The Association for Pathology Informatics (API) and Sunquest Information Systems will present a free webinar entitled “Digital Pathology Meets Surgical Pathology” on Thursday, March 5, 2015, at 1:00 p.m. EDT/10:00 AM PDT by Stephen M. Hewitt, M.D., Ph.D., of the National Cancer Institute. This is the last presentation in the API/Sunquest webinar series for the 2014-2015 season.
The nature of diagnostic histopathology has been a deliberate process of advancement in technology to ensure continuity of diagnostic accuracy and information. The converse is true of digital imaging in pathology -- it's a disruptive technology that changes how a pathologist views and interacts with a tissue specimen. Despite the predictions, digital pathology has not changed daily sign-out practice yet. A key question at this juncture, then, is how will whole slide imaging change surgical pathology in the future? Replacing microscopes with computers and screens offers little, if any, economic incentive. However, adoption of the additional technologic opportunities of digital pathology could change surgical pathology substantially.
This presentation will offer focus on the following three points:
In order the register for this presentation, click on in this link. Only minimal information is required. This webinar will undoubtedly be one of the most successful of this series with more than 142 people/sites having already registered. Take the time to participate -- Dr. Hewitt is one of leading experts in the field of digital pathology.
The other day I had a really great chat with Khaled El Emam, PhD, CEO and Founder of Privacy Analytics. We had a wide ranging discussion about healthcare data analytics and healthcare data privacy. These are two of the most important topics in the healthcare industry right now and no doubt will be extremely important topics at healthcare conferences happening all through the year.
In our discussion, Khaled talked about what I think are the three most important challenges with healthcare data:
I thought this was a most fantastic way to frame the discussion around data and I think healthcare is lacking in all 3 areas. If we don’t get our heads around all 3 pillars of good data, we’ll never realize the benefits associated with healthcare data.
Khaled also commented to me that 80% of healthcare analytics today is simple analytics. That means that only 20% of our current analysis requires complex analytics. I’m sure he was just giving a ballpark number to illustrate the point that we’re still extremely early on in the application of analytics to healthcare.
One side of me says that maybe we’re lacking a bit of ambition when it comes to leveraging the very best analytics to benefit healthcare. However, I also realize that it means that there’s still a lot of low hanging fruit out there that can benefit healthcare with even just simple analytics. Why should we go after the complex analytics when there’s still so much value to healthcare in simple analytics.
All of this is more of a framework for discussion around analytics. I’m sure I’ll be considering every healthcare analytics I see based on the challenges of data integrity, security and quality.
It seemed appropriate for me to follow up with part 2 of my experience with a new wellness focused medical practice called Turntable Health, an operating partner of Iora Health. In case you missed part 1 of the journey, you can find it here.
Walking into the clinic, there was a different feel. It felt more like walking into a local coffee shop than going for a doctors appointment. The lobby was so inviting that I wondered if some in the community used it as a place to go and work on occasion. I spend a fair amount of time in the Downtown Las Vegas tech community, so it wasn’t a surprise that I actually knew a few of the people in the lobby. So, I was able to connect with some friends while I waited for my appointment.
The check in process was simple and I was invited back by my health coach. In this case the health coach acted very much like an MA or nurse in a regular medical office, but the feel was more friendly an casual. We both knew we had an hour together so there wasn’t the usual frenetic pace the accompanied a doctors office.
I had a couple paper forms to sign (yes, the signature is still often easier on paper), but no major health history to fill out or anything like that. They had a one question survey that I think was about my current state of wellness. Over the hour the health coach did ask many of the questions that would be on a normal health history form and key them into the Iora EHR system. It was a unique approach since it gave me the opportunity to talk about the things as we went through them and many of the things we talked about (ie. my family health history) came up later in my conversation with the doctor.
The exam room looked quite a bit like any other exam room you might visit. The colors and lighting were nice and they had little touches like this local art work display in the exam room (see picture below). It’s kind of interesting to think about a doctor’s office as a kind of local art gallery.
At one point in the conversation with my health coach, we talked a bit about fitness tracking and she quickly emailed me some fitness apps that she liked. Little did she know that I write about such apps and that industry for a living on Smart Phone Healthcare. It also illustrated how much of a need there is for someone to be a trusted content curator of the 30k+ mobile health apps out there. Especially if we want healthcare providers to make a dent in actual usage of these to improve our wellness.
After completing her assessment, my health coach left the room and came back with the doctor. When he came in he told me that my health coach had talked with him about me and my health (in a normal practice this amounts to “Fever in room 3″) and he wanted to talk to me about a few of the issues I was dealing with. When he did this, the doctor and my health coach came into the room and we all sat around a small table. It was almost as if I’d just sat down for hot chocolate (I don’t drink coffee) with my doctor and my health coach.
There were a few differences though. When my doctor sat down he plugged in a chord to display his computer screen (my record) on a big plasma monitor that we could all see. I’m not sure why my health coach didn’t do that too. I almost moved over next to her to watch her enter the data, but I felt like that was just my inner EHR nerd coming out. Plus, I didn’t want her to necessarily know my background in that regard and that I’d be writing about the experience later. I wanted to see what they usually did for patients.
Because we were all sitting around the proverbial exam room “coffee table” I didn’t feel rushed at all. We talked about a couple sports issues I’ve been dealing with and ways that I could make sure they don’t continue to get worse (since I’m definitely not stopping my sports playing). We also spent some time talking about how to work on some long term wellness tracking around high cholesterol and diabetes.
After the visit, I realize that in many ways it wasn’t any different than a regular doctor visit. I could have gone into any doctor’s office and discussed all of these things and likely gotten similar answers. I think part of this is Turntable Health still working on the evolution of how to really treat a patient from a Wellness perspective. However, while many aspects of the treatment were the same, the experience felt different.
The long appointment time. The health coach. The doctor that wasn’t rushed all contributed to a much different visit than you’d get in most doctors’ offices. You can be certain that had I gone to a doctor for my sports issues, we wouldn’t have talked about things like cholesterol and diabetes. There wouldn’t have been time. Was the care any better or worse? It’s the same care that would have been provided by other professionals, but the care was given room to breathe.
