December 21,2014

0:57
The story: He gets into office as Health Minister - kicks off a six week review of the PCEHR - releases it 6 months later and is yet to actually to provide a Government response 8 months later! In passing leaves industry and Standards setting out in the cold and fails to properly evaluate what has been delivered for the $1.0 Billion or so! F- is generous - but as low as the scale goes. As for the co-payment debacle - his change of job says it all! God help all those poor asylum seekers and refugees. Here is a profile of the new Health Minister: http://patricklion.files.wordpress.com/2014/05/leyfeat.pdf David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
0:00
This week we have seen the most amazing set of political turn-arounds I have seen in quite a while.Let’s start with the AMA.When the Medicare Co-Payment Plan B was announced the view was that the plan was a ‘mixed bag’. After a week and a few (the most ever) angry e-mails from those in the trenches we get:“Last week I wrote to you outlining the details of the Government's latest co-payment proposal and asked for your feedback to help inform our ongoing advocacy.Many members took the opportunity to respond, and I really value the constructive input you have provided.As I said in my email, the AMA does not oppose co-payments for people with adequate means.The AMA does not support measures that take billions of dollars out of general practice, undermine the viability of individual practices, and ultimately disadvantage our patients.I write to make it clear to you that the AMA is strongly opposed to all three measures in the Government’s package that attack general practice, these...

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

December 20,2014

23:39
Sussan Ley has been moved into Health. Peter Dutton was clearly out of his depth in Health! I wonder what will happen next? She must be thrilled to have been given the unresolved PCEHR problem to fix! David. All the major details are here: Australian Defence Minister Dumped From Office As Tony Abbott Reshuffles Cabinet Paul Colgan Dec 21, 2014, 3:27 PM Prime Minister Tony Abbott. Photo: Getty / FileTony Abbott has announced a cabinet reshuffle, promoting Scott Morrison and dropping defence minister David Johnston in changes the prime minister says will “refocus the government” on driving economic reform next year. Abbott described it as a “ministry for jobs and families” and said the government would be putting the economy at the centre of its agenda. Morrison has been promoted to minister...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
18:35
Here are the results of the poll.Do You Think The Abbott Government is 'Strengthening Medicare' And Our Current Universal Healthcare System With The New Medicare Co-Payment Proposal? For Sure 3% (2) Maybe 4% (3) Neutral 13% (9) Probably Not 13% (9) No Way 65% (44) I Have No Idea 1% (1) Total votes: 68 A pretty clear response with large majority seeing through the suggestion that the Government is going to actually aid our Universal Healthcare System. Good to see a clear outcome. Again, many, many thanks to all those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
9:23

In my last two notes, I have been discussing the potentially disruptive effect of the Theranos business model, particularly with reference to Quest Diagnostics and Lab Corp (see: Finally, Some Important New Details about the Theranos Business ModelQuest Diagnostics and Lab Corp Business Models Becoming Obsolete). In my analysis, I made mention that Theranos must deploy software to manage their test results and then transmit them to hospitals and physician offices. In other words, they will need some type of LIS, perhaps one analogous analogous to Quest's Care360. An important question, then, is what software will they will choose or perhaps what software are they already using in their small number of Walgreens pilot sites.

I now digress briefly to discuss hospital lab outreach programs. Under such programs, lab testing is performed in hospital-based labs for ambulatory patients who most often are under the care of physicians with a relationship to that hospital. Think of this as hospital-based labs operating as reference labs and competing with Quest and Lab Corp. If the patients being tested are admitted to the hospital, it's important that their test results are available in a hospital system to provide a longitudinal health record for them.  Hospital labs commonly use outreach software to transfer the results from physician offices, most commonly to the hospital LIS database. However, I learned years ago that some hospitals were using such outreach software to transfer physician office test results to the hospital EHR and not to the LIS. This results in a fragmentation of lab database with the only complete record stored in the EHR and not in the LIS, the traditional repository of all test results.

