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:
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:
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:
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.
Last year I started a series of “Do’s and Dont’s” in hospital tech by focusing on wireless technologies. Folks asked a lot of questions about do’s and dont’s in other tech areas so here’s a list of more tips and tricks:
One of the most important activities you can undertake before you begin your EHR implementation journey is to standardize and simplify your processes to help prepare for automation. Unlike humans, which can handle diversity, computers hate variations. Before you begin your software selection process, get help from a practice consultant to reduce the number of appointment types you manage, reduce the number of different forms you use, ensure that your charting categories (“Labs”, “Notes”, etc.) don’t look different per patient type or physician, determine how you will manage medication lists and problem lists across the patient population, and deal with how you’ll manage paper in your digital world.
If you spend even just a few hours a week doing the prep-work before you buy any software, you will be better prepared in your selection process. Without some level of standardization your EHR implementation will either fail, be delayed, or have many unhappy users; the more you can standardize and simplify, the more likely you will have a successful outcome. A strong project manager with authority to make decisions will be the difference maker in the simplification process.
To help you with your workflow assessment and standardization efforts, check out the The Agency for Healthcare Research and Quality (AHRQ.gov) Workflow Assessment for Health IT Toolkit. Even if you’ve done workflow assessments before, the toolkit is worth checking out.
As most of my regular readers know, I work as a technology strategy advisor for several different government agencies; in that role I get to spend quality time with folks from NIST (the National Institute of Standards and Technology), what I consider one of the government’s most prominent think tanks. They’re doing yeoman’s work trying to get the massive federal government’s different agencies working in common directions and the technology folks I’ve met seem cognizant of the influence (good and bad) they have; they seem to try to wield that power as carefully as they know how. Since most of you are in the technology industry, albeit specific to healthcare, I recommend that you learn more about NIST and the role it plays – they can make your life easier because of the coordination and consensus building work they do for us all. I, for one, was thrilled when NIST was picked as the governing body for the MU certification criteria. These guys know what they’re doing and I wish they got more involved in driving healthcare standards.
A few years ago NIST came up with the first drafts of the seminal definitions of Cloud Computing; they ended up setting the stage for communicating complex technical concepts and helping making “Cloud” a household name. After 15 drafts, the 16th and final definition was published as The NIST Definition of Cloud Computing (NIST Special Publication 800-145) in September. It’s worth reading because it’s only a few pages and is understandable by the layperson. No computer science degree is required.
Yesterday I was speaking to a senior executive in the EHR space and we had a great discussion on what healthcare providers are doing in terms of cloud computing and how to communicate these ideas to small practices as well as hospitals. It reminded me of the numerous similar conversations I’ve had with other senior executives we serve in the medical devices and other regulated IT sectors. In almost every conversation I can remember about this topic over the past couple of years, I had to remind people that NIST has already done the hard work and that we can, indeed, rely on them. Most of the time the senior executive was unaware of where the definitions came from so I figured I’d put together this quick advisory.
My strong recommendation to all senior healthcare executives is that we not come up with our own definitions for cloud components – instead, when communicating anything about the cloud we should instruct our customers about NIST’s definition and then tie our product offerings to those definitions. The essential characteristics, deployment models, and service models have already been established and we should use them. When we do that, customers know that we’re not trying to confuse them and that they have an independent way of verifying our cloud offerings as real or vapor.
Below I have copied/pasted from NIST 800-145 their key definitions. Imagine how many debates you would avert with technicians at clients when, during conversations with a client, you communicated some of the following information first, showed them how it was a “standard definition” and handed them a copy of the publication, and then mapped your offerings and discussions to the different areas. Your sales teams and the marketing teams would appreciate the clarity, too.
Note that you do not need to map every offering you have to every definition – just start mapping the obvious ones and then figure out how you can communicate the “gaps” as being not applicable to your products / services or if those gaps will be filled in the future as part of your roadmap. Treat these definitions as canonical but not inclusive – meaning that just because your SaaS offering doesn’t fit every essential characteristic doesn’t mean that you’re not “cloud” – it just means partially cloud.
If you’ve got questions about how to map your product offerings, drop me some comments and I’ll assist as best as I can.
Here are the key definitions from NIST 800-145, copied directly from the original source:
Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics, three service models, and four deployment models.
On-demand self-service. A consumer can unilaterally provision computing capabilities, such as server time and network storage, as needed automatically without requiring human interaction with each service provider.
Broad network access. Capabilities are available over the network and accessed through standard mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile phones, tablets, laptops, and workstations).
Resource pooling. The provider’s computing resources are pooled to serve multiple consumers using a multi-tenant model, with different physical and virtual resources dynamically assigned and reassigned according to consumer demand. There is a sense of location independence in that the customer generally has no control or knowledge over the exact location of the provided resources but may be able to specify location at a higher level of abstraction (e.g., country, state, or datacenter). Examples of resources include storage, processing, memory, and network bandwidth.
Rapid elasticity. Capabilities can be elastically provisioned and released, in some cases automatically, to scale rapidly outward and inward commensurate with demand. To the consumer, the capabilities available for provisioning often appear to be unlimited and can be appropriated in any quantity at any time.
Measured service. Cloud systems automatically control and optimize resource use by leveraging a metering capability1 at some level of abstraction appropriate to the type of service (e.g., storage, processing, bandwidth, and active user accounts). Resource usage can be monitored, controlled, and reported, providing transparency for both the provider and consumer of the utilized service.
Software as a Service (SaaS). The capability provided to the consumer is to use the provider’s applications running on a cloud infrastructure2. The applications are accessible from various client devices through either a thin client interface, such as a web browser (e.g., web-based email), or a program interface. The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings.
Platform as a Service (PaaS). The capability provided to the consumer is to deploy onto the cloud infrastructure consumer-created or acquired applications created using programming languages, libraries, services, and tools supported by the provider.3 The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, or storage, but has control over the deployed applications and possibly configuration settings for the application-hosting environment.
Infrastructure as a Service (IaaS). The capability provided to the consumer is to provision processing, storage, networks, and other fundamental computing resources where the consumer is able to deploy and run arbitrary software, which can include operating systems and applications. The consumer does not manage or control the underlying cloud infrastructure but has control over operating systems, storage, and deployed applications; and possibly limited control of select networking components (e.g., host firewalls).
Private cloud. The cloud infrastructure is provisioned for exclusive use by a single organization comprising multiple consumers (e.g., business units). It may be owned, managed, and operated by the organization, a third party, or some combination of them, and it may exist on or off premises.
Community cloud. The cloud infrastructure is provisioned for exclusive use by a specific community of consumers from organizations that have shared concerns (e.g., mission, security requirements, policy, and compliance considerations). It may be owned, managed, and operated by one or more of the organizations in the community, a third party, or some combination of them, and it may exist on or off premises.
Public cloud. The cloud infrastructure is provisioned for open use by the general public. It may be owned, managed, and operated by a business, academic, or government organization, or some combination of them. It exists on the premises of the cloud provider.