As I left the visit, a part of me did feel a little disappointed. You might wonder why after this glowing review of the unique experience. I think the disappointment came from some improperly placed expectations. I’m not sure I really thought deeply about it, but I wish I’d realized that they’re not going to solve your wellness in one visit.
When I think about my psyche as it relates to doctors, I’ve always approached a doctor as someone you go into and they fix you and then you go home. When applying that same psyche to a wellness based approach to medicine, it leads to inappropriate expectations. Wellness is a process that takes time to understand and address. In fact, it’s a process that’s likely never done. So I think that led to my gut reflex expectation of what I’d experience.
I think one way Turntable Health could help to solve these expectations is to do a better job on the first visit to describe the full model and plan for what they want to accomplish with a patient. Otherwise, you really just feel like you’re going in for another doctor’s appointment. I’m not sure if that’s a cool chart of all their services and how they help me improve my wellness or if it’s a list of ways that they’re working to help improve my wellness.
Basically, I wish they’d over communicated with me how Turntable Health was different and how they were going to deploy a suite of professionals and services to better help my overall wellness. It’s easy for those working at Turntable Health to forget that new patients haven’t seen their evolution and don’t know everything they’ve done to improve the primary care experience.
A few other things I’d have loved to seen. First, I filled out their 20 minute (I think it took me 10-15) survey before the appointment. I didn’t get any feeling that the health coach or the doctor had actually seen the results. In fact, the health coach asked me some of the same questions. Redundancy can be appropriate on occasion, but it could have made the visit more efficient if they already knew the answer to those questions and instead of getting the info they could have spent the time talking about the answers as opposed to getting the answers. Plus, I’m sure my answers would have triggered some other discussions. It all made me partially wonder why I filled out the survey in the first place. Were those just part of some research experiment or were they to help me improve my health?
I was quite interested in their portal and what it offered (obviously, since I’m a techguy). It seemed like the framework as opposed to a fully fleshed out solution. I could see where it could grow to something more powerful, but was disappointing on first login. In one area called measurements it had graphs of my Blood Pressure, Fasting Glucose, and Weight. Unfortunately, after one visit they only had one data point and now way for me to easily upload all my weight measurements from my iHealth scale. Hopefully integrations like that are coming since that data could definitely inform my wellness visits. I guess they need to work on the first time user experience for the portal. At least I can schedule appointments through it.
I imagine some of you are probably looking at this as a pretty major investment in my health. Some might even think an hour long appointment would be more time than they want to spend with the doctor. I get that and I don’t always want my appointment to be that long. In fact, now that I have my baseline, I hope that many visits become an email exchange or other electronic method that saves me going into the doctor at all. However, as I’m getting older, I see this as an important investment in my long term health. Hopefully this investment has a good ROI.
With that in mind, I’ll do what I can to keep you updated on my experience. Since I’m on a journey of wellness, I imagine this is Part 2 of Many. I hope you enjoyed the look into my experience.
February 27, 2015 -- One of the oldest names in imaging informatics is going by the wayside as PACS firm DR Systems has been acquired by Merge Healthcare. While the DR Systems name will be retired as part of the deal, founder and CEO Dr. Murray Reicher has been named chief medical officer (CMO) of Merge.I've met Dr. Reicher one one occasion, and he is a perfect choice for CMO. He is very well spoken, and truly a pioneer in this business. In fact, DR holds quite a few core patents in PACS, as some other companies have painfully discovered.
The deal unites two midlevel PACS providers and gives Merge additional scale to compete with larger multinational firms in the imaging informatics space. It also expands Merge's geographic footprint to DR Systems' core market in the Western U.S., while broadening the combined company's portfolio of intellectual property.
The deal was finalized on February 25, according to Michael Klozotsky, vice president of marketing at Merge.
Founded in 1992
DR Systems was founded in 1992 by neuroradiologist Reicher along with another brain imaging specialist, Dr. Evan Fram. Reicher and Fram said they founded the company out of dissatisfaction with existing PACS software available at the time.
The closely held company charted its own course over the years, remaining fiercely independent even as the rest of the radiology industry consolidated. The company gained a reputation for high levels of customer satisfaction, as evidenced by a string of top rankings in KLAS reports, as well as for its aggressive defense of its patents for PACS software.
Through the years, Reicher maintained his active role with the San Diego firm, serving as a frequent speaker at industry events and publishing peer-reviewed articles on imaging informatics. He assumed the position of CEO again earlier this year after the retirement of longtime chief executive Rick Porritt.
In announcing the acquisition, Merge cited the broad array of healthcare information technology software that will be offered by the combined firm, including DR Systems' eMix image-sharing service, RIS software, and cardiology and pathology offerings. Both companies also offer traditional PACS and RIS/PACS software and, indeed, have long been competitors in the acute care and ambulatory markets, Klozotsky said.
Merge cited the high customer satisfaction ratings of the combined entity, with No. 1 ratings according to KLAS surveys for cardiovascular information systems, hemodynamic monitoring software, and RIS software. Merge also plans to offer its iConnect Network services, including exam preauthorization, through DR Systems' installed base.
In addition to adding Reicher as CMO, Merge said it plans to keep DR Systems' San Diego headquarters open as its West Coast regional office. DR Systems employs some 180 people, according to Wikipedia. Merge will also maintain support for DR Systems' core software platform, continue with current implementations, and support and advance all product lines, the company said.
Merge expects the deal to be accretive to earnings per share under nongenerally accepted accounting principles (GAAP) in 2015 and future years. Merge financed the deal through a combination of $20 million in cash on hand and $50 million in cash raised from the sale of shares of recently issued preferred stock.
The deal is the latest in a long string of acquisitions that Merge has made over the years as it grew from a niche firm offering data connectivity software to perhaps the largest independent PACS firm. Other acquisitions have included Amicas, Cedara Software, Confirma, RIS Logic, and eFilm Medical.