If I were forced to predict what IT steps Theranos might take, I suspect that they would prefer to deploy a system such as Epic's LIS called Beaker which I have blogged about in the past (see: Here Comes Epic's Beaker LIS -- Ready or NotDetails about Epic's Beaker LIS, Supplied by the Company). A Walgreens competitor, CVS's MinuteClinic, has already been reported as using the Epic EHR  (see: MinuteClinic taps Epic for EMR). By deploying Beaker as its LIS, Theranos would both acquire a LIS to manage its test results but also the ability to communicate test results to any hospital or health system with Epic. In a recent survey, 23% of physician respondents indicated that they used an Epic EHR. In 2011, it was claimed that 38 percent of all patients in the U.S. had records stored on Epic (see: ShandsHealth Goes Live with Epic; Company Penetration of the Hospital Market).

One additional point needs to be emphasized here. Epic's EHR has only one database. If the Beaker LIS is also installed in a hospital, there is no separate LIS database. If a hospital runs an Epic EHR and also runs an LIS from another vendor, that LIS will have a separate database interfaced to the Epic EHR database. Unfortunately, there is no "reverse feed" of test results transmitted only to the EHR database back to the LIS in such hospitals (see: "Reverse Feed" of Clinical Data from EHR to the LIS -- Will This Ever Happen?). 

December 19,2014

10:06

The number one topic of debate on this blog has definitely been Client Server EHR versus SaaS EHR. There are staunch parties on both sides of this aisle. No doubt both sides have a case to make and we’ll see both in healthcare for a long time to come. Although, I think that long term the SaaS EHR will win out.

As I was thinking about this recently, I realized that while client server EHR can do everything a SaaS EHR can do, it definitely makes a lot of things much harder to accomplish.

It’s much harder to create an API that connects to 2000 client server EHR installs.

It’s much harder to make 2000 client server EHR installs interoperable.

It’s much harder to evaluate data across 2000 client server EHR installs.

I’m sure I could keep going with this list, but you get the point. Even though something is possible, it doesn’t mean that they’re actually going to do it. In fact, if it’s hard to do, then it takes extreme pressure for them to do it.

All of this has me begging the question of whether client server installs are holding back the EHR industry. Up until now, many of the things I mention above haven’t been that important. Going forward I think that all three of the things I mention above are going to be very important.

The good thing is that I see many client server EHR moving to some kind of hosted EHR solution. That solves some of the problems mentioned above. At least if it’s a hosted EHR solution, they can control the environment and more easily implement things like API access and interoperability. That’s much harder in the client server world where if you have 2000 EHR installs, you have 2000 unique setups.

Of course, as soon as a large SaaS EHR has a massive breach, healthcare will go running after the client server EHR. The battle lines are drawn and each side knows each other very well. Although, I think the SaaS EHR have the high ground right now. We’ll see how that continues over time. Client server EHR have done an amazing job battling.

7:30
Well, that is your lot for the year unless we have some important news emerge of the 'silly season', that I feel an urgent need to post on. I plan to re-start posting in mid to late Junuary 2015. Till then stay safe and have a great break! David.

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

December 18,2014

18:00
The objective of this Study is to provide an overview of the current national laws on electronic health records (EHRs) in the EU Member States and their interaction with the provision of cross-border eHealth services mentioned in Directive 2011/24/EU. This entails first to identify and examine the national laws of the 28 Member States and Norway and identify legal barriers for cross-border transfer data from electronic health records and for
9:24

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
In my previous post I talked about the benefits of using social media in a medical practice and I said that the next post in the series would take a look at the tools, techniques, and social media platforms you should use to help you realize the benefits of social media. This will not be an exhaustive look at social media platforms or the way to get the most out of them. However, it will be a good place for you to start and will offer some techniques that those who’ve started might not have heard about.

