, and diabetes as hazards of working nights. Shift work has also been linked to obesity and depression.
Some suggestions to help mitigate sleep disturbances are:
Installing blackout curtains and wearing amber colored glasses when the sun sets can also help night shift workers.
There’s also some technology out there that claims to help with sleep disruption.
If none of that technology works for you, you can always try the old fashioned remedies eliminating screen time two hours before bed, restorative yoga poses such as legs up on the wall, and meditation or relaxation.
What are your tips for working the night shift and/or breaking through insomnia?
After ignoring IT department recommendations to upgrade aging infrastructure components, Bryant Community Healthcare in Ontario is paying the price. A power surge that resulted in a system-wide network crash and three days of unplanned downtime prompted hospital leadership to green light a new virtualized server environment that has eliminated unplanned downtime.
CMS releases a Healthcare.gov progress report outlining the improvements made. A new analytics platform has been installed that is allowing developers to monitor site performance in real time from a centralized war room where decisions are being made on which improvements to tackle next.
In North Carolina, Forsyth Technical Community College is launching a free "back-to-work" program that will build up a local supply of hard-to-find talent by training unemployed residents on key skills. One of the three career options students can chose from is an electronic health records specialist. The program will pay for registration fees, books and other incurred costs.
I’m so excited. Things are coming together for a really big announcement next Monday. I’m really excited about what we’ve put together and I think many readers will be interested in it as well. I’ve leaked the idea a little bit on Twitter, but I should be able to announce a lot more details next Monday. Watch for that next week.
Until then, it seems really appropriate at this time of Thanks to take a few seconds to recognize the many sponsors who support the work we do here at EMR and HIPAA. It’s been a really great 6 months and we’ve received a lot of amazing support. In fact, I’m really pleased by the variety of healthcare IT companies that are supporting the work we do.
I hope you’ll take a second to look over these new and renewing sponsors to see if they can help you solve some of your pressing issues.
interfaceMD – This EHR company is quite unique. Rather than try and explain their unique approach to EHR and EHR implementation, take a second and watch this video interview I did with interfaceMD CEO Joel Kanick. I think many of the things he shares will resonate with small practices out there. Joel and interfaceMD have taken a really holistic approach to implementing an EHR and all the IT in between. Check them out if you want to see what I mean.
Proven Backup – One of the biggest risks of any EHR is not having a proper backup. Unfortunately, many don’t pay attention to their backup plans until it’s too late. The best way I’ve seen to solve this is to do a mock situation where your database is corrupt. What will it take you to restore from backup? Do you have a backup that works? The beauty is that there are relatively inexpensive backup offerings like the one from Proven Backup. Done correctly, your EHR backup can be much more robust and less risky than paper ever could be.
Colocation America – One of the major features of all healthcare IT is the need for some sort of hosting. Colocation America offers a wide variety of hosting options for applications and organizations of all sizes. As a past server admin and data center manager myself, I can’t ever imagine building my own data center again. The service a hosting company like Colocation America provides is impossible for small organizations to build on their own and is likely out of reach for even the largest organizations.
HealthFusion – Some might not recognize this name, but might be more familiar with HealthFusion’s MediTouch EHR software. If you want to find out what’s unique about Health Fusion, check out this interview with HealthFusion’s Co-Founder and CEO. I was really interested with HealthFusion’s efforts to incorporate the native iPad interface in their EHR very early on. I don’t know many other EHR vendors who can say that “every EHR function that can be performed on the desktop can also be performed on the iPad.”
Doc Halo – HIPAA secure texting is starting to hit healthcare in a really big way. Many in healthcare have found the value of a simple text message communication. However, every healthcare compliance department is scared about the HIPAA implications of such text messages. The answer to this is to empower the end users to have the simplicity of a text message, but done on a secure platform like Doc Halo. If you want to learn more, the Doc Halo CEO has been contributing a number of blog posts on the subject as well.
gMed – If you are a gastroenterologist, then you need to take a look at gMed’s EHR solution. I’ve always been a fan of the specialty specific EHR software. They can offer a unique experience that gets washed over by most of the EHR vendors who want to apply a one size fits all approach to EHR. If you’re interested in Gastroenterology, you’ll want to check out this excellent whitepaper on the Future of Gastroenterology.
The Breakaway Group (A Xerox Company) – Many of you may recognize this company since they’ve been doing a monthly series of blog posts called Breakaway Thinking. You can expect a lot more amazing content on EMR and HIPAA from the talented people at The Breakaway Group. They have a lot of first hand experience with EHR training and ICD-10 training. Being on the front lines provides them some really interesting insight into the industry.
I’m always thankful for the ongoing support of our renewing sponsors. So, a big thanks to all of the companies listed below for renewing their support of us. It’s great to look over so many of these companies who have been supporting us for so many years. Here’s to many more years working together.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
Cerner – Advertising since 9/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012
Look for the really big announcement next Monday.
Rehabilitation Psychology - Vol 55, Iss 3
Dezutter, Jessie; Casalin, Sara; Wachholtz, Amy; Luyckx, Koen; Hekking, Jessica; Vandewiele, Wim
Purpose: This study aimed to investigate 2 dimensions of meaning in life—Presence of Meaning (i.e., the perception of your life as significant, purposeful, and valuable) and Search for Meaning (i.e., the strength, intensity, and activity of people’s efforts to establish or increase their understanding of the meaning in their lives)—and their role for the well-being of chronically ill patients. Research design: A sample of 481 chronically ill patients (M = 50 years, SD = 7.26) completed measures on meaning in life, life satisfaction, optimism, and acceptance. We hypothesized that Presence of Meaning and Search for Meaning will have specific relations with all 3 aspects of well-being. Results: Cluster analysis was used to examine meaning in life profiles. Results supported 4 distinguishable profiles (High Presence High Search, Low Presence High Search, High Presence Low Search, and Low Presence Low Search) with specific patterns in relation to well-being and acceptance. Specifically, the 2 profiles in which meaning is present showed higher levels of well-being and acceptance, whereas the profiles in which meaning is absent are characterized by lower levels. Furthermore, the results provided some clarification on the nature of the Search for Meaning process by distinguishing between adaptive (the High Presence High Search cluster) and maladaptive (the Low Presence High Search cluster) searching for meaning in life. Conclusions: The present study provides an initial glimpse in how meaning in life may be related to the well-being of chronically ill patients and the acceptance of their condition. Clinical implications are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
ETH-Zurich biotechnologists have constructed an implantable genetic regulatory circuit that monitors blood-fat levels. In response to excessive levels, it produces a messenger substance that signals satiety (fullness) to the body. Tests on obese mice revealed that this helps them lose weight.
Genetically modified cells implanted in the body monitor the blood-fat level. If it is too high, they produce a satiety hormone. The animal stops eating and loses weight. (Credit: Martin Fussenegger / ETH Zurich / Jackson Lab)