Merge's most recent acquisition is designed to give the combined entity the heft to move forward in a healthcare industry where size increasingly matters.
"As healthcare continues to consolidate, scale is very, very important," Klozotsky. "This allows Merge to really operate on an entirely different level of scale."
We are assembled here today to pay final respects to our honored dead. And yet it should be noted that in the midst of our sorrow, this death takes place in the shadow of new life, the sunrise of a new world; a world that our beloved comrade gave his life to protect and nourish. He did not feel this sacrifice a vain or empty one, and we will not debate his profound wisdom at these proceedings. Of my friend, I can only say this: of all the souls I have encountered in my travels, his was the most... human.Star Trek gave us hope of new worlds, of new ideas, in the midst of the strife of the 1960's. We need this encouragement even more today.
In light of yesterday’s short story post, and also my post on EMR and EHR about concierge medicine, I thought it timely for me to document might entrance into what many are calling the next generation of healthcare. They talk about it as primary care that puts people first.
In my case, it’s my recent membership in Turntable Health, an operating partner of Iora Health. When I had to switch insurance plans this year, I decided to try out this new approach to primary care. The insurance plan I chose included a membership to Turntable Health. For those not familiar with Turntable Health, it was started by the infamous ZDoggMD and is backed by Tony Hsieh’s (CEO of Zappos) Downtown Project in Las Vegas.
To be honest, I’m not sure exactly what I’ve gotten myself into, but that was kind of the point. I can’t remember the last time I went to a primary care doctor. In fact, if someone asked me who my primary care doctor was I wouldn’t have an answer or I might mention one that my wife visited. I’m a relatively healthy person (luckily I have some good orthopedic friends for my sports injuries) and so I’ve never felt the desire to go in and see my doctor. I feel healthy, so why should I go and pay a doctor to tell me I’m healthy? I think this view is shared by many.
Will Turntable Health be able to change my view on this? Will they be able to take a true Wellness approach to things that will change how I view primary care? I’ve written for years about Treating a “Healthy” Patient, and so I’m interested to see if Turntable Health is making that a reality.
One thing is for sure. They’re taking a different approach than most doctors. I scheduled my first appointment for later today (Side Note: Not sure what it says that it took me 1-2 months to schedule my first appointment.). They slotted me in for an hour long appointment (a requirement for the first appointment) so that they can really get to know me and my wellness needs. Plus, they said I’d get a chance to get to meet my care team. A care team? What’s that? I’ll let you know after my appointment, but looking at their team I’d say it includes physicians together with health and wellness coaches.
The idea of a team of people thinking about my and my family’s wellness is intriguing. Although, I’ll admit that this wasn’t the biggest reason I chose to sign up with Turntable Health. It was part of the reason, but I was also excited by the idea of unlimited primary care. With unlimited primary care, it opens the door to things like text messages or eVisits with your doctor since they’re truly interested in your wellness and not churning another office visit to get paid.
With a family of 4 kids, there are dozens of times where my wife and I debate whether an office visit is needed. Every parent knows the debate. Am I just being paranoid or are they really sick? Is that rash something that needs to be treated right away or should I give it some time? Final answer: Let’s just take them in, because I don’t want it to be something bad and then I feel like I’m an awful parent because I chose not to take them in. I’m hopeful that with Turntable Health we can alleviate those fears since we don’t have to pay for the visit and we can start with an online visit which saves us time. That’s extremely compelling to me.
I can already say that my experience has been different. After scheduling my first appointment, I got the usual email confirming my appointment, offering directions to the office, and inviting me to fill out an “Online Health Assessment.” I thought it was cool that they were asking me to fill out those lengthy health history forms electronically before the visit. Turns out I was wrong. It was a survey style assessment of my health and wellness. They asked questions about my mental and physical health. They asked about my diet and exercise. They even asked about my quality of life. There weren’t any questions about my neck issue or the pain in my hand, let alone my allergies or past medical history. I wonder if they’ll do that when I get to the office. Plus, I’ll be interested to see what questions they ask me about that true wellness assessment.
Like I said, this appointment should be interesting. To be honest, I feel like I’m learning a new healthcare system. I know what’s appropriate and how the regular doctors office works. Here I’m not sure what’s right or wrong. Take for example the list of health and wellness classes Turntable Health offers with their membership. What other primary care office offers Tai Chi, Hot Hula and Meditation courses? I might even have to start doing yoga. Why not? It’s free. Although, what a different approach to Wellness.
There you go. There’s part 1 of my introduction into a new model for primary care. How will it go? We will see. How will they handle the fact that I’m a picky eater and that doesn’t jive well with many of their perspectives on Wellness? Will they really care about my wellness enough to reach out to me beyond appointments? How will my family and I react to this outreach? Will we stonewall them or will we embrace the increased interaction? It will be a fun journey and I hope you’ll enjoy me sharing it with you.
All in all, it does feel like they’re trying to restore humanity to healthcare. We’ll see how much we like humanity.
Update: Check out part 2.
Can 10 successful entrepreneurs come up with solutions to 10 of healthcare’s most “wicked” problems in 10 days?
That’s the question Denver’s Tom Higley started asking himself three years ago. Tom, a successful entrepreneur himself and tireless Colorado startup advocate, is the brainchild and chief organizer of an event, dubbed 10.10.10, happening right now in Denver that aims to learn what’s possible.
In a first of it’s kind event, 10 entrepreneurs have been brought together to create products and companies to solve 10 of health care’s wicked problems. Day 10 is today Thursday, Feb. 26th, where we’ll find out what things the CEOs will be working on in the months to come.
Think of it as an executive-level healthcare startup hackathon that lasts 10 days. If it works, it’s going to be taken on the road and into other industries such as food, water, energy and education. With 80% of outcomes linked to things such as nutrition and education, I suspect some of these future events may have an impact on health care as well!
To be sure, coming up with solutions to such problems on short order, in an area where even Apple is apparently struggling to innovate, may seem like a tall order to many on the front lines of digital health, but the expectations are appropriately muted. Higley will measure success by having at least a few solid, fundable companies in the next nine to 18 months.