First, a word of warning. When starting to work with social media, be sure to pace yourself appropriately. As you start working with a specific social media platform, you might want to start “sprinting” and dive really deep into the product. That’s a great way to develop a deep understanding of the platform, but it’s not sustainable. After doing a deep dive into a social media platform, find a sustainable rhythm that your practice can sustain long term.

Social media is a marathon, not a sprint.

Facebook – With nearly 800 million active users, it’s hard to ignore the power of Facebook. Given these numbers, the majority of patients are on Facebook and they’re likely talking with their friends about their doctors. Unlike many other social media platforms, most people are connected to their real life friends on Facebook. That means the focus of your work on Facebook should be to help your most satisfied patients be able to remember to share this with their friends as the need arises.

On Facebook this usually takes the form of a practice Facebook page that your patients can “like.” Invite your patients to like your Facebook page when they’re in your office or through your patient portal. You can even test some Facebook advertising using your internal email list to get your patients to like your page. However, the most important thing you can do is to make sure you regularly update your Facebook page with quality content. That way, they will want to like your page when they find it.

When it comes to content, put yourself in the shoes of your patients and think about what content you would find useful as a patient. Don’t be afraid to post things that represent the values of your practice, but may not be specific to your practice. In most cases, what you’re sharing on Facebook is more about helping that patient remember your practice as opposed to trying to sell them something. For example, it’s more effective to post something entertaining that your patients will like and comment on than it is to post some dry sales piece that they’ll ignore.

Twitter – Similar to Facebook, you want to create a two step process with Twitter. First, think about content you can post to your Twitter feed that would be useful to your patients and prospective patients. No matter what marketing methods you employ to increase Twitter followers, if your Twitter account isn’t posting interesting, useful, funny, entertaining, or informative content, then no one will follow you.

Second, find and engage with people in your area that could be interested in the services you offer. Finding them is pretty easy thanks to the advanced Twitter search. When you first start on Twitter you’re going to want to spend a bit of time on that search page as you figure out what search terms (including location) are going to be most valuable to your clinic. Sometimes you’ll have to be creative. For example, if you’re an ortho doctor, you might want to check out search terms and followers of a local youth rec league.

Once you find potential patients on Twitter, follow them from your account and engage with those you find interesting. Just to be clear, a tweet saying “Come visit our office: [LINK]” is not engagement. Offering them answers to their questions or links to appropriate resources (possibly on your website, blog, or Facebook page) is a great form of engagement. You’ll be amazed how consistently following and engaging with potential patients over time will build your Twitter profile. Once they’ve followed your account, you have created a long term connection with that person.

As I suggested in my previous post, Twitter can be a great way to find patients, but it can also be a great way for your practice to connect and learn from peers and colleagues. I’d suggest using different accounts for each effort. The tweets you create for each will likely be quite different so don’t mix the two. However, the same search and engagement suggestions apply whether you’re connecting with patients or colleagues. The search terms will just be quite different.

Physician Review/Rating Websites
There are dozens of physician rating and review websites out there today. Some of the top ones include: Health Grades, Angie’s List, ZocDoc, Yelp, Google Local, and many more. Which of these websites you should engage with usually depends on where you live. In most cases one or two of these websites are dominant in a region. For example, Yelp is extremely popular in San Francisco while Angie’s List is very popular in the south.

Discovering which one is most popular in your region is pretty easy. Many of your patients will have told you that they found your practice through these sites. However, you can also do a search on each of these services and see which ones are most active. A Google search for your specialty and city is another way for you to know which services are likely popular in your area.

Many of these sites will let you claim your profile and be able to respond to any reviews. Do it (although, don’t pay for it). Responding to reviews is a powerful way to engage your patients. If they post a bad review, keep calm and show compassion, understanding, and a willingness to help and that bad review will become good. Plus, that negative review could be an opportunity for you to improve your practice. If they post a good review, show gratitude for them trusting you as their doctor.

