We know the adoption rate of electronic medical records software is low among physicians, but what about e-mail? Are doctors e-mailing their patients?

It turns out there's not much difference between the percentage of physicians who use an EMR and the percentage of doctors who regularly e-mail their patients. Thirty-one percent of physicians in 2007 said that they communicate with their patients via e-mail, up from 24% in 2005, according to a January 2007 survey by Manhattan Research. However, the remaining 69% of physicians said that concerns -- such as liability, lack of reimbursement and technology integration -- still remain barriers to adopting the technology.


The survey also found that most physicians approve of patients bringing information that they found online to an office visit. Sixty-five percent of physicians said it is a good thing when patients bring in information they found on the Internet, while 34% of physicians said it was a bad thing, according to the survey.

Many more physicians (50%) reported using a personal data assistant (PDA), most often relying on the device to store a prescription drug reference database, according to the survey.

Results are based on a telephone survey of 1,353 physicians in Q1 2007.

Election day is more than twelve months away, but the contest for president of the United States is already shaping up to be a fierce one. Many presidential candidates have either released or announced their intention to release a comprehensive plan for health care reform. Following is an attempt to summarize each candidate's position on health care information technology such as e-prescribing and electronic medical records. You are encouraged to visit each candidate's Web site on your own, as their positions may change in the future.

Joe Biden (D): His home state of Delaware is a leader in adopting new health information technology, and the candidate notes the Delaware Health Information Network (DHIN) is a state-wide health information and electronic data interchange network for public and private use. Biden says the potential savings to the health care industry from full adoption of electronic medical records is substantial. He notes that researchers at the RAND Corporation estimated that full adoption of electronic medical records could save $77 billion annually. RAND also determined that by 2004, 15 to 20 percent of U.S. physician offices had adopted electronic medical records systems.

To get to 100 percent adoption of EMR/EHR software, Biden says he would invest at least $1 billion dollars per year in moving to electronic health records systems, provide grants to states to develop electronic medical records and other health IT systems, and assist hospitals, medical facilities and doctors in upgrading to electronic record systems and implementing them in their practice.

Electronic Medical Records Information and Resources

Sam Brownback (R): Brownback advocates for lifetime electronic medical records. On his Web site, he notes that he is " ... the sponsor of a bill that would offer patients both ownership and control over their personal health information and ensure that personal health information is not used by third parties without the consent of the patient. This proposal would also offer patients debit-like cards containing their private and portable personal health information."

Hillary Clinton (D): In her comprehensive plan for health care reform, Clinton pledges to ensure that all health care providers and insurance plans use privacy-protected information technology. She says her proposal will give doctors financial incentives to adopt health information technology and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded. Clinton also notes on her Web site that the Business Roundtable, SEIU and AARP estimate that “widespread adoption [of such IT reforms] raises the potential savings to $165 billion annually.”

Chris Dodd (D): In his plan, Dodd says health insurance premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs and incentives for adoption of information technology and savings from better care. He implies that technology such as electronic health records and practice management software systems will help integrate clinical information tools, monitoring technologies and care management such that chronic diseases are kept under control.


John Edwards (D): Edwards advocates for universal health care, and healthcare information technology will be critical to ensuring his model delivers high quality care without breaking the bank. On his Web site, the presidential candidate notes: "Many insurers and hospitals still rely on cumbersome paper systems and incompatible computer systems. The outdated 'paper chase' causes tragic errors when doctors don't have access to patient information or misread handwritten charts. It creates needless administrative waste recreating and transporting medical papers, performing duplicative testing, and claiming insurance benefits. Edwards will support the implementation of health information technology while ensuring that patients’ privacy rights are protected."

Edwards pledges to support new technologies, such as handheld devices and electronic medical records, to give doctors the latest information at their fingertips. Edwards also promises to support public-private collaborations that reduce medical errors through electronic prescribing (e-prescribing).

Rudy Giuliani (R): Giuliani has pledged to invest in health information technology to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors. He sais public-private partnerships to improve and set standards for health IT but without overbearing regulations can play a major role in improving quality of care and reducing health care costs.

Mike Gravel (D): It does not appear that Gravel has a position on the role of information technology in health care reform; if he does, we were unable to find it.

Mike Huckabee (R): Huckabee is famously known for losing 100 pounds after being diagnosed with diabetes, and for his steadfast support for preventive health care. He has not released a comprehensive plan for health care reform, but he does note that health care can be made more affordable by adopting electronic record keeping, among other strategies such as medical liability reform and health insurance portability.

Duncan Hunter (R): There's no mention of health care on his Web site, let along discussion of electronic medical records.
Kucinich's proposal is for universal, single payer health care plan completely funded by the government.

Dennis Kucinich (D): Kucinich has proposed a universal, single payer health care plan completely funded by the U.S. government, called the United States National Health Insurance Act (H.R. 676). In his proposal, he calls for the creation of a "standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy," and that "notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record."

John McCain (R): He says that reforms to federal health care policy and programs should focus on enhancing quality while controlling costs, but we were unable to find any references to health care information technology in his campaign materials.


Barack Obama (D): In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging that paper-based medical records make it difficult to coordinate care, measure quality and/or reduce medical errors. He also says processing paper claims costs twice as much as processing them electronically.

Obama pledges to invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT, and promises to "commit the necessary federal resources to make it happen." He also pledges to ensure that these systems are developed in coordination with providers and front line workers, including those in rural and under served areas.

Ron Paul (R): He's a Medical Doctor, but he has not proposed a plan for health care reform, and makes no mention of electronic medical records in his campaign materials.

Bill Richardson (D): To achieve health care for all, Richardson proposes streamlining health care administration by using "21st Century Health Care Bonds" to invest in health information technology, thereby saving the system $22 billion per year.

Mitt Romney (R): In August, Romney shared his health care reform plan with physicians in Florida, where he underscored the importance of bringing market dynamics and modern technology to health care. In his presentation, Romney supported the idea of federal incentives to foster more widespread adoption of electronic medical records technology.

Tom Tancredo (R): He has announced a very basic plan for reform, but there's no mention of electronic medical records or other types of information technology.

Fred Thompson (R): Thompson says he is committed to a health care system with five key attributes. One of those five guiding principles: "Modernized delivery and administration of care by encouraging the widespread use of clinical best practices, medical information technology, and other innovations."


For more information on each candidate's health care ideas, visit the Association of Health Care Journalists.

Today's edition of the Washington Post examines the growing trend of physicians who dispense prescription medications at the point of care. We thought our readers would want to read the story, since we recently highlighted a national study that found most Americans would prefer to receive their medications directly from their doctors instead of the local pharmacy. The story is thorough, but it doesn't exactly discuss the role of technology in safely dispensing drugs to patients.

Read the story and let us know what you think about this practice.

 Thanks to e-Patient Dave for the image. See also the recent report Hospital Incident Reporting Systems Do Not Capture Most Patient Harm which found that "Hospital staff did not report 86 percent of events to incident reporting systems, partly because of staff misperceptions about what constitutes patient harm".

 by John Halamka, Life as a Healthcare CIO We began the meeting by relating our standards trajectory to today's agenda. Our outstanding standards issues for discussion include 1. Content Continued discussion of GreenCDA on the wire and overview of Stan Huff's CIMI initiative Standardizing DICOM image objects for image sharing and investigating other possible approaches (e.g., cloud based JPEG2000 exchange).   Consider image transfer standards, image viewing standards, and image reporting standards. Query Health i.e. I2B2 distributed queries that send questions to data instead of requiring consolidation of data Simplify the specification for quality measures to enhance consistency of implementation. The December meeting included an overview of Query Health and Quality measure standards, leaving the discussion of GreenCDA/CIMI and DICOM to our 2012 meetings. 2. Vocabulary Extend the quality measurement vocabularies to clinical summaries Lab ordering compendium The December meeting included a discussion of the lab ordering compendium, leaving the discussion of clinical summary vocabularies to our 2012 meetings. 3. Transport Specify how the metadata ANPRM be integrated into the health exchange architecture Additional NwHIN standards development (hearing re Exchange specification complexity, review/oversight of the S&I framework work on Exchange specifications simplification).   Further define secure RESTful transport standards. Accelerate provider directory pilots (Microdata, RESTful query/response that separates the transaction layer from the schema) and rapidly disseminate lessons learned. The December meeting included an update on the provider directory and certificate components of transport Our first presentation was an NCVHS update on ACA Section 10109 by Walter Suarez. The Committee emphasized the need to coordinate NCHVS work and HITSC work given that division between administrative and clinical data is becoming less distinct over time Our second presentation was an Implementation Workgroup Update by Liz Johnson about testing procedures that support the certification process. The committee emphasized the need to pilot these procedures, ensuring they are as simple as possible and reflect a practical evaluation of the functionality intended to support policy goals. Next, Doug Fridsma and Rich Elmore gave an ONC update.   Rich Elmore described the Query Health initiative, as referenced in my previous blog post about sending questions to data (rather than sending data to registries).  The committee endorsed the work and noted that further research will be needed to link patients across multiple databases to avoid double counting individuals in quality measure denominators.  The work of Jeff Jonas, as described in my earlier blog post about linking identity. Doug updated the committee about the S&I Framework initiatives - Transitions of Care, Lab Results, Provider Directories, Data Segmentation (for privacy protection), and electronic submission of medical documentation for Medicare review. We then discussed a preliminary framework for HITSC 2012 Workplan to ensure the items in the standards trajectory listed above are completed in 2012 as we continue to prepare for meaningful use stage 3. A great meeting.