Perhaps an even bigger story is the dedicated community of people are working to make Colorado a major player in digital health, with 10.10.10 as a showcase. The event and the entrepreneurs are supported by over 100 volunteers and as well as the Colorado Health Foundation, Kaiser, and many others. Bryan Sivak, the U.S. Department of Health and Human Services’ chief technology officer and entrepreneur-in-residence, sent a video in support of the event that was played at the kickoff last week.
There’s also a distrinctly consumer-centric perspective on solutions here as well. Esther Dyson, VC Brad Feld and SomaLogic CEO Larry Gold discussed as much yesterday on a panel, challenging the CEOs to come up with products and business models related to health, not health care, and providing access to data for consumer. If someone’s a patient, it’s often too late for intervention, according to Dyson.
You might want to keep Colorado on your map if you are thinking of starting a digital health company. A new state-of-the-art digital health campus called Stride, set to open in the coming year, will focus on creating a hub of digital health companies. Several major players in health care are rumored to be setting up a presence (more on this in the months to come). Places like Stride, events like 10.10.10, and the dedicated community that supports them, along with success stories like iTriage, are starting to put Colorado on the digital health map.
A cornerstone to the environment I see growing is the willingness of pitch in and help. Local VC Brad Feld talks about that helpful ethos of the Boulder startup community in his book “Startup Communities,” and it seems to have caught on among the digital health people throughout the front range.
Each element of the 10.10.10 event has a “coopetition” aspect to it, even the problems. Individuals and organizations pitched in and submitted problems and the final list was selected based value, difficulty and market opportunity.
The event so far
The first public-facing event was the kickoff where the problems and entrepreneurs were announced. The wicked 10 problems will be familiar to many in involved in digital health and certainly reflect the new realities of non-Fee-for Service (nFFS), quality-based care, public health and a few oldies but goodies:
The 10 Wicked Health Problems are:
Depending on how you categorize, the wicked problems are pretty evenly divided between public health, patient-empowerment, health IT, and science-focused. Now matter how you organize them, they are big, wicked and broad. It will be interesting to see how the entrepreneurs hone them down to problems to areas that are manageable.
At the midway point event, February 20, the entrepreneurs seemed to be leaning toward some solutions, but no decisions had been made. We’ll have to find out on Thursday where things are headed, I’ll tweet-report back this Thursday, so follow #101010health to find out more.
I hope the midway panel offered some insight to where things are headed. There was an excellent panel with Kaiser’s Dr. Jandel Allen-Davis, SomaLogic (Proteomics company) CEO Larry Gold and Peter Sheahan of ChangeLabs. The dynamic was great, had some great one-liners and made a few things pretty clear. I hope the 10 entrepreneurs, who were sitting in the front row during the session, use some of these takeaways as a guide:
Peter Sheahan related the story of a meeting where a fresh-faced twenty-something told the Joint Chiefs of the U.S. military that social media would help foment geopolitical unrest. Of course, they snickered and dismissed him out of hand. This was six months before the Arab Spring.
That story makes me hope that we have some of those kinds of thinkers at 10.10.10. I wonder who will be laughed at, but keeps on building, and is eventually proven right in health care? Will it be one of these?
Founder and CEO of medical device company Freedom Meditech.
Co-founder and CEO of Bia Sport, a sports watch company.
Seasoned executive with a long string of successful companies and an IPO.
Monique has started and grown several companies, including Swing by Swing Golf.
Lizelle van Vuuren, Denver, Colorado
Founder and CEO of marketing company Effectively.
Kelly O’Neill Dwight, Denver, Colorado
Principal consultant of KMD Consulting Services.
Founder of Liquid Compass, a radio streaming company.
Lincoln Powers, Billings, Montana
CEO and chief data architect of Rocky Mountain Technology Group.
Best wishes to all to fix some of these wicked problems! It won’t be easy, but we’re rooting for you! Looking forward to tonight to see where things are headed!
Many hospitals are now in severe financial difficulty, particularly smaller ones (see: Some Hospitals Experiencing Financial Distress and Even Bankruptcy). A recent blog note by Robert Pearl posted on the KevinMD blog discussed the financial challenges being experienced by small hospitals and one way to provide higher quality care to patients admitted to small, rural hospitals (see: Why rural hospitals are fighting a losing battle). Below is an excerpt from it:
Over the past five years, more than 40 rural facilities have closed their doors due to lack of funding. And because the majority of their funds come fromMedicare and Medicaid...,many rural hospitals may be fighting a losing battle. Understandably, small-town residents fear hospital closures or downsizing may leave them vulnerable when serious illness strikes. But the reality is patients in rural communities often don’t receive optimal care from their local hospitals. In fact, critical access hospitals in rural areas experienced increased death rates from 2002 to 2010 while mortality rates fell in other hospitals.....Fundamental to [the] Hill-Burton [Act] was the belief that residents of rural and low-population areas were best served by local community hospitals, no matter how small....[A]dvancements in medical practice further exploit the differences between America’s leading hospitals and the kind of care available to many of the 60 million people living in rural areas. The truth is many hospitals serving low-population areas don’t have the patient volume or specialists to manage the breadth of complex medical conditions they encounter today....What if rural facilities were used for the kind of routine care and simple procedures that generalist physicians and nurses can safely provide while designating regional hospitals for more complex, specialty care? With today’s video technology, a remote specialist can immediately evaluate a patient and initiate care prior to transport, minimizing delays in treatment. After preliminary testing and stabilization, patients could be safely transported to an operating room in a regional hospital for treatment mere minutes after arrival....But overall, more patients will die in sub-optimal hospitals than during transport to state-of-the-art facilities with the best doctors and nurses.If our goal is to save more lives, we as a country should invest in 21st century technology, communication, and transportation....