Hybrid cloud. The cloud infrastructure is a composition of two or more distinct cloud infrastructures (private, community, or public) that remain unique entities, but are bound together by standardized or proprietary technology that enables data and application portability (e.g., cloud bursting for load balancing between clouds).
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, “going forward”:
The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”
The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.
As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after “eating” too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).
HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.
What does all this mean? Well, as my mother always told me: You can’t do everything. I’d always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.
Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I’m going to have to apply a pretty strict filter.
What then are my filters?
First, if you’re an EHR company, then I’m probably interested in connecting with you in some form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I’m going to bring around my flip video and do an EHR series called “5 Questions with EHR Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.
However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I’m a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?
The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I’ll love you and likely write about that content.
I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I’m trying to discover what stories are being told at HIMSS that are worth telling. I’m always happy when people help me find interesting stories.
Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that’s an almost impossible task to ask anyone to do.
Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:
HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.
New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.
Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s been in the past. I personally like these dates better than the other ones.
There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d love to hear if you’re going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.
And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.
No related posts.
One thing that I love about this industry is its willingness to collaborate, and I’m not just talking about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you’re going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.
I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.
In his comments, he advocates for a mentor-protégé program: “Students still need some more help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing students with industry professionals who can mentor them into the industry. I’ve passively done that…to success. I think that will work.” He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.
I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:
It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really been tightly coupled with the workforce development program.
When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS’ career development page to look around and see what they have out there. I’m thinking of how we can connect [what they’re already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s what’s really necessary to get people plugged into this profession – especially if they’re coming from outside of this profession.
HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so they’ve been developing their career development program. They’re near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don’t need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they’re looking to get a job. That could be part of the whole mentorship program concept.
Isn’t there a double-edged sword to it financially? Wouldn’t students have to become paying members of HIMSS, and then would they have to pay for certification? If they’re looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There’s a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that’s going to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out to HIMSS.
One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.
I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.
If you’re in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.
This is part of the whole brainstorming session that I’m going to try to have over the next month or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up with a good strategy by the end of February. And then we’ll start piloting it in the March timeframe.
I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog comments, might actually create job opportunity in the industry.
I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.
Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.
One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.
The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.
HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.
I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.
The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.
In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.
So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.
The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.
Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?
EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know I have. My New Year resolution was a very unambitious I will exercise at least every other day, and I couldn’t hold on to that for a week. However, all is not lost. Even if you’re falling short on fulfilling your resolutions, you can still make a compelling video on some kinds of health IT related resolutions and maybe walk away with a decent cash prize. Don’t know what I’m talking about?
The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.
Here are some examples listed on the ONCHIT website:
I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.
I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.
I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)
I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.
I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.
I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.
Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to get creative and create your own HIT resolutions.
Of course, being as it is 2012, and well into Web 2.0fication of our lives, it’s not enough to make resolutions about improving our health. If you want to participate in the ONCHIT challenege, you’ll have to find ways to incorporate health IT into your resolution. I’ve worked pretty much my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT can only solve some classes of problems, so I’m a bit wary when developers and programmers bring their hey-I-can-create-an-app-for-that attitudes whenever they’re confronted with any problems. That said, I do think some aspects of health IT can be useful. And I’m excited to see what creative things people will come up with.
No related posts.
Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips
10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.
9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.
8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.
7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.
6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.
If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.
As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at most conferences, it’s hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES Press Room. Although, I must admit that I haven’t found too many things all that impressive. More on that later.
They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They’re also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I’m not bitter).
Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get the word out to more people. SOPA is an abomination that they’re trying to push through Congress. Here’s the tweet I sent out recently about it:
— John Lynn (@techguy) January 12, 2012
As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I’m good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.
No related posts.
“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
Have you taken the challenge yet? “What challenge?”, you ask. The Health 2.0 Developer Challenge or those on Challenge Post. These sites take advantage of the recent US initiative to make health databases available to the public.
Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons. Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.
Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!
containers that ring, play music and send emails to remind people to take sixteen different medications when loaded only once in two or three months. Another medication lid glows when it is time to take a pill and then records the time the bottle is opened and the pill was taken.
Multiple pedometers and sensors track steps, galvanic skin response, brain waves, and pulse and are easily synched with smartphone apps that forward reports to your doctor. Sensors can be placed in carpets, slippers, kitchen drawers and refrigerators to track movement of elders living alone. Reports can be sent to specified caregivers. One sensor tracks sleep patterns when placed in an arm band and then placed under your smartphone in the morning to sync and download and email the report. Airstrip Tech links doctors with EMTs in ambulances to follow monitors as the patient travels to the hospital. Two 5 minute Rapid Fire product demo sessions reviewed over 25 new products.
Several websites help patients track their medical information. Patients determine what they want to share and with whom. Some are open source; some are created by private companies. Patient groups like ePatient Dave and Patients Like Me encourage sharing collective medical information to foster a faster learning curve to how to best treat patients and diseases in the US and abroad.
I had the distinct honor of speaking on a panel about game play.
My expertise comes from creating and consulting on multiple smartphone apps related to food and nutrition. Gamification was a hot topic in multiple sessions, mentioned frequently as a terrific means to engage and educate patients. Interesting to me was the fact that some telemedicine products and apps already include game play. This is mostly in the form of Q&A or true/false questions. To celebrate Breast Cancer Month in October, a colleague, Nadine Fisher, MS RD LD, and I created the Apple app Breast Cancer Care. We included five true/false games and one food photo match game.
Many of the products I saw at Connected Health are first generation this year. One company rep said there were only a handful of tech vendors exhibiting last year. This year there were five exhibitor rows lining a hotel ballroom. This business is exploding. I have seen the future of medicine, and it is exciting and often fun. Games are a great hope to advance the health of the world for patients, caregivers, and professionals.
Here’s a link to a blog post about the panel on which I spoke. I was the only RD on the program.
Games for Health Project originated in the United States in 2004.
Ben Sawyer was instrumental in its foundation and development into the force that it is today. It’s annual meeting draws hundreds of global participants each year in Boston.
So it was exciting news this year when Games for Health announced a European partner. It’s first meeting will be held in Amsterdam on October 24 and 25. The central theme is: How games and simulations can improve health(care) and make it affordable. The program is dynamic includes topics on five core tracks:
Cognitive and emotional health
Exergaming, active gaming and fitness
Medical/Education and training
So if you are looking for an excuse to visit Amsterdam, the Games for Health Europe conference is a must do. It will be exciting to watch this innovative group develop and deliver fresh ideas and research on health games for the European health community.
Nick Yee, PhD, a research scientist at the PARC (the Palo Alto Research Center) has published studies that show how people’s behaviors change when they use avatars. One study notes how players engage when offered tall, attractive avatars, versus shorter, less attractive ones. He suggests that people will exercise longer and better when offered fit looking avatars.
James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.
Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!