 Why aren't we talking about pricing failures? The US, has consistently higher prices than any other country. The 2010 report by the International Federation of Health Plans consists of 23 pricing measures and the pattern is the same across each of these measures.  And a 2010 investigation of Health Care Cost Trends and Cost Drivers in Massachusetts found that "price variations are correlated to market leverage..." Before his departure from CMS, Don Berwick was interviewed by the New York Times and took a "parting shot at waste".  Berwick listed five elements of waste including overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules and fraud.  Pricing failures didn't make the list.  (Many folks have commented and analyzed the five factors including John Halamka's terrific piece on how EHRs can address these 5 factors.) Then in Berwick's December 7th speech to the IHI National Forum, he adds a sixth element: "Overtreatment – the waste that comes from subjecting people to care that cannot possibly help them – care rooted in outmoded habits, supply-driven behaviors, and ignoring science. Failures of Coordination- the waste that comes when people – especially people with chronic illness – fall through the slats. They get lost, forgotten, confused. The result: complications, decays in functional status, hospital readmissions, and dependency. Failures of Reliability – the waste that comes with poor execution of what we know to do. The result: safety hazards and worse outcomes. Administrative Complexity – the waste that comes when we create our own rules that force people to do things that make no sense – that converts valuable nursing time into meaningless charting rituals or limited physician time into nonsensical and complex billing procedures. Pricing Failures – the waste that comes as prices migrate far from the actual costs of production plus fair profits. Fraud and Abuse – the waste that comes as thieves steal what is not theirs, and also from the blunt procedures of inspection and regulation that infect everyone because of the misbehaviors of a very few. We have estimated how big this waste is – from both the perspective of the Federal payers – Medicare and Medicaid – and for all payers." The addition of pricing failures as a sixth element of waste is a subtle but critical shift for the national conversation.  It should not go unnoticed. Don Berwick defines pricing failures as "the waste that comes as prices migrate far from the actual costs of production plus fair profits."  Think about that:  "far from the actual costs of production plus fair profits".  At a time when total healthcare expenditures consume a huge share of GDP and increasing at rates higher than inflation and wage increases, why haven't pricing failures been on the table?  As we struggle to control costs and improve quality, there is intense focus on utilization, regulation and care coordination. Why not also focus on pricing failures? So why hasn't pricing failures been part of the conversation up to now? Here's how the conversation usually proceeds:  Health Affairs November 2011 article, Large Variations In Medicare Payments For Surgery Highlight Savings Potential From Bundled Payment Programs, "found that current Medicare episode payments for certain inpatient procedures varied by 49–130 percent across hospitals sorted into five payment groups. Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. But after adjustment for these differences, per episode payments to the highest-cost hospitals were higher than those to the lowest-cost facilities by up to $2,549 for colectomy and $7,759 for back surgery." Sounds like a clarion call for a focus on pricing failures doesn't it?  Actually, no...  The authors conclusions only speak to cost efficiency and utilization.  "Our study suggests that bundled payments could yield sizable savings for payers, although the effect on individual institutions will vary because hospitals that were relatively expensive for one procedure were often relatively inexpensive for others. More broadly, our data suggest that many hospitals have considerable room to improve their cost efficiency for inpatient surgery and should look for patterns of excess utilization, particularly among surgical specialties, other inpatient specialist consultations, and various types of postdischarge care." So is it time to broaden the conversation to include pricing failures?  At least one health system has realized that "the jig is up". Perhaps it's time to peel the onion a bit...  And take a serious look at pricing failures which deviate "far from the actual costs of production plus fair profits". _______________________________ Background tables from the IFHP report:

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Let you in on a little secret. February happens to be the month in which I was born. So to celebrate, I’m giving you dear readers a birthday gift. For the month of February you can get a free copy of the full report: iPHR Market Report Analysis & Trends. Be forewarned that this report is dated (yes, it does have a profile of Google Health), having been published in May 2008, but trust you’ll still find some worthy tidbits contained therein.

Happy reading!

Since its start in 2007, Chilmark Research has kept a fairly low profile as analyst firms go, focusing on a few discrete domains of healthcare IT (HIT). First there was patient and consumer engagement that led to the publication of our first report on Personal Health Records (PHRs). That first research effort led to a significant amount of consulting work and subsequently no reports published for broader market consumption until 2010. That year Chilmark research expanded into the mHealth domain, with the assistance of analyst Cora Sharma, and published the report: mHealth in the Enterprise.

In early 2011, Chilmark published what is arguably its most important, or certainly most popular body of research, a report on the Health Information Exchange (HIE) market. It was this report that clearly cemented Chilmark Research as a well-respected analyst firm providing unbiased, objective, and in-depth research on the domains it covers.

But there was a problem. By and large the vast majority of this work was done by one individual, myself, the founder of Chilmark Research. Over the course of 2011, particularly during the fall when a significant number of consulting assignments came in the door, I quickly came to the realization that I needed help. I was reaching burnout and the model needed to change.

What’s New:
In 2012, Chilmark Research is launching a subscription service called the Chilmark Advisory Service (CAS). This service will provide subscribers one of our annual market research reports (an updated HIE report is forthcoming, others in the works), a number of other content deliverables and direct access to Chilmark Research analysts for specific inquiries. More will be forthcoming regarding this service but encourage you to contact us directly (info @ chilmarkresearch dot com) if you wish to learn more immediately or schedule a meeting at HIMSS to discuss this service further.

Our research agenda for 2012 will look quite similar to our past work for we strongly believe these are the most important topics in healthcare IT today:

Patient & Consumer Engagement
Why it’s important: As the industry migrates to reimbursement models based on outcomes and providers take on more risk, it will become increasingly important to truly engage the patient and their loved ones as part of the care team. Also, in highly competitive markets, providers will be seeking new approaches to not only engage consumers, but build loyalty.

What we’ll be covering: Patient/consumer engagement and outreach strategies of both providers and payers including patient portals (Stage 2 meaningful use requirements are key market driver), telehealth, privacy & security (including consent management) and new models of care & outreach to not only improve consumer/patient satisfaction but improve outcomes.

mHealth
Why it’s important: No doubt about it, the growing ubiquity of smartphones and how they have become such an integral part of our lives (we store family pictures there, we record our expense reports on them, we answer emails, etc.) and an ever growing number of consumers are doing mobile searches to answer health-related questions. Couple this with near saturation of physician adoption of smartphones and the growing use of touchscreen tablets by providers, it is not too hard to imagine a future where mHealth becomes the touch-stone for provider-patient engagement.

What we’ll be covering: Primarily address consumer-centric and clinician-centric mHealth Apps, how the market is developing, what is being adopted and used and why, and lastly, what is the trajectory for this rapidly evolving, ever changing market.  Currently, we are in the midst of producing a report (ready by HIMSS’12) that takes a close look at mHealth Apps for provider-patient engagement.

Health Information Exchange
Why it’s important: The HIEs being put in place today are the fundamental infrastructure, “the pipes,” that will enable one, be it clinician or consumer, to create a true longitudinal, patient record which will lead to safer, more effective care (at least basic logic points to such). These pipes will also allow researchers, public health officials and others to perform advanced analytics on this clinical data that can lead to better, more effective and responsive care. Lastly, as we move to new outcomes-based reimbursement models, HIEs will become an absolute necessity for virtually all medium to large size healthcare organizations.

What we’ll be covering: As mentioned above, last year’s HIE Market Report put Chilmark Research firmly on the map as a firm providing unmatched coverage of this market. We have every intention of keeping that title. First off, we will be releasing an update of the HIE Market Report (target HIMSS’12 release date) with in-depth profiles of some 25 vendors. Second, we are launching a major research project in early February on end users’ experiences and future strategies for their HIE deployments. We have much more planned for this market, but that is a very good start!