Small hospitals are not going to disappear because they are the major employers in many smaller towns. Perhaps Congress will come up with some new subsidy programs to offset the decreased reimbursement from Medicare and Medicaid. However, I am generally in agreement with the arguments made by Pearl. For patients with complex problems, it stands to reason that the care delivered in small rural hospitals will often not be equivalent to that delivered in regional referral centers with medical specialists on their staffs. The question here then reduces to what is the best way to ameliorate this problem without undercutting the mission of the smaller hospitals. I agree with the above statement by Pearl: After preliminary testing and stabilization, patients could be safely transported to an operating room in a regional hospital for treatment mere minutes after arrival. I also agree with the idea of creating telemedicine links between smaller hospitals and regional centers to assist the admitting physicians, when necessary, in the initial diagnosis of patients and their stabilization. Perhaps federal programs are necessary to deploy the necessary technology for telemedicine in small hospitals and put financial incentives in place to so that the regional centers are willing to participate eagerly in such relationships. However, It's not clear to me how the healthcare scenario outlined by Pearl will protect the small rural hospitals from impending bankruptcy.
Every once in a while I come across a piece of healthcare prose that I have to share, but there’s no good way to share it in pieces. I found that once in The Old Man and the Doctor Fable. It’s a must read if you haven’t read it.
I recently had another such example shared with me called “Please Choose One“. This one took me a second to really get into it, but about a quarter of the way through, I couldn’t stop reading and had to figure out how it ended. I’m sure that many physicians will feel the heartache shared in this short story. Thank you Philip Allen Green, MD for sharing. If you haven’t gone and read it, go read it…we’ll be back here once you’re done.
Obviously, the story is told in an exaggerated worst case scenario fashion. Although, to me that’s what illustrates the point so well. The lesson I took from the story is that we can’t take the human out of healthcare. Technology should help us offer more humanity to patients as opposed to less. Furthermore, we’re at risk for doing the opposite.
What’s your takeaway? I’d love to hear your thoughts on the story.
When we start purchasing our EHR, many times we don’t spend enough time thinking about what happens when we reach the end of life for the software we’re purchasing. I was particularly reminded of this when writing my post about the legacy EHR ticking time bombs. During our EHR or other healthcare IT software purchase, we don’t think about 5, 10, 15 years down the road when we might want to switch systems. What happens at the end of a system’s life is not our concern during an EHR purchase, but it should be.
A lot of people like to talk about EHR data portability. This is a very important subject when you’re looking to sunset an old system. However, if you haven’t put the right items in your EHR contract, it becomes a major issue for you to get that data out of the EHR. If you haven’t read the section on EHR contracts in my now somewhat dated EMR selection e-Book, take some time to read it over and check out your EHR contract.
When you can’t get the data out of your EHR, then you’re stuck in a situation that I described in my legacy EHR ticking time bomb post. You limp your legacy EHR system along and have issues with updates, fear the lost of the system completely, and much more. It’s just an ugly situation.
It’s nice to think that an EHR system will just work forever, but technology changes. It’s just the reality of life. I’m interested to see if the concept of an EHR vendor neutral archive will really take off. That would be one major way to combat this. However, I think many are afraid of this option because it’s tough to preserve the granular data elements in the EHR. Plus, it takes a forward thinking CIO to be able to make the investment in it. Although I’ve met some that are doing just this.
What has your organization done to prepare for the day that you’ll sunset your EHR or other healthcare IT systems? Is this a concern for you? Or are you like some CIOs who figure that it will be someone else’s problem?
As with all Pebble software, we’ve built an open platform. You can allow apps and developers to add ‘pins’ to your timeline, so you can keep track of things like upcoming events, sports, weather, traffic, travel plans, pizza specials and more.Had you been on the stick, you could have had one of the first 10,000 watches for $159, but they went fast. Pebble has raised $4 Million within hours (minutes?) of the Time's debut. You can still get in at $179 if you act fast. The retail price will be $199.
The Pebble operating system has been re-imagined with a new visual style. While all existing Pebble apps will still work great, we’re inviting developers to upgrade their apps to support color. More details coming soon!
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On January 21, the Office of the National Coordinator for Health IT announced that Michael James McCoy, MD, would be the department’s Chief Health Information Officer, a newly created position. According to the announcement, Dr. McCoy will serve as the lead clinical subject matter expert on interoperability, and he has a background perfectly tailored to the task with experience both as a practicing physician and as a leader at the IHE for more than a decade.
Thanks to Dr. McCoy for answering the following questions about the new position and his vision for a learning health system.
Q. First, congratulations on the new appointment with the ONC. You previously practiced medicine and held various leadership positions in the private sector, what attracted you to working with the ONC and what vision do you hope to bring to the department as the industry moves into stage 3 of Meaningful Use?
ONC is at a crossroads, coming through a period where significant funding was applied to incentivize the adoption and use of basic electronic health information technology to one where the information can flow to help achieve better care, smarter spending of health care dollars, and healthier people. Now we need to make sure that the infrastructure we have established through the supports created in the HITECH Act can provide returns, with data and analytics capabilities that progress us, as a nation, toward a Learning Health System.
I had the good fortune to be in the right place at the right time to be able to join ONC and the great team of people here to further the goals of improving health, health care, and reducing costs of health care delivery with a person-centric view. Dr. Karen DeSalvo, the National Coordinator for Health IT – my boss – continues to be supportive about the importance of health information technology as the tool to support achieving better health (not as an end unto itself).
I hope that my experience as a practicing clinician with early EMR use in the office, as someone with vendor and implementation experiences, and with system-level knowledge of the challenges for adoption and utilization of the data available, can provide a balanced perspective across ONC. There are many offices within ONC that have huge impacts on policies, procedures, rules, and regulations – way more than I realized before joining the team here! There is significant coordination required between the various teams, and Dr. DeSalvo has been working to ensure the views are balanced with senior clinical and legal/legislative perspectives applied.
My vision is that I may be impactful in advancing the notion of person-centric health, and in some small way, help influence the direction that our advancement to a Learning Health System takes. I fully embrace a person-centric concept, and think announced initiatives, including Precision Medicine, will continue taking our nation’s health system down that path.