Strong research is the foundation of the health professions, and health game development is no different. When a person’s health is being manipulated, then people expect the method or product to be well researched before being recommended. After all, the physician’s oath is, “First, do no harm …”
From the start, early thought-leaders recognized that progress in this emerging industry needed to rely on health professional collaboration based on sound, scientific research to prove efficacy. This is what researchers call, “the scientific method.” Developers, designers, funders, and players want to see supportive data. Multiple colleges and universities have stepped up to take the task, and many privately funded developers eagerly share their methods and results to further the cause. Unfortunately, researchers publishing their results has been a problem. Traditional scholarly journals do not target video games for health — until now.
Mary Ann Liebert, Inc, publishers of scores of well-respected peer-reviewed scientific journals have announced plans to publish Games for Health: Research, Development, and Clinical Applications this fall. Games for Health will be a peer-reviewed journal and has a stellar editorial board line-up. The Liebert press release stated the journal would be published bi-monthly and would be “dedicated to the development, use, and applications of game technology for improving physical and mental health and well-being. The Journal breaks new ground as the first to address this emerging, widely-recognized, and increasingly adopted area of healthcare.”
The Games for Health journal and it’s accompanying online presence is a welcome home for the health video games community. For more information check out www.liebertpub.com
Organized by the the IU School of Informatics at Indiana University–Purdue University Indianapolis (IUPUI), the 2nd annual Midwestern Conference on Health Games conference will be held in Indianapolis on October 28, 2011. Abstracts are being accepted now. The submission deadline is June 1. 2011. For more information please contact Vicki Daugherty at email@example.com or 317-278-4123.
Tonight, President Obama spoke to the nation about his plans for healthcare reform. He outlined how he plans to reform the current system and how he plans to pay for it including cutting over $100 billion worth of subsidies to insurance companies as part of Medicare.
Few key points:
He also touched upon the need to increase health IT and move way a fee for service system to a team-based approach to deliver healthcare.
Full Text: Obama’s Remarks on Health Care
(without question/answer session)
Following is a text of the prepared remarks by President Obama before his White House news conference on Wednesday, as released by the White House.
Good evening. Before I take your questions, I want to talk for a few minutes about the progress we’re making on health insurance reform and where it fits into our broader economic strategy.
Six months ago, I took office amid the worst recession in half a century. We were losing an average of 700,000 jobs per month and our financial system was on the verge of collapse.
As a result of the action we took in those first weeks, we have been able to pull our economy back from the brink. We took steps to stabilize our financial institutions and our housing market. And we passed a Recovery Act that has already saved jobs and created new ones; delivered billions in tax relief to families and small businesses; and extended unemployment insurance and health insurance to those who have been laid off.
Of course, we still have a long way to go. And the Recovery Act will continue to save and create more jobs over the next two years – just like it was designed to do. I realize this is little comfort to those Americans who are currently out of work, and I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.
And the fact is, even before this crisis hit, we had an economy that was creating a good deal of wealth for folks at the very top, but not a lot of good-paying jobs for the rest of America. It’s an economy that simply wasn’t ready to compete in the 21st century – one where we’ve been slow to invest in the clean energy technologies that have created new jobs and industries in other countries; where we’ve watched our graduation rates lag behind too much of the world; and where we spend much more on health care than any other nation but aren’t any healthier for it.
That is why I’ve said that even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before. And health insurance reform is central to that effort.
This is not just about the 47 million Americans who have no health insurance. Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It’s about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate we’re having right now.
I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Tonight I want to answer those questions. Because even though Congress is still working through a few key issues, we already have agreement on the following areas:
If you already have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you’re happy with it. It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.
If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan through a health insurance exchange – a marketplace that promotes choice and competition Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition.
I have also pledged that health insurance reform will not add to our deficit over the next decade – and I mean it. In the past eight years, we saw the enactment of two tax cuts, primarily for the wealthiest Americans, and a Medicare prescription program, none of which were paid for. This is partly why I inherited a $1.3 trillion deficit.
That will not happen with health insurance reform. It will be paid for. Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over one hundred billion dollars in unwarranted subsidies that go to insurance companies as part of Medicare – subsidies that do nothing to improve care for our seniors. And I’m pleased that Congress has already embraced these proposals. While they are currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families.
In addition to making sure that this plan doesn’t add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. Our proposals would change incentives so that doctors and nurses are free to give patients the best care, not just the most expensive care. That’s why the nation’s largest organizations representing doctors and nurses have embraced our plan.
We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis – a proposal that could save even more money and ensure the long-term financial health of Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Not all of the cost savings measures I just mentioned were contained in Congress’s draft legislation, but we are now seeing broad agreement thanks to the work that was done over the last few days. So even though we still have a few issues to work out, what’s remarkable at this point is not how far we have left to go – it’s how far we have already come.
I understand how easy it is for this town to become consumed in the game of politics – to turn every issue into running tally of who’s up and who’s down. I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to “go for the kill.” Another Republican Senator said that defeating health reform is about “breaking” me.
So let me be clear: This isn’t about me. I have great health insurance, and so does every Member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This is about the woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment – who had to use up her retirement funds to save her own life. This is about the middle-class college graduate from Maryland whose health insurance expired when he changed jobs, and woke up from emergency surgery with $10,000 in debt. This is about every family, every business, and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades.
This debate is not a game for these Americans, and they cannot afford to wait for reform any longer. They are counting on us to get this done. They are looking to us for leadership. And we must not let them down. We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year. And with that, I’ll take your questions.
The ONC policy committee on meaningful use has published an updated matrix on the subject. It can be found here.
Someone in the GOP needs to learn how to use Microsoft Visio, or the Democrats need to come up with a better plan for improving our healthcare system.
If you believe this nightmare chart created by Congressman Kevin Brady’s office (R-Texas 8th District), then you’ll need a PHD in obfuscation to figure out what the Democrats are planning. More likely, however, is that Brady is painting an overly bleak picture of what a government plan might look like.
Jokes aside, as this battle continues to play out, both sides are sticking to their guns; however, the Obama administration believes it has the trump card: 60 votes. Bloomberg News is reporting that “Obama Open to Partisan Vote on Health-Care Overhaul.”
We’ll follow how this plays out, and keep you apprised of any interesting happenings.
UPDATE July 22, 2009:
A graphic designer, Robert Palmer, took it upon himself to “correct” the republican nightmare chart and made it significantly easier to understand. The updated chart, along with a PDF can be found on Mr. Palmer’s Flickr page. He also penned a note to Representative Boehner:
Dear Rep. Boehner,
Recently, you released a chart purportedly describing the organization of the House Democrats’ health plan. I think Democrats, Republicans, and independents agree that the problem is very complicated, no matter how you visualize it.
By releasing your chart, instead of meaningfully educating the public, you willfully obfuscated an already complicated proposal. There is no simple proposal to solve this problem. You instead chose to shout “12! 16! 37! 9! 24!” while we were trying to count something.
So, to try and do my duty both to the country and to information design (a profession and skill you have loudly shat upon), I have taken it upon myself to untangle your delightful chart. A few notes:
- I have removed the label referring to “federal website guidelines” as those are not a specific requirement of the Health and Human Services department. They are part of the U.S. Code. I should know: I have to follow them.