How We’ll Do It:
As mentioned previously, I had some help, but not enough and certainly not enough to launch a major expansion of Chilmark Research. To address this issue I went out and found some incredibly bright young people (always believed in the adage, surround yourself with people smarter than you) to join Chilmark Research. They are:

The returning Cora Sharma who’s research use to be the mHealth domain but has now moved to Patient & Consumer Engagement Strategies & Tools.

The former Washingtonian who has returned to his New England roots, Naveen Rao. Naveen’s research focus will be HIE & analytics/BI domains.

And last but certainly not least, my son, John Moore III who in addition to leading an mHealth start-up of his own, will be focusing his research efforts at Chilmark on, you guessed it – mHealth.

Brief bios on these three stellar additions to the Chilmark Research team are over in the “About” section of this website.

I do not hire readily (learned my lessons there long ago) and have been very judicious in choosing only those who show significant promise. I have no doubt in my mind that with some mentoring, these three have the chops to become some of the finest analysts in the industry and the credibility that Chilmark has established in the market will continue to grow.

Speaking on behalf of the Chilmark Research team, we look forward to continuing to provide this vitally important industry that impacts us all with the critical research that is needed to help guide it forward in the successful adoption and use of IT to truly improve healthcare delivery. Each of us are very passionate about this issue, it is a mission for us and through our research we intend to make a positive impact.

Admittedly, our predictions for 2011 were modest. Most of those predictions were logical and did not take a whole lot of imagination to envision thus our success rate, 7 “hits”, 2 “toss-ups” and 2 “misses was quite high. And though are biggest accomplishment, predicting Blumenthal’s departure just a few short weeks before he actually announced such intentions is laudable, by and large these predictions just didn’t go far enough. So for 2012, rather than make simplistic predictions such as “analytics will be a high growth area” or “mHealth will create greater security concerns” or even “ACOs will begin to take hold” as none of these are all that thought provoking, we’ll go out on a limb with many of our predictions. Hopefully that limb won’t crack sending us crashing to the ground.

Without further adieu, here are our predictions:

Consumer/Patient Engagement – Not What it Seems
Despite the best efforts of the team at ONC to beat the consumer/patient engagement drum, providers by and large are still struggling with such basic issues of taking live their certified EHRs, making the transition to ICD-10, meeting physician demands to have everything served up on their new iPad and of course mapping out future strategies in anticipation of payment reform. Thus, we foresee consumer engagement remaining a tertiary issue in 2012. Just too many other pressing priorities at the moment. WebMD’s implosion on Jan. 10^th may portend that this is not such a bad move – at least in the near term.

Bloom is Off the Rose, EHR Market Plateaus
Going out on a limb, we see 2012 as the year when we start talking of the post EHR-era. Yes, there will be plenty more EHR sales in the year to come but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4’12. You heard it here first folks, it is time to collect your EHR winnings and seek new places to invest.

Finally, We’ll See Some Fairly Competent Tablet Apps from Legacy Vendors
Though physicians continue to adopt iPads at a rapid rate, they struggle to effectively use them in the hospitals to which they are affiliated simply because most hospital HIS cannot serve up an application effectively on an iPad. Sure, many have tried using Citrix as a stop-gap measure but this is just isn’t cutting it. In speaking to one CIO of a major IDN recently, he was so frustrated with his core EHR vendor’s slow pace of development that he is about ready to self-fund the development of an App for his physicians. Fear not CIOs and frustrated physicians, we have had the opportunity to see several alpha versions of iPad Apps that major EHR vendors are developing and they actually look pretty good. Look to Q2-Q3 ’12 for general availability release of these touch-screen native (mostly iPad-centric) Apps.

At Gunpoint, Direct Project Gains Traction
In 2011, the message came down from on high, or at least from the feds, that all State HIEs must include the use of Direct in their strategic plan. Pretty clear that this was politically motivated as to date, for the $500M plus we, as taxpayers are spending on these public HIEs, there is very little to show for it and we are now running headlong into an election year and this administration needs to show something, anything, in the way of success as it pertains to health information exchange. Sure Direct facilitates health information exchange (the verb), but so does a fax machine and frankly, Direct is only a modest step beyond faxing. Therefore, Direct will gain traction in these “forced” instances but we do not see it extending its reach into the much larger market of private, enterprise HIEs (does not sufficiently support care coordination, population health and analytics) and thus Direct’s overall impact in the market will be small and fade to nothing in three years time.

First CPT Codes for mHealth Apps Issued
mHealth Apps for care provisioning have not seen any significant adoption beyond pilot studies, studies which typically show some efficacy in their use. The big hang-up is a simple one, the risk to reward ratio for physicians to adopt and use mHealth Apps as part of the care process is too low. What might change that risk-reward ratio though is a CPT code whereby a physician actually gets paid to use, or have a patient use an App as part of the care process. WellDoc is one of the few mHealth App companies that is quite aggressive in moving the ball forward and we would not be too surprised if WellDoc did industry ground-breaking work to secure the first CPT codes for their diabetes management App.

Train has Left the Station as Supreme Court Rules on ACA
Though the Supreme Court will hear arguments for and against the constitutionality of the Affordable Care Act (ACA), it is unlikely that their subsequent ruling will throw out all of ACA (they may prune it). More importantly, the move to value-based reimbursement models is already in full swing, which is something that will not be reversed. Whatever the Supreme Court rules, its impact will be minimal and the numerous changes we are seeing take place today (move to accountable care models, patient centered medical home, etc.) will continue as the train has already left the station.

Changing of the Guard as Dynamic Duo Departs
Last year we predicted the departure of ONC head, Dr. David Blumenthal. This year is an election year and it is expected that there will be a significant changing of the guard across the administration. We predict that the dynamic duo that is Aneesh Chopra, White House CTO and Todd Park, HHS CTO will both be leaving their posts by end of the year.

M&A Continues, but at far more Reasonable Valuations
Okay, yes we have had this prediction for three years running, but we just can’t help ourselves as we see far too many vendors in this market (some 300+ EHR vendors alone!) and some rationalization must enter at some point. We are seeing rationalization on valuations (e.g., no one was willing to pay what Thomson Reuters wanted for their healthcare business unit despite there being a sizable number of bidders) and this will create an opportunity for acceleration in M&A activity in 2012.

Floundering HITECH Initiatives Attract Political Spotlight
Yes, we are seeing some modest success and adoption of EHRs as a result of the HITECH Act but the preponderance of such success is at hospitals that first have had some form of EHR already in place and also have a lot to lose if proposed reimbursement cuts from CMS come to fruition at the end this multi-year march to certified EHR adoption and meaningful use. Yet, under the covers we are still not seeing wide-spread EHR adoption at the ambulatory level, especially among smaller practices, State HIE initiatives struggle to define what they’ll actually be when the grow-up, the Beacon programs have not reached the promise land, and the RECs, well we were never a big fan of these for obvious reasons we outlined previously. As this is an election year, healthcare and anything with the stamp of the Obama administration on it, will become fair game and dragged into the limelight. Get ready for healthcare to become the political piñata of 2012

HIE Vendors Stumble
By the end of 2012, the final awards for State HIEs will conclude and with it the evaporation of the $500M plus honey-pot that attracted so many vendors into this space. What’s next for these vendors? Some will stumble out of the market with little to show for their efforts. Others will work with their public clients to stand-up these public HIEs in order that they provide value to their respective communities, which will not be easy and lead to more stumbling. And of course HIE vendors who have traditionally been focused on public markets will reposition themselves for the private, enterprise market. Some of these vendors are now stumbling in this transition to the enterprise market (requires different sales resources and tactics, technology requirements, etc.). This will result in yet another shakeout in this niche industry sector. (Our forthcoming HIE Market Report will provide further details)

The funny thing about doing these predictions is that as one actually goes through the process of thinking about this market, which is currently going through nearly unprecedented change, one ponders so many other predictions that just end up on the cutting room floor. Some of those include:

Payers continue to struggle with exactly what they’ll offer on the State Health Insurance Exchange.

Pharma companies look to insert themselves directly into physician workflow, via HIT.

Despite rising cost share, consumers still struggle to make intelligent, informed decisions.

Telehealth gets some wind under its wings as big telecoms start aggressive lobbying efforts.

You get the idea, plenty of turmoil, no lack of potential trajectories in technology adoption and use within the healthcare sector and we here at Chilmark Research look forward to continuing to provide thoughtful insight on this ever evolving market in 2012.