Q. Karen DeSalvo was quoted as saying you would serve as the ‘lead clinical subject matter expert on interoperability.’ This brings to mind the inclusion of patient-generated health data into the medical record. How do you think the big questions about responsibility for the PGHD (e.g., Is the physician legally responsible to monitor the data? Are patients responsible for accuracy of reported data? etc.) will be resolved?
The subject of patient-generated health data (PGHD) has many complexities, but in reality, some of the biggest questions relate to similar concerns expressed by clinicians in reviewing “data dumps” from Transitions of Care (TOC) documents, or receiving old records from other physicians. Those concerns relate to the (receiving) physician missing some critical data element in the old record (whether paper or electronic) and their liability as a result of missing that information. There have been lawsuits on this with paper records, and now with electronic records, there is even more data (potentially) for a clinician (or attorney) to review. Whether the data comes from another EHR or from PGHD, there is some obligation for the clinician to review the information received. To what extent and how much data validation must occur (the trust or provenance of the data source) are not yet defined clearly. The legal requirements, the ethical requirements, and the practical requirements for that “minimum level of review” have not been fully established, nor has a consensus view been achieved on what is “right.” ONC is certainly not, in my view, the arbiter of such, though it could, through outreach and coordination and/or through its advisory committees, convene such discussions.
To me, the concerns, about PGHD misses the bigger picture: individuals are now beginning to drive their own health care decisions in a big, and growing exponentially bigger, way. If physicians do not choose to engage with the increased consumer demands, they may find themselves increasingly marginalized in the care delivery system.
This presents opportunities for developers and other technically savvy entrepreneurs to look at the challenge of filtering signals from the noise. Everyone is busy these days; finding the important e-mail amongst all the other e-mails and spam received is a great thing. Physicians want the same thing from the PGHD received, and from all of the other interactions with their health information technology (rules and alerts that make sense). Usability, and good (actionable) information, not just data or noise.
Q. A person-centered health system seems to make perfect sense when it’s talked about at the water cooler, yet I sense there is a large chasm that exists between the goings ons in the health care system and the majority of patients in the U.S. How can we be sure that patients really want to be engaged with the health care system?
Not every “patient” wants to be engaged. That is the reality. Sometimes it is exactly those patients, though, that need to be engaged.
However, looking at the opportunity from a different perspective, the way to a better, healthier country is to engage people before they become patients. Witness the growth of wearable devices, connected to the Internet of Things. The FTC report forecasts 25 billion devices communicating over the network this year and 50 billion by 2020.
Further, assuming it is just a patient that wants to engage is another fallacy. Many of us have roles as caregivers, whether for spouses, children, or parents. Many of us live remotely from the person receiving care. Having access to be able to assist in understanding the care received, ensuring good communications with care providers, and being actively and proactively engaged is possible only through application of health information technology.
There are so many opportunities to improve the relationships between people (whether a patient, caregiver, or healthy individual) and clinicians (in hospital settings, offices, long-term care settings), and technology can help. Many physicians still seem to view patients coming in with externally garnered information (“Dr. Google”) as problematic, instead of as interested and engaged in their health.
The whole care delivery system is in the midst of transformation (even disruption), and embracing and adopting the change is a better approach than becoming obsolete.
Q. As a former board member, you obviously have a lot of interest in IHE’s activities. Where you surprised there was no mention or talk about IHE in the most recent JASON report? What role do you think IHE will play as HL7 FHIR progresses?
The November 2014 JASON report did not reference IHE, but I don’t find that too surprising given the constituency of the advising body. As in many other circumstances, one approach may be favored by those in office at one time and less so by subsequent office holders. IHE references and use was quite prominent in the HITSP days, less so until recently. One may note that in the 2015 Interoperability Standards Advisory draft, IHE is mentioned multiple times, with XDR, XDS, PIX/PDQ, XCA, XCPD, CSD, and HPD all called out.
There are many technically savvy people (aka “geeks”) that work in and with both HL7 and IHE, and harmonization and collaboration between the two groups can only help the overall advancement of health information technology. Perhaps in my simplistic (? naive ?) way, I view the constructs as HL7 and others (SNOMED, LOINC, RXNORM) providing the “ingredients” to IHE’s recipe (e.g., IHE PCC’s APS, LDS for obstetrics) on utilizing in a meaningful way the constituent parts. Much as a cake recipe calls for sugar, eggs, and flour as ingredients, the “how much sugar,” “how to mix,” “how long to bake and at what temperature,” etc. define the end product (the cake). Many different cake recipes exist, just as many different use cases for health data exists….
Q. What do you hope the health care system will look like in 5 years?
In 5 years, I hope we are well on our way to the Learning Health System, with little or no thought required to get my health data into or out of any part of the care delivery system I am interacting with. I want to be able to take my personally derived data (from exercise on my bicycle or from monitoring my weight with my WiFi-connected scale) and have it available for those with whom I wish to share. I want to be in a health care system that is focused on wellness and general health as much as it has been focused on episodic care and illness.
The draft Interoperability Roadmap (open to public comment until April 3rd) provides the proper vision towards a Learning Health System that will achieve those goals. It may be an aggressive timeline to some. It certainly is reflective that ONC cannot carry the burden alone. Public, private, state, and federal cooperation and collaboration is essential to achieving success. Our nation’s health depends on it. I think it is the most worthy goal one could have as a health care professional. I certainly am proud to be associated with the dedicated and brilliant team here at ONC working to achieve the goal!
Special thanks to Peter Ashkenaz and Brett Coughlin from the ONC for their help facilitating this post.