- I have relabeled the “Veterans Administration” to the “Department of Veterans’ Affairs.” The name change took effect in 1989.
- In the one change I made specifically for clarity, I omitted the line connecting the IRS and Health and Human Services department labeled “Individual Tax Return Information.”
In the future, please remember that you have a duty to inform the public, and not willfully confuse your constituents.
California 53rd District
The Certification Commission for Healthcare Information Technology (CCHIT) has responded to the Office of the National Coordinator’s recently released Meaningful Use matrix [pdf]–and responded with a vengeance.
The bottom line: “CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013.”
Its recommendation was formed by comparing the CCHIT 2008 criteria against the meaningful use matrix prepared by the National Coordinator’s Workgroup on Meaningful Use and finding that while many of the 22 proposed objectives are fully supported by the current certification, at least 8 have minor to major gaps with the CCHIT 08 criteria.
The commission argues that “the lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years,” and for this reason it recommends postponing the 2011 measures until 2013. It isn’t that some EHRs do not currently meet the standards drafted for 2011 (MTBC’s EMR does), it’s that CCHIT criteria does not currently cover or test for all of the proposed 2011 measures. Additionally, CCHIT does not believe that the marketplace is fully ready to support some of the reporting standards outlined in the draft.
As always, we will continue to cover this story as new developments arise and as key shareholders continue to weigh in with comments and responses.
Why don’t you let us know what you think? Should the 2011 measures be postponed until 2013?
When you buy a car, the manufacturer usually offers some kind of warranty on your purchase e.g. bumper-to-bumper coverage for 50,000 miles or 5 years, whichever comes first. Or coverage for 100,000 miles for the power train and 50,000 miles bumper-to-bumper. Some are now offering oil changes for life, free car washes, dry cleaning, or the salesman will pick up your kids from soccer practice if you make a purchase now. Ok, maybe they won’t pick up your kids, but you will please! buy now?
Francois de Brantes, a nationally known advocate of health care quality, is hoping to bring warranties to healthcare. He and a few associates penned an article in Health Affairs describing the benefits of a new payment model for physicians which may inspire physicians to improve patient outcomes by putting their skin (and money) in the game.
The warranties which de Brantes proposes–Prometheus Payment as he’s called it–flip the current medical billing payment model on its ear. Prometheus Payment offers set fees to providers for recommended services, treatments and procedures. However, unlike the current system where all fees are covered by third-party payers, the provider now becomes a party in the payment process by assuming fiduciary responsibility for outcomes–should patients develop an avoidable outcome, providers become responsible for half the costs. The warranty is based on the costs of these avoidable outcomes and is risk adjusted for elderly or frail patients.
de Brantes and his co-authors explain that “the warranty concept has filtered into the self-pay portion of health care, such as corrective eye surgery, general cosmetic surgery, and dental care, which are often based on a global fee that includes any necessary rework by the provider. But it has taken much longer for warranties to appear in the third-party payer system.” They argue that with this global-fee model, overall costs in the healthcare can be reduced while improving outcomes for patients by making (and paying) the provider for any expenses before, during, and after the procedure.
The abstract to the Health Affairs article reads:
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers’ behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins.
I find two points interesting.
This whole idea adds a new wrinkle to medical billing. As your billing service, we’d not only be incentivized to help you collect more money but also provide you tools to provide better patient care. Great news for you, we have a CCHIT-certified EMR which provides just the tools you need. Find out more here.
We will keep you posted if this model crops up at any payers near you.
Read more about Prometheus Payment:
On June 16 the Workgroup on Meaningful Use presented its recommendations on the definition of Meaningful Use. They prepared a preamble describing their overall path to this definition and a matrix to organize their recommendations for each year. For those who have been under a rock for the past 6 months, “meaningful use” is the defining measure by which the incentive payments included in the American Recovery and Reinvestment Act (ARRA) will be determined.
With this working definition, vendors, physicians, and hospitals can better plan for implementation and delivery of technology and services to achieve the measurable goals outlined by the Workgroup.
Meaningful Use for Whom?
First it is important to note that “meaningful use” will have different meanings for hospitals and for groups in private practice. The preamble states “some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital.” This means that proving “meaningful use” will be a more rigorous exercise for private practices than it is for hospitals. However, private practices have a broader range of options and lower barriers of entry (cost, availability of technology, shorter implementation time frames, etc) when it comes to implementing technologies which can deliver “meaningful use.”
Let’s go over some of the measures which are planned for 2011 and look at some examples of each item. More details for each of the items below can be found in the matrix. John Halamka, MD of the CareGroup Health System of Harvard Medical School and the chairman of the US Healthcare Information Technology Standards Panel (HITSP) said in Healthcare IT News that this matrix still needs to be populated with the most up to date standards and an implementation guide. These details will help vendors and physicians alike ensure that their software meets these measures. Expect this in July.
Each of the items below has associated metrics which will need to be reported to verify meaningful use; for example, one of the objectives calls for reminders to patients for preventive/follow-up care. In order to prove meaningful use, the EMR application must be able to provide a reporting of the percentage of patients over 50 with annual colorectal screening. Keep in mind that each of the items below has an associated measure (found in the matrix) which will require reporting to an authorized agency.
Items marked with a Yes! indicate that the MTBC EMR helps your practice meet or exceeds these measures.
Now that you know the definition of Meaningful Use what should you do now? The answer is simple: get an EMR. Ok it is not that simple, but you will be happy to know that you have plenty of options in the marketplace. Dr. Halamka writes, “Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.” Never before have there been so many EMRs which provide such a high level of functionality and interoperability. Today’s major differentiators are not function, but price and service.
MTBC Can Help
MTBC’s CCHIT certified EMR (free to MTBC medical billing clients) can help your practice meet the goals of 2011. Click here to find out more about MTBC’s unified medical billing and practice managagement services.
However, if “free” is not your bag, you have plenty of other options beginning at the $1,000 range and your imagination as the only limit. Vendors have become very creative in their pricing with new options emerging such as monthly subscriptions, charges for each fax sent from the EMR, hosting fees for web-based applications, fees for technical support by email, server replacement plans (a la replacement plans sold by big box stores), 50¢ per 100MB of storage, and many others.
MTBC’s EMR rivals those of its competitors because it is implemented, supported, and updated completely free of charge of its premium medical billing clients. To find out more about how MTBC’s EMR can help you meet the goals of Meaningful Use, request a demo today and, if you are not currently an MTBC billing client, find out how you can download a free trial.
Watch this space for more information regarding meaningful use and its impact on the healthcare IT.
Ahem….what do we say about privacy and data selling…bingo it appears as if you read through the entire article why else would this type of data be shared with Wall Street Investors to make a market for selling some new analytic algorithms. Now get this the investors got to see this “private” information that a patient can’t even get access to see. This reminds me of ePatientDave, “give me my damn data” and this is a total abuse here as the data is not being used for better care but for “better money”.