So now it’s your turn. Are we on the mark with our predictions? Did we reach too far? Is there a particular prediction that you have which we totally missed? It is you, the community of readers that make this site far richer than we ever could do on our own and we look forward to your feedback.

This is a good article and if you like privacy well worth the read here to find out what goes on behind the scenes with data mining and giving out all kinds of information about yourself to those that mine and sell data.  This article in the New York Times kind of reiterates what I talk about here from time to time.  Now we know what the health insurance companies have “games”.  I have said it before and it comes from a higher resource than me now.  Here’s a couple examples and again I don’t know how popular they are since I don’t do games and don’t use coupons.

Aetna To Offer Online Game Social Game For Personal Wellness- Joins Humana As They Have An Online Game Called FamScape

Health Insurer Humana Introduces a New Game Called FamScape–Making It Fun to Get And Maybe Mine Your Data?

The article further discusses how it used to require a bigger pay back to get folks enticed to play but not any more, egos and being #1 on on social jag is all it takes:)  Who wins?  I think you can figure that out when it comes to the data and what you gave away, but they have the ultimate at the other end, “the data'”.  So did you win or lose?  Healthcare is not alone though as the financial area has some games out there too where you can be a virtual investor and there’s a pretty good chance they have some data to sell.  This is big business as even the retail chain Walgreens said their data selling business is worth just under $800 million and that was last year so maybe it’s growing?  So what’s in a reward today?  Actually the use of data for sale with high frequency traders and Hedge Funds is growing at a rate faster than Facebook

High Frequency Traders Using Social Networks and Growing Rapidly With Algorithms That Find, Sort and Leverage-Growing At A Rate Faster Than Facebook

A new type of analytics the article says…I would agree with that comment and it makes billions for Corporate USA from “free data” that you contribute.  Along that topic there’s also the free data gained from mining state government servers and it has gotten so bad that some states have added software to block the bots.  In North Carolina they threw out CoreLogic and revoked their license to mine and some of these folks that mine are too cheap to pay a few hundred dollars every quarter to update information.  Do wonder why it is so hard at times to get something that is erroneous off your record?  That’s the story on that end. 

Once again this brings me back around to my case of the “Killer Algorithms” that are out there and how they suck you in one way or another and then some work against you later.  If you want to dig deeper on how you get sucked in, the link below has a great video that will explain a lot of this and how it is designed to do just that, suck you in. 

Context is Everything–More About the Dark Arts of Mathematical Deception–Professor Siefe Lecture Given at Google’s New York Office–Big Healthcare Focus

So in essence just one more set of crafted algorithms that get you to participate for nothing and your data gets sold.  I would think many would be tired of this by now but until the education as to what happens on the other side sinks in I suppose it will thrive.  How do you stop it, answer is you don’t as it’s almost impossible but what I think we should do is license and tax those folks that do this and require a disclosure site so anyone wanting to “play the game” knows what happens on the back side and call it the Alternative Millionaire’s Tax as that’s who would be getting taxed, companies making millions for zero output and take free taxpayer data and make billions off consumer’s backs while they entertain themselves with these very crafty algorithms online. 

The Alternative Millionaire’s Tax–License and Tax Big Corporations Who Mine and Sell Taxpayer Data They Get for Free From the Internet-Phase One to Restore Middle Class With Transparency, Disclosure and Money

We don’t know or have a clue as to exactly what is collected and how much the value is on the data, but the billions made sure makes a huge statement and you know we are all still stuck paying federal excise taxes on tires we need for our cars, so this doesn’t make a bit of sense to me. 

You Are the Product–Privacy Anonymity and Net Neutrality On the Internet - Excellent Stanford University Lecture (Video)

This leads me to one final link here and actually it is post I made back in August of 2009, “Do we need a department of algorithms” or something along that line?  I made the post about the time the Madoff case hit the news…SEC certainly needs some new efficient algorithms as it looked like the Facebook IPO filing shut down their site this week too, so see the power that big corporate USA has with their data and algorithms in knowing how to game you and the system?  There was also a comment in the Times article too about how we are headed for a real backlash with all of this and in my opinion the sooner the better as that will indicate a much smarter consumer crowd out there.   BD   

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

FOR the last few weeks, Kenneth Brown has reigned over Samsung Nation, an online loyalty program that offers virtual rewards to consumers who talk up Samsung, the electronics giant.

In the three months since the program was introduced, Mr. Brown, owner of Atlantic Detail Service, a steel detailing business in Athol, Mass., has racked up more than 4.5 million points, often placing him atop the site’s leader board.

Along the way, he has earned a virtual “Twitterati” badge — a turquoise circle — for posting dozens of links to

Samsung.com on his Twitter account. He’s nabbed a virtual “Connoisseur” award for his frequent comments on the Samsung site. And, while newcomers who register for the program might attain mere “Novice” status, Mr. Brown has joined the ranks of the elite “Cognoscenti” by answering many questions from site users.

Game techniques, Mr. Duggan says, prompt consumers to spend more time on company Web sites, contribute more content and share more product information with Facebook and Twitter adherents. One of his clients, he says, uses a gamification program to collect information about 300 actions — like posting comments or sharing with a social network — performed by several million people.

Ian Bogost, a professor of digital media at the Georgia Institute of Technology, for example, refers to the programs as “exploitationware.” Consumers might be less eager to sign up, he argues, if they understood that some programs have less in common with real games than with, say, spyware.

“Why not call it a new kind of analytics?” says Professor Bogost, a founding partner at Persuasive Games, a firm that designs video games for education and activism. “Companies could say, ‘Well, we are offering you a new program in which we watch your every move and make decisions about our advertising based on the things we see you do.’ ”

“There is probably a backlash coming,” Ms. Robertson says. Pretty soon, she predicts, companies may differentiate themselves with anti-gamification promotions like “No points. No annoying missions. Just clean services.”

http://www.nytimes.com/2012/02/05/business/employers-and-brands-use-gaming-to-gauge-engagement.html?_r=1&smid=tw-nytimesbusiness&seid=auto

Well let’s place some serial numbers on those implants, and of course this idea came to light after the situation in Europe with the questionable breast implants and the arrest of the creator.  The chip has been around in many forms and has evolved as I covered it for a few years here myself and owners have changed a bit too.  You can soon have a chip off the old boob. 

VeriTeQ Acquisition Corporation Buys VeriChip Implanted Chip and Health Link Personal Health Record Technology from Positive ID–Implantable RFID and Sensors

The company was the first to announce the chip that talked back to a scanner and even connected with HealthVault but I don’t think it was widespread in use.  We go back to the conversation of “do I want to be chipped”.  I don’t think most of us have issues with chipping our pets but the jury is still out on us having chips. 

PositiveID Corporation's Health Link Personal Health Record – First PHR to Communicate Real-Time Blood Sugar Readings for Diabetics and Their Caregivers/Physicians

“VeriTeQ will focus on three main areas: patient identification and personal health record (PHR) access through the VeriChip implantable microchip and Health Link web-based PHR; implantable sensor applications; and identification of medical devices within the body. VeriTeQ will also focus on identification and sensor applications for animals.”

Siemens like the idea and the back track below tells about their investment.

PositiveID The “Chip” People are Back-an Agreement with Siemens To Expand Wireless Body Monitoring With A Chip Implant

If you are a diabetic, there’s also work being done for an implanted chip to read your glucose numbers and automatically send it to their software which can connect to other software, called GlucoChip.   I don’t know they might hit on something to sell that chip but time will tell.  They are also working in Israel on Inhaled insulin too, so inhale and let the chip do the reporting someday?  In the meantime we have boob chips on the way and I wonder if the boobs will do text and email?  Don’t laugh as there are devices out there that do that and the cardio vascular area has some trials in that part of the body.   

Will there be any charities donating to this cause in the case of reconstruction for breast cancer?  Sorry I just had to add that and a tiny bit of demented humor here.  BD

(RTTNews.com) - VeriTeQ Acquisition Corporation Friday said it will offer its FDA-cleared VeriChip microchip, a rice grain-sized, passive RFID microchip, for the identification of breast implants and other medical devices.

Following the international breast implant scare involving breast implants from French company Poly Implant Prothese (PIP), which used industrial silicone for its breast implants to decrease costs, it was announced yesterday that the European Union is contemplating a manufacturer requirement to embed microchips in breast implants to provide for accurate and immediate traceability of these and potentially other medical devices. It is estimated that approximately 400,000 PIP implants were sold around the world.