Some very interesting studies are now staring to emerge using DNA analysis to study the presence and distribution of bacteria in cities like New York. One such study revealed the presence of marine bacteria in a NYC subway station, probably as a result of previous flooding due to superstorm Sandy (see: Post-Sandy NYC Subway Brims with Unknown Microbes). Below is an excerpt from the article:
Researchers identified nearly 1,700 species of bacteria, viruses and eukaryotes to create a “metagenomic” map of the city. One cluster of points on this grid offered a reminder of exactly how inundated and overwhelmed the city was more than two years ago when Superstorm Sandy hit. Nearly half of the mapped DNA came from as-yet undocumented organisms, highlighting how much remains unknown to science about the microbial world around us. The results are detailed in ,,,[a recent study]. ....The most commonly identified DNA in the sample came from bacteria. And although strains of the causative agents of anthrax and bubonic plague surfaced, the vast majority of species identified were harmless....[The author of the study] says these dangerous DNA snippets occurred only at trace levels, so they could have been fragments that other bacteria picked up through horizontal gene transfer or even have come from dead organisms. Most of the bacteria identified are types that placidly thrive on our skin and are of no concern ....But researchers found one of the [subway] stations was not like the others. The South Ferry station in Lower Manhattan had the most unique profile of bacteria in the system, and still resembled a marine environment. When the storm surge from Hurricane Sandy hit the city in 2012, the station filled with about 57 million liters of water that rose to 25 meters deep....The researchers isolated 10 bacterial species that were only found at South Ferry. Among these were Shewanella frigidimarina, which has been found in the North Sea, and Flavobacterium, which can harm certain species of fish. The unique bacteria are usually found in cold, marine environments, so the researchers wondered if Sandy's storm water dragged them in.
Here's another quote that makes reference to this same microbiology DNA study (see: Big Data and Bacteria: Mapping the New York Subway’s DNA):
The big-data project, the first genetic profile of a metropolitan transit system, is in many ways “a mirror of the people themselves who ride the subway,” said Dr. Mason, a geneticist at the Weill Cornell Medical College. It is also a revealing glimpse into the future of public health. Across the country, researchers are combining microbiology, genomics and population genetics on a massive scale to identify the micro-organisms in the buildings and confined spaces of entire cities.
For me, an interesting aspects of this study is the suggestion that marine organisms might be able to thrive in a "dry" NYC subway station unless the DNA detected is merely residual from dead organisms or related to horizontal gene transfer to other bacteria. If, in fact, these marine bacteria are growing in the South Ferry subway station, one wonders if there are any possible adverse health consequences. However, I suppose that most New Yorkers would consider bacterial growth as one of the lesser threats encountered in subway stations.
The Medical Group Management Association has filled the leadership void created when Susan Turney, M.D., left in July, hiring Halee S. Fischer-Wright, M.D., as its new president and CEO. She will start March 23.
According to Englewood, Colo.-based MGMA, Fischer-Wright, a longtime physician executive, is CMO of St. Anthony North Health Campus, a Centura Health System facility in Westminster, Colo. She previously was president of Rose Medical Group, a large, Denver-based management services organization. Fischer-Wright also was one of three authors of Tribal Leadership: Leveraging Natural Groups to Build a Thriving Organization, a 2011 book that spent time on the New York Times bestseller list.
“Dr. Fischer-Wright’s unique expertise and experience from working in both clinical and administrative roles will be critical in helping MGMA members prepare for value based payments and leverage the full clinical and operational power of their practices to enhance patient care in their practices and position them for this success,” MGMA board Chair Debra J. Wiggs said in a press release.
The U.S. Food and Drug Administration (FDA) has ordered a recall of thousands of MRI scanners manufactured by GE Healthcare to correct a problem that could "result in life-threatening injuries" if magnet shutdown modules are disconnected, according to an FDA notice.You can find the FDA notice HERE. You'll have to scroll through thousands of serial numbers to get to the meat of the notice:
In the notice, dated February 18, the FDA announced that it has ordered a class I device recall of all GE MRI scanners using superconducting magnets. The recall covers some 33 brand names of scanners and thousands of systems distributed throughout the world, manufactured from 1985 to today.
The notice describes the problem as pertaining to the systems' magnet rundown units (MRUs), which are designed to initiate a controlled quench and turn off the magnetic field in the event of certain problems with the scanner, such as a ferromagnetic object introduced into the MRI suite. Such shutdowns are only intended for extreme emergencies and can put an MRI magnet out of commission for a week or more and cost up to $30,000 to replace lost helium, according to the website MRIQuestions.com.
In GE's case, a scanner's magnetic rundown unit may not actually be connected to the scanner, according to the FDA recall notice. In an emergency, a disconnected MRU "could delay removal of a ferrous object from the magnet, potentially resulting in life-threatening injuries," the notice said.
|At certain sites, the MRU may not be connected to the magnet. In emergency situations, a disconnected MRU could delay removal of a ferrous object from the magnet, potentially resulting in life-threatening injuries. The MRU must be connected to the magnet at all times.|
|TRAINING: Employee Error|
|Action||GE Healthcare sent an "Urgent Medical Device Correction" letter GEHC Ref# 60876 dated January 6, 2015 to affected consignees. The letter was addressed to Hospital Administrators / Risk Managers, Radiology Department Managers, & Radiologists. The letter described the Safety Issue, Safety Instructions, Affected Product Details, Product Correction & Contact Information. Customers were instructed to do the following: As a preventative measure, confirm that MRU is connected to the magnet by performing the following four step test on the MRU. |
1. Verify the green CHARGER POWER LED is lit.
2. Depress and hold the TEST BATTERY switch for 15 seconds. The green BATTERY TEST LED should light and remain lit while the TEST BATTERY switch is depressed.
3. Place the TEST HEATER toggle switch in the A position. The green HEATER TEST LED should light. If it does not light, depress TEST HEATER LED switch to verify that the LED is functioning.
4. Place the TEST HEATER toggle switch in the B position. Green HEATER TEST LED should light. If it does not light, depress TEST HEATER LED switch to verify that the LED is functioning.