Now this also says something about access to revenue cycling too, payers and integrators might want to visit this scenario and make sure that it stays on a server for one and what levels of access will be granted. Now this gets worse as the types of information and patients were related to mental health, HIV, Parkinson's and more. How many investors glazed over these records? Accretive gets paid on the revenue boost is provides. There are a lot of these types of 3rd parties around in healthcare and here’s another one used by Blue Cross who had some bad algorithms.
Actually when it comes down to payer disputes you wonder did the hospital bill erroneously on purpose or did they get some bad algorithms and a bunch of promises? If I were one of these patients, court might be on my mind and I would want to know what investors on Wall Street potentially or did see my data! On their website they talk about bringing increased discipline to the revenue cycle so is that the revenue cycle on Wall Street?
Well Fargo just dumped one of these types of companies recently and remember the big data breach at Stanford, also the fault of a 3rd party, so with history being built here who wants to trust a 3rd party today if you don’t have to as patient records end up on the web and in the hands of investors on the street. The 3rd party folks are the algorithm makers though that promise better profits and use of money. This whole scenario though is kind of sad as they were supposed to be helping a couple non profits boost their revenue but the hospitals probably had no clue on the methodologies like showing patients records was in the plan.
“The screen shot also includes numeric scores to predict the “complexity” of the patient and the probability of an inpatient hospitalization, and a box to describe the “frailty” of the patient.”
Tine to start licensing and taxing those data sellers and have a federal disclosure site so we all know what’s going on, beginning to make more sense every day! The link below will describe a bit of this brainstorm. BD
ST. PAUL, Minn. - Minnesota Attorney General Lori Swanson has filed a lawsuit against a debt collector accused of failing to protect the confidential information of 23,500 hospital patients after a company laptop was stolen from a rental car parked in the Seven Corners are of Minneapolis.
The lawsuit filed Thursday alleges Accretive Health, Inc., a debt collection agency that is part of a New York private equity fund conglomerate, failed to protect the confidentiality of patient health care records and failing to disclose its involvement in their health care.
Last July, Accretive lost a laptop computer containing unencrypted health data of about 23,500 patients of two Minnesota hospital systems -- Fairview Health Services and North Memorial Health Care.
Under both contracts, Accretive controls and directs the work of hospital employees and “infuses” its own employees into the staffs of the hospitals. Accretive gets base compensation and incentive pay for helping the hospitals boost revenue or cut costs.
“The debt collector found a way to essentially monetize portions of the revenue and health care delivery systems of some nonprofit hospitals for Wall Street investors, without the knowledge or consent of patients who have the right to know how their information is being used and to have it kept confidential,” Swanson said.
The state seeks an order requiring Accretive to fully disclose to patients:
- What information it has about Minnesota patients
- What information it has lost about Minnesota patients
- Where and to whom it has sent information about Minnesota patients
- The purposes for which it amasses and uses information about Minnesota patients.
One more the mergers and acquisitions speak out again on how health insurance companies have diversified their portfolios and are no longer “just an insurance company” with numerous subsidiaries both in the Health IT area and even others in what you might consider “unrelated” businesses. Here’s one example below with a diversified interest with a new division created to distribute hearing aids and offer incentives for those in certain areas of the us to sign up for insurance plans. I sometimes wonder how other insurers view this?
Here’s another example of what one might consider a business outside of what we might normally consider a related business with low incoming housing investments in New Mexico. One thing to keep in mind today is all the aggregated data that flows and the algorithms and SQL statements that bring some of this together. Data is big business.
Just a couple weeks ago we read about the investment with mobile health and again we venture down into the data business here again as the Optum division which has many subsidiaries has a huge focus on data, and part of the renamed group was the old “Ingenix” company that has consulted and provided data services for years and last year settled their case with the AMA with short paying providers for out of network services.
This kind of brings me around again to what I call the “Alternative Millionaire’s Tax” with companies that buy and sell data and this seems to be a good place for a mention here as the Optum Division has been making money for years with aggregating and selling prescription and other data. With big profits as such we certainly could entertain a license and tax situation for those making billions on the data selling business. As a short comparison from another Healthcare company, Walgreens has estimated their data selling business to be valued at just under $800 million, so again something to give some thought to as hospitals, providers, and patients struggle to afford medical care today.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. At a certain point in time we might need to REALLY think about the value of some of the data we analyze today and the cost and this is worth a mention as this is the big growth area for United, algorithms and software analytics via consulting services. It is also worth a note that United last year hired the former Assistant Attorney General for the State of Minnesota for their general counsel.
Below is one example of the algorithm/software business as the company created a clearinghouse business and collaborated with an medical records company to integrate the services with Epic and of course this means more data revenue for the company and puts a bit of stress on other smaller existing clearinghouse businesses in the US as well.
One more thing too is let’s not forget that they also own a bank with over $1 billion on deposit with health savings accounts and I would guess this also leaves them open to lend money on monies held here and somewhat compete with other banks. As you can read in the quote below the funds are largely generated by employers, in other words large US corporations so they seem to go hand in hand, right?
“OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”
There’s also the Chinese investment the company bought early in 2010.
If you were to stop and look you might also notice one more subsidiary that can consult with biotech and device companies to introduce new products to the FDA and you know when you think about it they might just have a subsidiary to handle the entire process from FDA approval all the way down to provider reimbursement too.
One other related item too is the purchase of physicians groups which is growing and the acquisition of Monarch in Orange County is one big example of buying a huge managed care group.
Again, in summary with such large profits and a lot coming from the data end of the business, this looks like one company where licensing and taxing the data sold for huge profits could fit and there are many more as Hedge Funds, Facebook and tons of other companies are cashing in royally and this all leads to bottom line profits for running algorithms on servers 24/7 that you can’t see, touch or talk to as far as the consumer is concerned, but automated algorithms for data mining and selling are yielding huge profits for corporate USA while as consumers we are becoming “data chasers” to fix a lot of the flawed data that is out there today. It’s a good idea today to read up and see how the corporate USA scene has changed tremendously due to the huge array of mergers and acquisitions as companies are not the same ones they were 2 to 3 years ago by any means. BD
UnitedHealth Group (NYSE:UNH) today reported fourth quarter and full year 2011 results, highlighted by strong enrollment and revenue growth in each of UnitedHealthcare’s benefits businesses and strong revenue growth at all Optum business units. Full year and fourth quarter 2011 net earnings were $4.73 per share and $1.17 per share, respectively. Cash flows from operations were $7 billion in 2011.
The Company continues to estimate 2012 revenues in the range of $107 billion to $108 billion and net earnings in the range of $4.55 to $4.75 per share.
Is there money in those algos? This story might answer that. Why would this employee who was a contracted programmer take this code? It’s worth money and if you read often enough you know I discuss those algos and software is nothing more than a group of algorithms, words of Bill Gates.
A co-worker said the employee said the accused confused he lost the drive containing the code and get this, it’s the software (aka algorithms) that cost $10 million to develop to track the billions of dollars that the US government dispenses “daily” to government agencies..these are some pretty commanding algorithms…so the programmer apparently took the code and who knows where it would go next? A lot of government code is open source but don’t think that is the case here…what’s the next security breach to occur? BD
Bo Zhang, 32, of Queens, New York, worked as a contract programmer at the bank. He was accused of illegally copying software to an external hard drive, according to a criminal complaint filed in U.S. district court in Manhattan.