Scott Silverman, chairman and CEO of VeriTeQ, said, "The current system for identifying surgically implanted medical devices is archaic and flawed. Once a device is in a person's body, there is no way to know for certain which company manufactured the device or what the specific device is. Embedding our VeriChip within a medical device prior to insertion enables a healthcare professional to scan the area of the patient's body where the device is implanted and receive immediate and accurate confirmation of what the device in question is and its manufacturer."

http://www.nasdaq.com/article/veriteq-to-offer-implantable-rfid-microchip-for-traceability-of-breast-implants-20120203-00781

As you can read below, the full plans remain to be seen yet when it gets down to the actual nitty gritty here.  LSU has been the temporary replacement for patients who formerly were seen at Charity Hospital which we all remember was destroyed with hurricane Katrina.  Last week I made a post about healthcare IPOs and I think it also fits here with the dog and pony shows we still see on Wall Street with the financial side and the fact that hospitals are still struggling.

Greenway Medical Records IPO–Videos and Pictures at NYSE Getting Old as Hospitals and Doctors Struggle for Income And Close

Actually I don’t know why the NYSE still has this big building as all the action takes place over in New Jersey on servers and trading is pretty much all electronic these days and perhaps it would be better suited as a museum since it is part of our heritage and any money collected for tours could be donated to charities, you think?  This comes to mind after the recent Komen stories and how it was all lit up in “pink” for the big shindig that was held there. 

A new hospital is being built and it appears there’s still money from that after reading this article.  I wonder why Senator Vitter is not more pro-active here with his state or is he?  The Vitter Problem…..Of late he seems more pre-occupied with abortions and the silliness that has occurred with wasting everyone’s time.  LSU hospitals have lost $100 million over the last 3 years and have reduced employees by over 400.

There are seven hospitals in the system to be affected and other hospitals are considering their own cuts.  Again, strange times we live in today when we have a lawmaking body that is so out of touch.  BD 

Louisiana State University authorities announced $34 million in cuts to its public hospital system Friday, with a $15 million hit to Interim LSU Public Hospital in New Orleans that will mean eliminating the chemical detox unit and closing beds in the emergency department, mental health emergency extension and psychiatric inpatient unit at the DePaul campus. LSU administrators will submit a detailed layoff plan to the state Civil Service Commission on Tuesday, the same day that individual workers will get their layoff notices.

A drop in state tax revenues necessitated the midyear budget reductions, which where ordered by Gov. Bobby Jindal's administration. The cuts affect the seven-hospital system anchored in New Orleans. The system and its $780 million budget also include facilities in Baton Rouge, Bogalusa, Houma, Independence, Lafayette and Lake Charles. Separately, LSU hospitals in Shreveport, Monroe and Pineville must consider their own cuts.

The Jindal administration maintains that LSU effectively brought the cuts on themselves by budgeting based on money that was never actually appropriated.

At the New Orleans hospital, the big-ticket cuts include:

• Eliminating the 20-bed chemical detox unit: $841,632.
• Closing nine inpatient psychiatric beds on the DePaul Hospital campus, leaving 29 open: $663,007.
• Closing 10 mental health beds in the emergency department, leaving 10 open: $853,673.
• Closing four general emergency department beds, leaving 40: $1.43 million.
• Closing 24 medical/surgical beds: $1 million.
• Cutting additional personnel across all departments: $4.94 million.
• Scaling back treatment for state prisoners: $2 million.
• Cutting professional services contracts with Tulane physicians/professors: $2.29 million.

According to the LSU Health Care Division's most recent annual report, Interim LSU Public Hospital had 283 staffed adult and pediatric beds, along with 38 staffed psychiatric beds, with almost 15,000 annual inpatient admissions. Nineteen nursery and neonatal ICU beds have since closed. The hospital had 2,284 full-time employees.

The hospital, the temporary successor to Charity Hospital, is expected to remain in operation until early 2015, the promised launch for the $1.1 billion University Medical Center project under way in Mid-City, across Tulane Avenue from LSU's existing medical campus.

http://www.nola.com/politics/index.ssf/2012/02/lsu_making_15_million_in_cuts.html

I'll be taking a break from Tech Medicine as Healthline redesigns its Health Experts Network. If you're interested in more musings on technology and medicine, here's how to find me:Blog: Info-SnacksTwitter: JoshuaSchwimmerNephrology and Internal Medicine: www.kidneydoctor.us

Image via CrunchBaseThe first iPad reviews are out, and they're very positive. Here's a selection of the reviews (compiled by MacRumors): David Pogue, New York TimesWalt Mossberg, All Things DAndy Inhatko, Chicago Sun TimesHere's a roundup of recent medical blogs commentary on the iPad: iMedical Apps has a nice review of how 5 medical apps might appear on the iPad, including the Blausten Human...

Image via WikipediaIn November 2009 Hall & Partner published a study sponsored by Google titled "Connecting with Physicians Online." (Here's the webinar on YouTube and here's the PDF of the presentation.) The study's aim was to better understand how physicians use the internet in their clinical practices. As you'd expect from a study sponsored by Google, it was particularly focused on how...

Those who fail to learn from history are doomed to repeat it, or so the saying goes.

My controversial piece on Silicon Valley missing the point of healthcare last summer doesn’t seem so controversial now, as I recently got some validation from others closer to the action than I am. First, reDesign Mobile analyst Rocky Agrawal wrote in VentureBeat that Silicon Valley might be “too smart for their own good,” building products more suited for highly educated techies than for the masses. Last week, former Apple and PepsiCo CEO John Sculley suggested at the Digital Health Summit at 2012 International CES that technology for its own sake is rather useless if you don’t understand the market you’re targeting.

“”The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,” Sculley said, as I report in InformationWeek Healthcare and in tomorrow’s MobiHealthNews.

After raking Rock Health over the coals in my commentary last summer, I offered qualified praise to the San Francisco-based investor/business accelerator for healthcare start-ups last month on this blog. “I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients.” I wrote.

“I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.”

Tomorrow, I am planning on attending the kickoff event for Healthbox, a similar healthcare business accelerator that differs from Rock Health in at least one key way: it is not in Silicon Valley, but right here in down-to-earth Chicago. Does that make a difference? Well, the kickoff isn’t at a hotel ballroom or Healthbox’s office, it’s in an artsy space called the Ivy Room, in the heart of River North, an area usually populated by more tourists than locals.

I sure hope I’m not in for an over-the-top extravaganza that will highlight cool, direct-to-consumer apps with a snowball’s chance of catching on with the entities that actually pay the bills for healthcare. I want to believe there’s something real here, which is why I’m giving up at least a couple hours of my time to see the presentations. Please tell me that Chicago isn’t becoming a Silicon Valley clone, but rather the hub of health IT innovation it could be.

For what it’s worth, here is the list of companies scheduled to present tomorrow: UnitedPreference, DermLink, SwipeSense (“a comprehensive hand-hygiene solution,” whatever that means, The Coupon Doc, CareWire, Iconic Data, PaJR-Patient Journey Record (helping hospitals avoid 30-day readmissions, potentially making it a Big Deal), CareHubs, Corengi (linking diabetics to clinical trials) and PUSH Wellness. I see real potential in at least four of those, possibly more.

 

Related posts:

1. Join the discussion on substance vs. style in healthcare innovation
2. Rock Health seems to be learning
3. Someone else takes a swing at Silicon Valley hype

Other locales may get more press in this industry,  but the Chicago area has a surprisingly strong community of health IT vendors.

It is well known that Allscripts is headquartered at the Merchandise Mart. GE Healthcare, while based just outside Milwaukee, maintains a large IT center in northwest suburban Barrington, Ill. CDW, based in Vernon Hills, Ill., runs its healthcare division from a downtown Chicago office. Numerous smaller vendors dot the area, too. And then there is Merge Healthcare, a medium-sized firm that historically has specialized in software for medical imaging.

Last week, I visited Merge’s home office in the Aon Center, an iconic skyscraper previously known as the Amoco Building and, before that, the Standard Oil Building. There, CEO Jeff Surges gave me a history of the company and talked about changes in the company and in the health IT field in general. Then, I turned on my video camera so Surges, sporting an orange necktie, could explain why Merge has adopted orange as its company color.

Following my interview with the CEO, Gilbert Gagné, also wearing an orange tie, gave me a demo of Merge iConnect Access, an image viewing system than works through any Web browser. I got the iPad portion of the demo on video, too.

I shot this in 720p high definition, but only uploaded it at 360p to save time. Let me know if you want HD so the iPad screen appears a little sharper.