Once you’ve discovered which website is most valuable in your region, encourage your satisfied patients to go on that site and post a review of your practice. In some cases that might be handing the patient a reminder to rate you as they leave. In other cases, you might send them an email after their visit asking for them to review you on one of these sites. With mobile phones being nearly ubiquitous, a sign in the office can encourage a review as well.

Summary
There are hundreds of social media platforms out there today. However, if you focus on the platforms and techniques I mention above, you’ll be off to a great start. Mastering these techniques will make sure you get the most value out of your social media efforts.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

December 17,2014

19:48

In my note of two days ago, I discussed the challenge that Theranos is presenting to the two major reference labs in the U.S., Quest Diagnostics and Lab Corp (see: Finally, Some Important New Details about the Theranos Business Model). Although the focus of that note was on Theranos, my arguments got me thinking about the business models of these two large companies. It occurred to me that there might be fundamental flaws in them such that a new entrant into the lab testing market, Theranos, could threaten their core business with what could be described as disruptive innovation. The purpose of today's note is to discuss these potential flaws that are listed below:

  1. Information technology. Effective IT lies at the heart of any modern clinical laboratory. To stay abreast, every laboratory must frequently upgrade their LIS or seek new software to operate more efficiently. Both Quests and Lab Corp have grown, in part, by purchasing regional labs and grafting their operations into their IT infrastructure. This has resulted in large IT systems with a patched mixture of older, commercial systems plus homebrew software. They can't shut it down and can't replace it. By comparison, a relatively new company like Theranos can begin operations with homogeneous, state-of-the-art software.
  2. Client base: The key clients of Quest and Lab Corp are physician offices whose staff members draw blood samples from patients or refer them to reference lab service centers (PSCs) to have blood drawn. The test results are then sent back electronically to the physician office's office EHR supplied by the reference lab (e.g., Care360) or to a commercial office EHR. Such systems are very complex, partly because there are so many office EHRs available in the market. The fundamental problem here is that private physician practices are disappearing or being bought by health systems. The health systems then install their own brand of EHRs in the physician offices and switch the physician practices to the hospital-based pathology labs.
  3. Sample collection: Quest and Lab Corp have built patient services centers to collect patient blood samples. As noted in my previous note about Theranos, it has been able to leverage the physical space provided by retail drug store chains like Walgreens for sample collection. Moreover, I anticipate that the range of clinical services offered by these retail drug store chains will increase, thus increasing the success of the Theranos enterprise.
  4. In-vitro testing platforms: Quest and Lab Corp depend on the major IVD companies to provide them with large-scale analyzers and reagents and are thus highly dependent on these companies for innovation. In contrast, Theranos is vertically integrated, designing and manufacturing its own testing platform. Moreover, it has developed a radically new testing technology based on lab-on-a-chip (LOC) technology and microfluidics (see: Elizabeth Holmes: The Breakthrough of Instant DiagnosisLab-on-a-chip). This technology uses very small amounts of blood collected in a "nanotainer" and very little reagent. Because Theranos owns its upstream technology, it will utilize all of its manufacturing capability for its own business purposes and scale it up as demand for testing increase. It will also, obviously, deny the technology to its competitors.
  5. Point-of-care (POC) testing: I believe that hospital lab testing will gradually move away from what can be called the general lab model and toward point-of-care-testing (POC). The general lab model consists of the transportation of blood samples to a laboratory in a hospital or reference lab where they are processed using large-scale analyzers with a low cost-per-test. Point-of-care testing, as the name implies, involves sample analysis near the patient using compact analyzers and at higher cost-per-test. In the short term, Theranos can pursue the ambulatory care market with Walgreens as its partner. Quest and Lab Corp may react to a loss of outpatient testing business by bidding on hospital contracts, trying to gain more inpatient testing business. At some later time, Theranos can then begin to sell its patented chip-based analyzers to hospitals as the demand for inpatient POC testing increases.
18:00
PhilipsRoyal Philips (NYSE: PHG; AEX: PHIA) and Volcano Corporation (NASDAQ:VOLC), a global leader in catheter-based imaging and measurement solutions for cardiovascular applications, have entered into a definitive merger agreement.
9:58

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of  Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data.  One way to bridge this gap is through standardized role-based education.