Authorities said the software, owned by the U.S. Treasury Department, cost about $9.5 million to develop.
A New York Fed spokesman said in a statement that the bank immediately investigated the suspected breach when it was uncovered and promptly referred the matter to authorities.
Zhang told investigators he took the code "for private use and in order to ensure that it was available to him in the event that he lost his job," the complaint said.
The code, called the Government-wide Accounting and Reporting Program (GWA), was developed to help track the billions of dollars the United States government transfers daily. The GWA provides federal agencies with a statement of their account balance, the complaint said.
This is kind of an alarming incident but when you read further it does not stop the treatment process and the secondary outbursts are surgically removed. This affects about half of those treated to be on alert, but not all of those develop the secondary skin cancer, only about a quarter of the 50% risk group.
This sounds like a big step in recognizing undesired side effect with oncology treatments. BD
Drug Used to Treat Melanoma with One Mutation Sets off a Cascade that Results in a Different Type of Skin Cancer in Cells with Another Mutation
Patients with metastatic melanoma taking the recently approved drug vemurafenib (Zelboraf®) responded well to the twice daily pill, but some of them developed a different, secondary skin cancer.
Now, researchers at UCLA’s Jonsson Comprehensive Cancer Center, working with investigators from the Institute of Cancer Research in London, Roche and Plexxikon, have elucidated the mechanism by which vemurafenib excels at fighting melanoma but also allows for the development of skin squamous cell carcinomas.
The very action by which the pill works, blocking the mutated BRAF protein in melanoma cells, sets off a cellular cascade in other skin cells if they have another pre-disposing cancer mutation and ultimately accelerates the secondary skin cancers, said Dr. Antoni Ribas, co-senior author of the paper and a professor of hematology/oncology.
About 50 percent of patients who get melanoma have the BRAF mutation and can be treated with vemurafenib, Ribas said. Of those, a fourth of the patients develop skin squamous cell carcinomas. The squamous cell carcinomas were removed surgically, and vemurafenib was not discontinued for this side effect.
“We wondered why it was that we were treating and getting the melanoma to shrink, but another skin cancer was developing,” said Ribas, who studies melanoma at the Jonsson Cancer Center. “We looked at what was likely making them grow and we discovered that the drug was making pre-existing cells with a RAS mutation grow into skin squamous cell cancers.”
The 18-month study appears in the Jan. 19, 2012 edition of the New England Journal of Medicine.
The combined research team performed a molecular analysis to identify the oncogenic mutations in the squamous cell lesions of patients treated with the BRAF inhibitor. Among 21 tumor samples studied, 13 had RAS mutations. In a different set of 14 samples, eight had RAS mutations, Ribas said.
“Our data indicate that RAS mutations are present in about 60 percent of cases in patients who develop skin squamous cell cancers while treated with vemurafenib,” Ribas said. “This RAS mutation is likely caused by prior skin damage from sun exposure, and what vemurafenib does is accelerate the appearance of these skin squamous cell cancers, as opposed to being the cause of the mutation that starts these cancers.”
Ribas’ group found that blocking the non-mutated BRAF in cells with mutated RAS caused them to send signals around BRAF that induced the growth of the squamous cell cancers.
The discovery of the squamous cell cancer mechanism has led to strategies to inhibit both the BRAF mutation with vemurafenib and block the cellular cascade with a different drug, a MEK inhibitor, before it initiates the secondary skin cancers, said co-senior author Professor Richard Marais from the Institute of Cancer Research in London, who developed the animal model for the study.
“By understanding the mechanism by which these squamous cell cancers develop, we have been able to devise a strategy to prevent the second tumors without blocking the beneficial effects of the BRAF drugs,” Marais said. “This may allow many more patients to benefit from these important drugs.”
Ribas said that this is one of the very few times that oncologists understand molecularly why a side effect to cancer treatment is happening.
“The side effect in this case is caused by how the drug works in a different cellular setting,” he said. “In one case it inhibits cancer growth, and in another it makes the malignant cells grow faster.”
Studies currently are under way testing BRAF and MEK inhibitors in combination in patients with metastatic melanoma, Ribas said.
“Our data provide a molecular mechanism for the clinical toxicity of a targeted oncogene inhibitor that apparently contradicts the intended effects,” the study states.
The study was supported by Roche, Plexxikon, the Seaver Institute, the Louise Belley and Richard Schnarr Fund, the Fred L. Hartley Family Foundation, the Wesley Coyle Memorial Fund, the Ruby Family Foundation, the Albert Stroberg and Betsy Patterson Fund, the Jonsson Cancer Center Foundation and the Caltech-UCLA Joint Center for Translational Medicine.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 11 of the last 12 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.
Jon goes back to Foxconn-revisited…in his usual style and he says we need to make our factories look more like those in China. Workers live in dormitories and don’t know each other, cuts down on commuting and friendship.
Workers are finding ways of improving their conditions, hotlines with trying to stop suicide and put nets around buildings to catch jumpers…I think we remember this from a year ago and he says in the US we call this “treating the symptoms”.
“It’s me, Siri, in your pants pocket working on giving you testicular cancer”…If it works for those factories, electronics would cost more..modern work fare…a game to the rescue…this is great humor but there are somethings I does make one ponder…there’s just one level and this is it…(the middle class) as algorithms are marketed and designed and sold to consumers.
He shows the work of the algorithms in place for sure in a humorous way. Why are health insurance companies getting into the low income housing business though? I hope this is not a Foxconn plan to create communities with jobs that pay little and have medical care on campus? What is up with this?
The same company owns a subsidiary that will basically give you a free hearing aid made in China if you sign up for their health insurance…more below…and the subsidiary they built to distribute and coming to Walmart soon as I understand…
He moves on to the next part, a game that has one level…hmmm…we another insurance company banking on this too…data to sell? Will this make you healthy? I prefer real knowledge.
I just ask is there where we are headed with mining and selling data today and big corporations taking over our day to day decisions? The more information they have to judge and discriminate, the ability to control and humiliate the middle class grows.
At any rate with the use of algorithms today that have teeth and the amount of flawed data out there, are we going in this direction? I put this out for an awareness and perhaps to generate some though processes. I like technology and the good things it brings but am not oblivious to how it can also be abused as well and a NYU professor says it even better than me, read and listen up.
I sure hope Richard Cordray understands math and the power of the algorithms when used both in an intuitive and good manner and the reality of those who design for pure profit that hurts consumers. You can see, smell or touch them, but they are running on server 24/7 every day making like impacting decisions, crafted by some of the smartest programmers and developers that the money on Wall Street can buy.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. BD
“Wall street hires the best software developers money can buy. They write clever algorithms. These algorithms will only get more clever as time goes on. Which means they will always be changing. Now, writing software to detect what other software is doing is 100 times more difficult. Which in the software world means 100 times more expensive. Which means hiring people that do not exist, since Wall Street already snapped up the best, and you need the best times 100 (you can't make it up in quantity and just get 100 times more wizards, because many will have poor social skills, and you need these people to communicate).”