Related posts:

1. Merge Healthcare opens its code
2. Video: Overview of mobile healthcare technologies
3. Video: athenahealth’s Jonathan Bush at HIMSS11

As I first mentioned in August, John Lynn and I had the thought that it would be great if Twitter co-founder and HIMSS12 keynote speaker Biz Stone would show up at John’s 3rd annual New Media Meetup. Stone didn’t respond to our halfhearted attempt back then, but now the conference is less than two months away, and I have to imagine he will be making his plans soon, if he hasn’t done so already.

HIMSS social media guru Cari McLean also would love for Stone to meet and greet conference attendees at the HIMSS Social Media Center after his keynote on the morning of Tuesday, Feb. 21, per her tweet in response to one of mine:

That means that now is the time to put social media to work to get Stone to make a couple of appearances. Stone’s Twitter handle is @Biz. Tweet away, using the hashtag #BizatHIMSS12 and perhaps add #hcsm (for healthcare social media). Blog about this effort. Post on LinkedIn, Facebook and Google Plus. I may even make a YouTube video. Let’s impress Stone with the power of social media and get him to mingle with the masses in Las Vegas.

 

Related posts:

1. Get Biz Stone to come to New Media Meetup at HIMSS12
2. Twitter founder Biz Stone to speak at HIMSS12
3. Confusion with HIMSS12

The FreeMedForms team is glad to announce the release of a new stable version of the pharmaceutical drug prescriber FreeDiams.

This version comes with multiple update: drugs database updated, interaction engines and data updated. Experimental potentially inappropriate medication in the elderly drug engine based on the Beers criteria (without diagnosis or conditions).

Feel free to contact us: freemedforms@googlegroups.com

Download and information: Visite our web site

GNU Solidario is happy to announce the release of GNU Health 1.4.1, in which we have incorporated support for PyPI, the Python Package Index

In marking 10 years of the Southern California Linux Expo (SCALE) and 20 years of Linux, the SCALE team wants to incorporate an open-source approach to this year’s expo logo designs for publications and for swag. With this in mind, the SCALE team announces a contest to select the artwork for use on this year's conference materials. The designer of the winning submission will win a free pass to SCALE 10x, including airfare within the continental United States, as well as a three-night stay at the Hilton Los Angeles Airport. SCALE is a community organized Linux and open-source conference held annually in Los Angeles, CA. SCALE's call for papers is open through November 17th as well, for those who wish to submit a session proposal.

The West Virginia Record reports the filing of a medical record breach action against West Virginia University Medical Corporation dba University Health Associates (UHA) under the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The action filed in Monongalia Circuit Court was filed by Jennifer M. McGinley on behalf of Randy Friend (11-C-774).

The complaint asserts that Mr. Friend received a letter from UHA indicating that an employee had accessed his medical record without authorization. Mr. Friend claims that his medical record was accessed multiple times by a former UHA employee and that this former employee related the medical information to several other people living in Mr. Friend's community causing him emotional distress and embarrassment.

Also, Jeff Drummond at the HIPAA Blog reports on an interesting lawsuit filed by the Minnesota AG against Accretive Health in Minnesota. The action involves Fairview Health and North Memorial who hired Accretive Health as its debt collection company. Accretive Health lost an unencrypted laptop with medical and other personal information. As Jeff indicates this has some interesting aspects including the question of direct liability of a business associate under the HITECH amendments to HIPAA and also whether the covered entities only disclosed the "minimum necessary" information to its debt collection company. Interesting case to watch develop.

UPDATE: The complaint filed in the United States District Court District of Minnesota, State of Minnesota, by its Attorney General Lori Swanson v.Accretive Health, Inc.

The West Virginia Health Care Authority has announced the 2012 certificate of need capital expenditure minimum threshold of $2,916,104. The new threshold is effective beginning January 1, 2012. The threshold is used as a part of the analysis by health care providers who must determine whether or not a certificate of need is required for a proposed project or health care acquisition. 

Pursuant to W.Va. Code 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment isbased on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2011 is 2.9%.

InterSystems Corporation, a global leader in software for connected care, announced that InterSystems HealthShare™ has been chosen to support health information exchange (HIE) throughout Denmark.

Birmingham City Council has launched its large-scale, city-wide telecare service in partnership with Tunstall. The service, which is believed to be the first of its kind in the UK, will benefit up to 25,000 people over the next three years

7 February 2012, 3pm Central European Time.
This HIMSS Europe webinar provides theoretic background as well as practical insights from Onkologikoa, a specialized Oncology hospital, as well as MedicalExchange Medting, which offers a family of web products for eHealth, from collaboration platforms to online medical viewers.

If you are a compliance officer, medical code auditor, or work in a physician medical office that is moving toward a formal compliance plan, a toolkit offered by AAPC Physicians Services could make your job easier. The new and improved Compliance Toolkit...(read more)

The rate of electronic health record adoption among priority primary care providers is rising rapidly in Pennsylvania, Delaware, and Southern New Jersey, according to directors of the regional extension centers in those states. The directors presented...(read more)

As the economy continues to squeeze donors, a recent report conducted by Campbell Rinker showed disturbing results-that nearly 7 in 10 Americans say they will give more sparingly to charities in the coming months. As a result, people are looking for other...(read more)

HHS has published Hospital Incident Reporting Systems Do Not Capture Most Patient Harm that only 14 percent of patient harm events experienced by Medicare beneficiaries are captured.The major highlights from a survey of 189 hospitals:Hospital staff did not report 86 percent of events to incident reporting systems, partly because of staff misperceptions about what constitutes patient harmNurses most often reported events, typically identified through the regular course of care; 28 of the 40 reported events led to investigations and 5 led to policy changesHospital accreditors reported that in evaluating hospital safety practices, they focus on how event information is used rather than how it is collected.A great systems topic to explore how these silos can be put together and submit your findings to the Clinical Informatics area of the systems-oriented Health Systems.

The Crosson et al (2012) study just published in The Journal of the American Board of Family Medicine reinforces what has been known for some time.  E-prescribers continue having trust issues with electronic formulary checks and electronic medication histories.  Why would an e-prescriber spend the time checking an unreliable e-formulary if the pharmacy must do so anyway for adjudication?  How do you trust the completeness of a medication history (from claims database) when many filled prescriptions may not appear (e.g., paying cash for $4 generic at Target rather than $25 for same generic via insurance coverage).  The authors point out pharmacy sales data might be a better alternative.  Even if the information were available, there are issues with secondary use of pharmacy sales data that need to be addressed.The premise of e-prescribing is that increasing the ease of information access enables collaboration in this inter-organizational network.  Information integrity has been a known problem in inter-organizational environments as the importance of controlling integrity via the infrastructure has not been appreciated (Wilkin and Chenhall, 2010).  There are no easy solutions but a meaningful dialogue must begin.  The prescribers do want this information (Lapane et al, 2011).CROSSON J C, SCHUETH A J, ISAACSON N and BELL D S  (2012)  Early adopters of electronic prescribing struggle to make meaningful use of formulary checks and medication history documentation. The Journal of the American Board of Family Medicine  25(1), 24-32. LAPANE K L, WARING M E, DUBÉ C E and SCHNEIDER K L  (2011)  E-prescribing and patient safety: Results from a mixed method study. The American Journal of Pharmacy Benefits  3(2), e24-e34. WILKIN C L and CHENHALL R H  (2010)  A review of IT governance: A taxonomy to inform accounting information systems. Journal of Information Systems  24(2), 107-146.

Mini-Track Cochairs: Nelson King and Sweta Sneha Healthcare information technology (HIT) is shaping the future of healthcare whether by mandate or the desire of healthcare organizations to improve the quality of patient care.  The push is towards integrated HIT which arguably mirrors the push over the past 20 years to move from silos of automation to enterprise systems.  This mini-track seeks papers that take a systems view towards clinical informatics. Clinical informatics brings together clinical workflow and business strategies of a healthcare organization through timely and accurate exchanges of information.  Healthcare organizations and the information they exchange are becoming increasingly complex necessitating fresh methodological and theoretical approaches on the part of researchers.  Submissions with a systems orientation and clearly articulated context of use that showcase inter-disciplinary thought are trademarks of papers published in this area.  The boundaries of the system should be defined and the interplay within and external to the system should be described.  By systems, we mean a broader view than a singular focus on the efficacy of a feature or function within a specific HIT.  An integrated system might be multi-function HIT like an EMR/EHR or a set of technologies that result in measurable outcomes.  Such outcomes should reflect the interplay between functionality, workflow, information and strategy.  Alternatively, the implications of infrastructure on HIT functionality and system use could be explored (e.g., e-infrastructures). The system might also be the interplay between social and technical aspects of an HIT.  Submissions that can be readily extended to a quality journal article will be considered for fast-tracking by the editors of Health Systems Journal (HSJ) coordinated by Nelson King (Clinical Systems Area Editor).  Any invitation would be subject to the willingness of reviewers to continue through the HSJ submission process and an assessment that a solid extension of the work is feasible.A complete description of the Systems-oriented Clinical Informatics Mini-Track is available on the AMCIS 2012 website.