If the MRU test does not perform as described in each of the 4 steps above, GEHC strongly recommends that you stop using the system, and immediately call your GEHC representative. Customers with questions may contact their local service representative. For questions regarding this recall call 262-513-4122.
|Quantity in Commerce||12,968 (5,708 US, 7,260 OUS).|
|Distribution||Worldwide Distribution - US Nationwide in all states in continental USA including DC, PR, GU, and the countries of ALBANIA, ALGERIA, ARGENTINA, AUSTRALIA, AUSTRIA, AZERBAIJAN, BAHRAIN, BELARUS, BELGIUM, BOLIVIA, BOSNIA & HERZEGOVINA, BRAZIL, BULGARIA, CANADA, CHILE, CHINA, COLOMBIA, COSTA RICA, CROATIA, CYPRUS, CZECH REPUBLIC, DENMARK, DOMINICAN REPUBLIC, ECUADOR, EGYPT, EL SALVADOR,K ESTONIA, FINLAND, FRANCE, FRENCH POLYNESIA, GEORGIA, GERMANY, GREECE, GUADELOUPE, GUATEMALA, GUYANA, HONDURAS, HONG KONG, HUNGARY, ICELAND, INDIA, INDONESIA, IRAN, IRELAND, ISRAEL, ITALY, JAMAICA, JAPAN, JORDAN, KAZAKHSTAN, KENYA, REPUBLIC OF KOREA, KUWAIT, LATVIA, LEBANON, LIBYAN ARAB JAMAHIRIYA, LITHUANIA, LUXEMBOURG, MACEDONIA, MALAYSIA, MALTA, MARTINIQUE, MAURITIUS, MEXICO, MOROCCO, NETHERLANDS, NEW CALEDONIA, NEW ZEALAND, NICARAGUA, NIGERIA, NORWAY, OMAN, PAKISTAN, PANAMA, PARAGUAY, PERU, PHILIPPINES, POLAND, PORTUGAL, QATAR, REUNION, ROMANIA, RUSSIA, SAUDI ARABIA, SERBIA, SINGAPORE, SLOVAKIA, SLOVENIA, SOUTH AFRICA, SPAIN, SUDAN, SWEDEN, SWITZERLAND, SYRIA, TAIWAN, THAILAND, TUNISIA, TURKEY, UKRAINE , UNITED ARAB EMIRATES, UNITED KINGDOM, URUGUAY, UZBEKISTAN, VENEZUELA, VIETNAM, ZAMBIA.|
The company said it learned of the problem after discovering that some MRI scanners in India had been modified by service personnel or by equipment users to disable the magnet rundown unit. In addition to alerting customers to the problem, GE noted that the red magnet rundown button should only be pressed in an emergency situation.Now why, one might ask, would anyone want to disable the MRU? Inquiring minds want to know. And did we really need the reminder that the big red button that says, "PRESS IN CASE OF EMERGENCY" should be pressed only in an emergency? Perhaps that tells us something about GE's opinion of its customers.
It (the MRU) was never connected or properly installed. We can't disconnect it. So it was a GE issue. Big problem though.
Well, that didn’t last long. My full-time job ended abruptly today, less than three weeks after I started. So here I am back to freelancing and blogging. Any leads would be appreciated. Meantime, stay tuned for new content.
I have blogged previously about tests and imaging procedures relating to the diagnosis of Alzheimer's disease (see: Early Detection of Alzheimer's Disease: Mutations of Three Genes Studied; Using Altered Metabolic Pathways to Diagnose Alzheimers Disease; Alzheimer's Amyloid Tangle Theory Will Be Tested with Merck Drug Trial). I don't think that any test or imaging procedure to date has proven to be foolproof. However, a recent article raised the important question of whether one would want to even know the result if such a test were available (see: New Test Claims It Can Tell If You Will Develop Alzheimer's... But Do You Want To Know?). Below is an excerpt from the article:
The dichotomy of those who want to know and those who do not is separated by a deep chasm in beliefs, and could forever alter the way individuals, families and wealth managers prepare for disease, as well as how insurers and care providers pay for and provide care. While genetic tests are presently able to determine about 4,000 diseases and disorders, the breakthrough of predicting Alzheimer’s disease could vastly change the behaviors and costs to society, actually bending the cost curve health experts so often talk about as necessary for economic stability....In January, Amarantus reported positive top-line results of its LymPro Test...for Alzheimer’s disease. The Company also entered into an exclusive option agreement with Georgetown University (GU) to commercialize sets of blood-based biomarkers for Alzheimer’s disease....But how will individuals react? How about the care provider and insurance markets? When there is presently no cure, it is expected that individuals and families will be torn on the decision to test. In contrast, it seems inevitable that employers, health officials and insurers will want to know the future demands, needs and composition of their populations....While LymPro is not ready for the shelves of CVS or Walgreen ’s, it may not be long before in clinic and in home testing is available to consumers. Without a cure or highly effective symptomatic treatments to go hand-in-hand with the blood test, the risk and reward of such a test will certainly take a toll on individuals, families, health care markets and communities.
Here's a brief summary of the LymPro test mentioned in this excerpt copied from the Amarantus web page:
The Lymphocyte Proliferation Test (LymPro Test) is a diagnostic blood test that measures the ability of peripheral blood lymphocytes to withstand an external stimulation inducing them to enter the cell cycle. It is hypothesized that certain diseases are the result of a compromised cellular machinery that leads to abhorrent cell cycle re-entry by neurons.The inventive step for LymPro that makes a unique asset involves using peripheral blood lymphocytes (PBLs) as a surrogate for neuronal cell function, suggesting a common immune-based relationship between PBLs and neurons in the brain.
There is no single answer as to whether one would want to know if he or she was destined to develop Alzheimer's disease with no effective treatment for the condition. Some individuals with a strong predisposition to planning might benefit from such information, particularly if the test would offer some time prediction for the onset of the disease. On the other hand, such bad news could destroy another person psychologically. What is clear, however, is that the precise identification of those who have, or will develop the disease, is a requirement for the development of clinical trials for drugs that ameliorate or cure the disease. In fact, the availability of such clinical trials could provide an incentive for individuals to seek the test because only those who test positively would be admitted as a subject to them.
“Please, sir, I want some more.” – Oliver Twist
In this super-sized world, we tend to believe that “more” is better than “less.” I personally believe more trumps less in many areas:
Of course more isn’t always better. Quite often – especially in the health IT world – less is actually “more.” Consider the following:
Oliver Twist and chocoholics may disagree, but sometimes less can be the best way to go.