“You see the folly of trying to regulate the markets in real-time? Real-time raises the cost exponentially times a million. To a level that all the kings in the world couldn't afford. It would be one thing to track in real-time, things that had known behavior. Like your checking account being overdrawn. Maybe credit card fraud in the making (which, by-the-way, hasn't been perfected yet, despite lots of money and time thrown at the problem). “
To go back a little bit in time the chip was also set up to communicate with personal health records like Healthvault. The latest development on the chip was the ability to communicate real time glucose readings. The FDA has approved the product and the HealthLink software.
In addition, Medcomp who makes vascular access catheters will use the chip in vascular ports for identifying the port in a patient for proper medication dispensing. As it read here though the use with Medcomp still needs to secure FDA approval. This chip keeps coming back around with many lives. BD
DELRAY BEACH, Fla., Jan 17, 2012 (BUSINESS WIRE) -- VeriTeQ Acquisition Corporation ("VeriTeQ" or "Company"), a marketer of implantable, radio frequency identification ("RFID") technologies for patient identification and sensor applications, announced today it has acquired the VeriChip implantable microchip and related technologies, and Health Link personal health record from PositiveID Corporation. VeriTeQ is majority owned and led by Scott R. Silverman, former Chairman and CEO of PositiveID and VeriChip Corporation. PositiveID has retained an ownership interest in VeriTeQ.
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.
VeriTeQ's acquisition also includes the rights to a Development and Supply Agreement with Medical Components, Inc. ("Medcomp"), a leading manufacturer of vascular access catheters. Under the terms of the agreement, Medcomp will embed the VeriChip microchip in its vascular ports to facilitate identification of the port in a patient and proper medication dispensing.
The number of RFP’s for data archiving projects has increased greatly over the past year. Personally, I don’t think it’s the need that is growing (I think it was always there!); I just think more institutions are finally treating solutions such as ours with the formality they deserve. Archiving requirements vary greatly within and across departments depending on the type of data, the type of system, the age of the data, and what the data is being used for, not to mention the institution’s strategic initiatives around electronic medical record and data retention.
When a large facility is seeking a data archiving partner, there are things that need to be considered:
Make sure you ask for “like” responses from all vendors. Some questions that will assist with this include:
“Please provide any PER USER or PER LICENSE pricing that your solution requires.”
“For each functional requirement, indicate if the implementation of that requirement is included in the prices quoted or if additional fees would be incurred.”
“For each functional requirement, indicate if a modification is required or if your base solution contains this functionality. If a modification is required, please estimate the additional cost”.
“Please indicate any PER INTERFACE or PER REPORT pricing that your solution requires”.
“Please indicate if your system has standard screens or if screens are customizable. For customizations, please indicate the additional charge and/or support implications.”
“Please cost out a typical Revenue Cycle archiving system cost that includes the following:
1. NN custom reports that will run daily, weekly, monthly
2. N Agency interfaces that include demographics outbound and transactions inbound (posting)
3. UB/837 outbound interface, running daily
4. 100 users.”
Finally, make sure that you allocate enough time for the on-site demos and that all stakeholders are present. Break them up by functional area if necessary to allow all decision makers a chance to thoroughly see the vendor’s solution. Provide a script if possible that the vendors should follow so that the demos are easy to compare each step of the way.
Managing an RFP for an archiving partner can be a complex and difficult task, but the time spent diligently on the selection process will pay off in the long run and provide you with a partner that you can have extreme confidence in far into the future.
I have been doing a lot of reading lately on Accountable Care Organizations, or ACO's. Yet another acronym in healthcare, as if we needed any more! As a consumer of healthcare, I get it. No one has any problem paying for good service when it is received. We take our car to get repaired, and we expect it to be fixed when it is returned. Prior to taking it, however, we do shop around. Some of us are looking for the highest quality work at the best price. Others of us might have to sacrifice quality or make adjustments to our expectations based on what we are able to spend. ACO's, if implemented correctly, would certainly provide consumers with the information to make such informed decisions when it comes to their healthcare and would compensate providers based on quality outcomes.
There are just a few problems with this model, however. First of all, human beings are not cars. While the average person understands that if they cannot afford to get their car fixed, they must make sacrifices or find alternate transportation, those same people tend to feel they have a right to the highest level and quality of healthcare regardless of their ability to pay. I don't want to get into any sort of debate here about socialized medicine or a person's right to health care, my point is just that people have a different mindset about the quality of their healthcare vs other consumer services.
The other problem with the model also goes back to the fact that human beings are not cars. Healthcare is an art, not a science, so while we are very progressed as far as identifying and curing illnesses, the fact remains that outcomes are not 100% predictable no matter how high the quality of the services performed.
So what, pray tell, does this mean to me, or for that matter FOR me, in terms of my business? It means that the powers-that-be have a lot of work to do to put together a sustainable model for ACO's, and that the main component of that work is going to be (insert sound of trumpets here)…DATA. There is not going to be one simple formula to determine a quality outcome, and there is not going to be one simple dataset that will go into the calculation. Besides the obvious data that is collected during a episode of care, the data will need to include family history, personal health history, habits, environment, even social and cultural factors, as all of these items can influence a person's health and response to treatment.
It really means that now, more than ever, all types of providers MUST preserve ALL data that they collect, no matter their longterm EHR strategy, no matter their conversion strategy, or what data elements the "experts" have determined are important. EVEN IF you convert data to a new application, you run the risk of missing that crucial piece of information, that small nuance, that could be impacting outcomes. Are you willing to take that chance??
Healthcare is transforming like never before, and in all aspects, from the business structure to the reimbursement structure to how care is monitored and managed. Now, more than ever, the data that you collect across that continuum of delivery must be preserved in its original format, definition and detail. It is essential that providers have a cost effective, risk mitigating solution that allows this level of data preservation.
One thing about being the last leg of the revenue cycle, we get to live life through the eyes of our customers as they implement and learn to work with their new Patient Accounting systems. Because we are working with them not only through "go live" and the honeymoon period but also long into the new system's production-status, we experience many of the trials, tribulations, and victories associated with it even while we are just supporting the legacy data.
It makes me realize the wealth of knowledge LDA has built right within these very four walls. We are often helping our customers not only manage their old data and balances off their legacy system, but also helping them tie the old data with the new and troubleshoot production issues. The actual combinations of the systems we have touched are mind-boggling - leaving STAR, going CERNER, leaving STAR going HealthQuest, leaving GE going Sorian, leaving HealthQuest going CERNER, leaving Invision going STAR, leaving ANYTHING going EPIC, and yes, even leaving EPIC (but no worries - going to another hospital's EPIC!).
What does this mean to you? It means that we can offer valuable advice and a perspective of what worked and what didn't. We have seen what gets over-emphasized and what does not get enough attention. We have seen the Revenue Cycle processes that have fallen by the wayside or have become manual, or that had to be completely re-engineered. We can tell you what to look out for, what you may need help managing, and what others have done in your situation.