NIST would like suggestions from the public regarding how federal agencies should be involved in the standardization system. Standardization areas include but are not limited to: smart grid, health information technology, cybersecurity, emergency communications interoperability, radioactivity detector and radiation monitors. Public comments are due by February 7, 2011.

Read the full story:
http://www.healthcareitnews.com/news/nist-seeks-input-government-involvement-standardization

By yesterday, two states had already sent out checks to Medicaid participants just two days after registration for the program had opened. The checks came from Kentucky and Oklahoma, with many other states soon to follow. There has been some skepticism regarding how smoothly the meaningful use incentives programs will go. Maybe these recent events will put people more at ease.

Read the full story:
http://www.healthdatamanagement.com/news/meaningful-use-ehr-incentive-check-medicaid-41699-1.html?ET=healthdatamanagement:e1596:159225a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_010611

Experts are already making disheartening predictions for health information privacy in 2011, such as increased fines, data breaches, regulations, penalties, etc.

What are your thoughts on the issue?

Read the full story:
http://www.healthcareitnews.com/news/experts-name-top-7-trends-health-information-privacy-2011

 

Just today we announced the expansion of HealthVault in China, specifically in the Jiangsu province of Wuxi. This is definitely a big step in the international expansion of HealthVault outside of the United States and joins the other international deployments in Canada (doc), Germany and the UK.

Microsoft Corp. and iSoftStone Information Technology (Group) Co. Ltd. have signed an agreement that enables iSoftStone to introduce Microsoft HealthVault technology to the Chinese market. HealthVault, a personal health application platform, enables individuals to store and manage their health information in a personal, online account. Initially focused on Wuxi, in the province of Jiangsu, the vision of the Microsoft-iSoftStone relationship is to enable citizens to connect to various health systems and services run by government organizations, physicians, hospitals, pharmacies and even fitness facilities for a comprehensive view of their personal health information. iSoftStone will be the exclusive operator of HealthVault in Wuxi and will develop and offer the HealthVault-based services to developers, application providers and device manufacturers to provide citizens with tools that will help foster dynamic, trusted and personalized healthcare.

Check the rest of the press release online.

iSoftStone Signs Agreement With Microsoft to Develop Citizen Health Solutions in China Using HealthVault: Digital health innovation center is first step of a joint healthcare effort in Wuxi, China.

Well, this is at least a partial excuse for my absence from this blog :-)

Today we announce the acquisition of Sentillion, Inc demonstrating again Microsoft’s level of commitment to the healthcare industry.

Many of you reading this are familiar with Sentillion and this acquisition is the culmination of years of successful partnership between the two companies. Our primary goal with the acquisition is to make it easier for healthcare professionals to deliver better patient care by streamlining access to multiple IT applications and patient data by combining Amalga UIS and Sentillion’s solutions for single-sing-on and context management.

So far we have received excellent feedback and I am really excited about the Sentillion folks joining the ranks of the Health Solutions Group and Microsoft.

For more detail please have a look at the press release.

The HealthVault Solution Conference that we did last year has evolved into a broader event that includes more of the solutions that Microsoft has to offer in Health.

The Connected Health Conference will be held on June 10-12 in Bellevue, WA and we’re going to feature a lot of content both around Amalga UIS and HealthVault and an exceptional lineup of speakers including David Kibbe, Governor Michael Leavitt, Uwe Reinhardt, Mark Smith and Peter Neupert. Lastly we’re going to have a few surprises in store both for HealthVault and Amalga UIS, so make sure you rush and register, we have limited space available and we expect a lot of people!

Web 2.0 was coined as a cool name for a conference about the state of the internet back in 2004. Kind of a play on the fact that software is released in ‘versions’ (1.1, 1.4, 1.2.3.1.2, etc, etc) whereas the web is clearly evolving and branching in a way that defies this kind of classification.

Web 2.0 draws an arbitrary line that says the current state of the web is significantly different now from how it was a few years ago.

There’s been a lot of talk about what Web 2.0 really means and what it doesn’t (here’s the official line from Tim O’Reilly who coined the term).

Here’s an anthropological take on Web 2.0:

Learn about heart anatomy and physiology through the power of song…

More medical videos.

This online app could be use for students creating their own learning projects or for staff to create course notes and resources for their students.

This is the next post in my series of Do’s and Don’ts Healthcare IT. As we all know, some of our most important citizens live in rural settings, small cities, the countryside, or remote areas. These areas have smaller populations and less direct access to vital healthcare resources. In the past 15 years or so we’ve made some great strides in remotely accessible healthcare; these offerings, called telemedical tools, provide important clinical care at a distance. Here are some do’s and don’ts of telemedicine:

• Do use commonly available web meeting and online video tools bring expert caregivers anywhere. WebEx, GotoMeeting, Adobe Connect, Skype, and a variety of other “web meeting” tools used mostly in professional office settings and remote sales pitches are wonderful tools to connect caregivers in populated communities to their rural patients. A simple $30 to $50 per month account on the physician side with almost no direct cost for the patient is an excellent way to engage with patients. These kinds of web meetings can happen securely either at the patient’s home or patients can be brought into satellite offices with high-quality telepresence. Then, instead of waiting for days or weeks for a health professional to travel to an area or patients having to take off many hours or entire days traveling to experts in big cities, care can be given almost immediately with less inconvenience. Don’t assume that kinds of web meeting solutions are HIPAA compliant out of the box; however, do realize they can be made HIPAA compliant with appropriate protections.
• Do use medical devices for remote monitoring of in-home care improve clinical observations. While web meetings are great for basic primary care, it’s not perfect for elder care, long-term care, and other types of clinical requirements. There is a new class of devices that can put near-hospital-quality patient monitoring devices into patient homes and “beam” that data to monitoring centers that can watch for important events across many patients in different geographical areas. Toss in a nurse or other caregiver that can visit once a week or once a month to calibrate the devices and you can see how much more convenience patients can have and have their physicians, wherever they may be, have immediate access to their actual vitals and clinical status.
• Don’t assume that medical device connectivity will be fast or easy to do on your own — you’ll need something like Qualcomm’s 2net platform. 2net is a trustable, Class I FDA-listed, standalone gateway with an embedded cellular component that sends clinical data truly “in the cloud” without requiring local internet connectivity. Medical data can be sent from devices in the same way that e-books can be read on Kindle devices – using 3G cellular, from mobile phones, and software APIs.
• Don’t always send patients to labs; instead, take labs to patients with mobile imaging and lab specimen collections that allow remote reading and web-based report distribution. It’s difficult for many rural communities to have their own full diagnosticians but mobile imaging centers and lab specimen “kiosks” can do the X-rays, take pictures, and perform collections and then send the data electronically to large populated centers where they can be “read” and analyzed; the reports can be distributed via secure e-mail or other web-based applications to doctors in the rural areas or physicians remotely available and connected through web meeting or other similar tools.
• Do try and make behavioral health, mental health, and related care made more accessible. Veterans of our foreign wars are coming home with many problems that can be easily diagnosed with proper access and many of the veterans live in rural communities; while primary care and specialty care is difficult to get in smaller population regions, behavioral and mental health is even harder to access. Telemedical assistance through online chat, Skype-like video conversations, and secure online messaging can provide quick relief.
• Don’t leave patients on their own and encourage them to join online communities. Online community building tools allow populated city citizens to meld with their rural counterparts. Patients helping other patients is a terrific approach to extending care; sometimes what a patient needs is not necessarily a health professional but a curated session with fellow patients going through the same problems. Online, electronic, community tools such as PatientsLikeMe.com can connect geographic communities and bring them closer together without increasing costs or requiring anything more than a simple mobile phone or computer.

What do’s and don’ts would you add to a telemedicine strategy? Drop me a comment below.

I recently wrote, in Do’s and Don’ts of hospital health IT, that you shouldn’t make long-term decisions on mobile app platforms like iOS and Android because the mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A couple of readers, in the comments section (thanks Anne and DDS), asked me to elaborate mobile and mHealth strategy for healthcare professionals (HCPs) and hospitals.

A couple of the key points were:

• (Anne) how can you avoid making long-term mobile decisions at this point?  After all, hospitals that don’t steer their doctors are going to be managing whatever technology the doctors invest in, aren’t they?
• (DDS) the risk is that people will take this to mean that they shouldn’t move at all on mobile app platforms, and this would be a mistake. This is the perennial issue with health IT; if it’s not perfect, then wait.

The approach I recommend right now for mobile apps, if you’re developing them yourself, is to stay focused on HTML5 browser-based apps and not native apps. So, to answer Anne’s and DDS’s question specifically, no you shouldn’t wait to allow usage of mobile apps by anyone; but, if you’re looking to build your own apps and deploy them widely (not in simple experiments or pilots) then you shouldn’t write to iOS or Android or WP7 but instead use HTML5 frameworks like AppMobi and PhoneGap that give you almost the same functionality but protect you from the underlying platform wars. In the end, HTML5 will likely win and it’s cross-platform and quite functional for most common use cases. If you’re not developing the apps yourself and using third-party apps, then of course you must support the use of iOS native, Android native, and soon Windows native apps on your network.

So, from a general perspective you should embrace mHealth but do so in a strategic, not tactical manner. Here are the most critical questions to answer in a mHealth strategy — it’s not a simple one size fits all approach:

• How will you allow doctors’ or patients’ own devices within your hospitals / organizations — simply by providing connectivity and wireless access on the production network or some other means?
• How will you allow doctors’ own devices to connect to hospital IT systems?
• How will you extend hospital IT systems via hospital-owned mobile devices?
• How will you allow the hospital or organization to “prescribe” the use of apps to patients and track the usage of apps?
• How will you approve or deny the use of certain apps that may not meet FDA regulations if they get close to MDDS or Class 1/2/3 devices?

If there is interest in this topic, I will expand on my list of Do’s and Don’ts — mHealth is a very complex topic and requires a good strategy. Just saying that you allow the use of mobile devices like smartphones in your hospital is not an mHealth strategy.

In case you haven’t seen it, MU attestations data is now available on Data.gov and it includes analyzable vendor statistics.

The data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the National Coordinator for Health IT, Certified Health IT Products List. This new dataset enables systematic analysis of the distribution of certified EHR vendors and products among those providers that have attested to meaningful use within the CMS EHR Incentive Programs. The data set can be analyzed by state, provider type, provider specialty, and practice setting.

The data set does not include dollar amounts or the difficulty of attestation (e.g. how many times it took to pass). I’ll try and find out if that data might be available in the future. It’s also unclear whether the provider counts were broken up into each line (meaning one provider per row) or if multiple providers were aggregated into lines (meaning multiple providers were grouped).

The dataset is available now on Data.gov at http://www.data.gov/raw/5486 and is worth checking out. Since the file has been downloaded over 75 times, it’s clear some of you already know about this so if you’ve done some analysis with it; if you’ve done any analysis or posted results please drop me a note below so that everyone can benefit.

Add this one to the ledger tallying health IT's efficacy. A large study from Surescripts, which looked at more than 40 million prescription records from 2008 to 2010, found that e-prescribing resulted in a 10 percent boost to the rate of first-fill medication adherence -- an outcome that has significant...

If you’re a single physician or small practice, you may be feeling overwhelmed at the abundance of options you have for an electronic health records system.  Before purchasing electronic health records software, you should keep several factors in mind including practice management features...

EHRoutlook continues its investigation into commonly asked questions about the federal EHR Incentive Program. In this installment of the FAQ series, we consider a physician's options when he sees a patient at a site devoid of certified EHR system. Question: If an eligible professional (EP) sees a...

Mobile Health (mHealth) also involves managing the mobile workforce, but I don't often hear this administrative function being discussed.  In our efforts to increase access and the quality of healthcare and reduce costs we are moving beyond COWs (computers on wheels) and leveraging and adopting more mobile technologies, such as, tablets and smartphones.  So, lets see what kind of discussion this blog post will generate.

A few months ago I read the book Managing the Mobile Workforce and appreciate the guidance on leading, building and sustaining virtual teams.  I was especially happy to see a couple of examples drawn from healthcare environments. One of these examples caught me a bit by surprise.  It involved looking at employees who spend most of their workday out of any office (or nursing station) and on the units attending to patients.  Or those in ancillary and support roles who move from department to department or drive between clinics or other sites throughout their workday. 

My first question is have we, as healthcare leaders, really thought about the new workforce paradigm and our ability to communicate with and supervise workers who are increasingly on the move during the day?

I do believe that effective healthcare leaders will begin to recognize the strategic value of more flexible work arrangements and this will include virtual and remote workers.  Telemedicine technologies are facilitating access to clinicians at a distance and remote coders and IT support are becoming more popular.  But, there are other functions that can easily be performed from a distance with today's technology -- at least a portion of the time.  Traditionally, hosptials and other providers have expanded their real estate to house these workers, rather than turning to "telecommuting" arrangements.  

My second question is are healthcare leaders beginning to recognize that mobility can actually increase productivity and will they follow other industries who are turning to remote and virtual workers to stay competitive?  If so, have they really thought through how to develop motivated and engaged virtual teams?

A new, more mobile workforce in healthcare will also require thought about the type of person needed to fill the job that needs to be accomplished.  And, it will require that supervisors learn strategies to train, support, motivate and manage the performance of teams that include both onsite and remote workers.

My third question is do healthcare supervisors and managers recognize the importance of trust and how to build it with workers across vast distances?

A final question focuses in on the technologies that are improving our ability to even consider the idea of expanding the remote and virtual workforce.

Do healthcare managers, especially high-level ones, know what the tools can do, and what their limitations are, so they can manage their teams more effectively?  

 

In December, I came across 5 considerations for hiring remote workers and I believe they are an ideal starting point for healthcare leaders who are beginning to reflect on mobility in their workforce.  These five considerations set the foundation for starting to create your organization's strategy for managing a mobile workforce.

1. Create Common Goals

2. Set Individual Goals and Expectations

3. Develop Trust and Accountability

4. Overcome Isolation

5. Plan Regular Communications

A new online toolkit will serve as a pilot program for providing health information technology (HIT) resources to rural health care providers. The toolkit was developed by the Rural Assistance Center and the National Rural Health Resource Center and is designed to help rural providers find resources for HIT, electronic health records (EHR), meaningful use and related topics.

The toolkit provides guidance with planning, setup, implementaiton and operation of a HIT infrastructure, as well as, information on training programs, funding support and management expertise.  Using the toolkit, rural communities will be able to:

• Address challenges in finding capital funding
• Provide support to community colleges to enhance training programs
• Stay informed about legislation affecting EHRs
• Leverage multiple federal resources for project development

Terry Hill, executive director of the National Rural Health Resource Center, emphasizes, “A lot of rural providers need guidance on putting an HIT system in place. This toolkit gives them a starting point and can help them get through the entire implementation process.”

 

Hospital—General – These toolkits contain evidence-based resources to help inpatient facilities improve performance around some of the most common and most serious patient safety problems faced by hospitals today.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients
• Patient Multidisciplinary Training for Medication Reconciliation
• Implementing a Program of Patient Safety in Small Rural Hospitals ;
• Preventing Venous Thromboembolisms in the Hospital
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia
• Reducing Discrepancies in Medication Histories and Orders at Handoffs
• Testing the Re-Engineered Hospital Discharge (One of my favorites- see Louise)
• Using Military Simulation to Improve Rural Obstetric Safety

Emergency Departments – These toolkits contain resources to help hospitals apply evidence-based safe practices in the Emergency Department (ED) to improve patient flow, implement a multidisciplinary simulation-based safety curriculum, and improve medication safety by implementing a formal ED pharmacist program.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Patient Flow in the Emergency Department
• A Simulation-Based Safety Curriculum in a Children's Hospital Emergency Department

Hospital Care Units – These toolkits contain resources to help hospitals apply evidence-based safe practices.

• Implementing Reduced Work Hours to Improve Patient Safety
• Improving Patient Safety Through Enhanced Provider Communication
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia

Outpatient Settings – These toolkits contain resources to help facilities address outpatient medication safety by applying evidence-based safe practices.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Safety in Clinics for Patients 55 and Older 
  Improving Warfarin Management
• Patient Multidisciplinary Training for Medication Reconciliation
• Testing the Re-Engineered Hospital Discharge

Consumer/Patient Care – These toolkits contain resources to help facilities educate consumers in medication safety and post-hospital care.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Improving Medication Safety in Clinics for Patients 55 and Older
• Improving Warfarin Management
• Testing the Re-Engineered Hospital Discharge
• Using Military Simulation to Improve Rural Obstetric Safety 

Additional toolkits may be added as they are developed and will be found at http://www.ahrq.gov/qual/pips/