We don't just take your legacy data and archive it for safe keeping; we take your hand, and become your partner in your overall revenue cycle, because we have a vested interest in your success. Don't just take my word for it - talk to any of our customers. They will tell you about the times we have gone beyond the extra mile for an audit, or a special project, or even for a simple query. I walk around the office and see the team and what we have built here, and it makes me feel honored to be apart of this intelligent, motivated group of people that make up Legacy Data Access.
It is finally spring. Seems like this past winter was more brutal than most...lots of snow and ice. We even had our share here in the Atlanta area. Makes me even more happy to welcome the warm weather, even if it does come with a fine coating of yellow pollen on everything.
The end of winter also brings with it that age-old tradition of spring cleaning. As I switch out our sweaters for shorts, put the light comforters on the beds and wash the windows, I also have a list of spring cleaning items for your data center that will keep things running smoothly.
Replace and then wipe and destroy old media. There are probably tapes or CD's, DVD's, or even removable hard drives around your data center that can be wiped and/or destroyed. Even if your processes are perfect and they dont have PHI on them or they are encrypted, chances are you have media that is aging out. The last thing you want to do is have a critical backups or files on data that is less than reliable.
Review and update documentation and throw out your paper. I am betting that even if you have all your systems documented properly when they went live, you may not have visited that documentation in a while. It is important to review this information at least yearly, make sure the latest copies are available to your DR plan, and throw out any outdated paper copies that may exist. Try to go to a paperless repository if you don't already use one, but make sure you can get to the information if your systems are down. Documentation can be one of those irritating items that, left unchecked, can really bite you in the case of a outage or even a simple audit.
Check the patch levels and release levels of operating systems on your network. There are many tools that will do this for you, but the bottom line is you really need to make sure that all the computers in your network - from system servers to the desktops in doctor's offices - are running the latest OS releases and latest patch levels. There are government compliance issues to face if they are not - and no one wants to go down that road.
Verify your anti-virus software installations. Along with OS levels, it is always a good idea to make sure all computers in your network are running your standard anti-virus software and that the latest virus definitions are installed. While your servers may be up to snuff, it is very easy for a user to disable or stop a virus software from updating on their desktop, and before you know it you are dealing with a system-wide problem.
Review your hardware inventory and network maps. These items must be kept up-to-the-minute. This is getting harder and harder, with laptops, handhelds, iPads, tablets, smart phones and the like. You must know who has what running within your firewall.
Review your Disaster Recovery plans. Make sure they are up to date and comprehensively on track. As you implement various systems throughout the year, a task may be to add that system to the plan, but you need to review that plan as a whole to determine any holes, conflicting information, references to systems you are no longer running, or confusing or ambiguous references.
Make sure you are not running systems that are no longer in production or no longer needed. Of course since this is my blog, I am going to reference the need to move retired data to Legacy and clean out your data center, but if you're here then you pretty much know that drill. You also need to make sure you are not running old versions of production systems, or old test systems, or even still running those old systems you DID retire with Legacy.
Review your backup processes and make sure the whole backup system is running smoothly. Good return codes on backup jobs are only part of the picture. Make sure the encrypted files can be decrypted. Verify that what you think is going off-site truly is being transferred. Inventory your off-site backup library. Destroy any old backups that are no longer relevant or that contain data that has been purged from the production system. Run a small test to make sure that you can get to the backup file you need quickly and easily. If log files are integral to your backup and recovery process, make sure these are intact, identifiable, and usable as well.
Most of this is common sense, and you are probably doing one or more of these on a regular basis, but it seems like health care IT is moving at double speed lately. With all of us short on resources and no shortage of projects, some of the above items tend to get overlooked or put off. Make the time to keep your data center processes tidied up - even if you have to ask your stakeholders to add a couple of weeks to their projects so you can carve out the time. All they have to understand is how critical these items are to the overall health of your IT systems and they will gladly work with you to get it scheduled.
I ran across an article in Healthcare Finance News regarding bad patient debt and its increase due to the current economy.
Bad Debt is one of those things that is just a part of healthcare finance, for some reason. It has always baffled me how people don't take healthcare debt as seriously as they take their mortgage or credit cards. It seems like the doctors and hospitals are always at the bottom of the list as folks divvy up their paychecks each month.
The article stated what is probably the obvious: layoffs, foreclosures, unemployment, inflation, high cost of fuel - all together are making it harder and harder for providers to collect what is owed to them.
What it did NOT cover, however, is the opportunity that exists to lower the costs to collect these debts. Many hospitals and even physicians offices are continuing to run older legacy systems to collect the outstanding balances and are not really analyzing the cost per dollar to collect those balances. Add to it the fact that more and more of those balances are uncollectable, and you have quite an expensive operation on your hands.
If you visit the Apple App store, you will find ROICalculator. It is an application we put together - it's FREE - that will help you compute the cost of collections. It is built to help you analyze the cost to maintain a system from the IT perspective vs. moving to a solution like ours, but you can easily include your other collection costs in the equations. How many collectors do you have working the legacy system and what is their compensation? Do you have any agencies working the data and taking a cut? Be sure to include those costs.
Once you have identified the monthly costs to maintain your old system, get your last 3 month end reports that show you the total dollars collected from those older systems. Divide that by the cost to maintain the system and look at your cost of collections. Even if you keep the same resource infrastructure around the collection activities once you have migrated the data to LDA, you will see a decrease in the cost to collect.
Additionally, by migrating it to LDA, you have the opportunity to streamline processes, consolidate agencies, and automate some processes that may further reduce the cost of collections. In today's world, every little bit counts!
Yes. It has taken me a whole week to get to my final HIMSS post. It has been just that crazy. Wednesday was the shortest "last day" ever, with another full round of great contacts, interesting vendors and good leads. We ended the day with a very fun evening at the Ice Bar, that was rented out by Tek System for a great party. We stopped by Tommy Bahama's and visited with our friends from Encore to close out the night. It was a great way to continue the networking and relax and let off steam.
I left this HIMSS with a general feeling of optimism about where we are headed as an industry. I saw a lot more doing and a lot less talking- and that is a good thing. I might not be Obama's #1 fan, but at least this meaningful use initiative has most people doing SOMETHING, even if it is not exactly the correct or strategic thing. Most attendees seemed to have at least a plan for their EMR and a great number are actually past selection and well into implementation. The industry really has done a lot in one year. My prediction is that HIE's, standards, and companies that map between individual EHR interpretations of the standards are going to be the theme in Las Vegas.
Thanks again to all those that came by the booth and registered to win the iPad. I will post the winner and his picture by the end of the week. We did the drawing in time for him to come by the booth and pick it up on Wednesday.
I returned to Atlanta with my long list of projects still in flight and many more on the calendar. We are preparing for our next HIMSS regional conference on the marketing side, developing new features and functions on the application side that will be announced soon, and constantly working on our strategy in the C-Suite here at LDA. Never a dull moment!