Conclusion
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort.  Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT.  As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

8:59

Having returned recently from the NJ/Delaware HIMSS Fall meeting in Atlantic City, I am recalling multiple conversations and sidebars on the topic of data governance.

But here’s the thing. To my knowledge, there wasn’t a single presentation on the topic.

Now I admit I may have had a glass or two of Cabernet at the reception. But my clear recollection is that data governance, while not on the official agenda, seemed to be the unofficial theme of the meeting in the minds of many attendees.

What is data governance and why is it claiming our attention? These are good questions to ponder.

In healthcare, as in other industries, data is seen as a valued asset, and data that is inaccurate is recognized as a lethal (sometimes literally) liability. As data is transformed into information for decision makers, in healthcare enterprises there is a rising appreciation of the need to have “right” data all the time.

Innocently, one may think data is data. Why the need for governance, meetings, committees and enterprise attention on data?

Well, the temperature of the room is the temperature of the room, right? But is the temperature in degrees Centigrade, Kelvin or Fahrenheit? And who measures the temperature? How is it measured?  Who records it and where? Is there a backup record? And who decided we should measure room temperature anyway?

And to further the need of a structure, suppose different end users had different meanings for the word “temperature.” Expressions such as “Admission Time” and “census” have different meanings for HHS and those staffing hospitals.  Admission Time for HHS is when the attending physician writes the order to admit the patient. Some patients are admitted and never occupy a licensed hospital bed, spending three days in a bay in the ER. What is your census then?

The challenges of responsible data management seem endless. Even when a parameter is defined, i.e., serum sodium, enterprises need stewardship of the metric. Depending on which chemical analyzer is used in a lab or system, the range of normal values will be different. Data governance demands a prominent place in the enterprise that values and uses data.

Industry definitions
Data governance has multiple definitions. The May 2011 Oracle white paper, Enterprise Information Management: Best Practices in Data Governance, nicely summarizes some of them.

In distillation, data governance is the formalized authority and responsibility for managing the enterprise’s data assets. This management addresses definitions, standards, processes, security, integrity, recognizes stakeholders and supervises the creation, reading, updating and deletion (CRUD) of data.

There is another similar and also increasingly popular term, information governance. As data and information are different concepts but occasionally used interchangeably, so are data governance (DG) and information governance (IG) innocently interchanged. Data governance and information governance, while reasonably having some overlap, are different, as Robert Smallwood points out in his August 2014 post.

I see the simple distinction as follows: Information governance is the enterprise’s front end, strategic, 30,000-foot view, and data governance is back end, tactical and granular.

Where IG and DG intersect seems to be in the area of security and confidentiality. Information arising from PHI data, duties the controllers of information to the same HIPAA confidentiality requirements.

The interests in data governance shared by the Atlantic City meeting participants were timely, confirmed by the release on November 25 by ECRI of their Top 10 Technology Hazards for 2015.  Validating the concerns in Atlantic City, ECRI identified as the number-two hazard for 2015, “Data Integrity: Incorrect or Missing Data in EHRs and Other Health IT Systems.”

The ECRI report highlights the complexity of the data integrity challenge, “What makes this problem so troubling is that the integrity of the data in health IT (HIT) systems can be compromised in a number of ways, and once errors are introduced, they can be difficult to spot and correct.” This is the classic dilemma – you don’t know what you don’t know – and a call for data provenance.

Drilling down on corrupted data, the report identifies patient data appearing in wrong patient EHR.  Before there were electronic records, unique name identifiers challenged and still challenge our brightest wits.  Who is John Paul Jones? Is he the same patient as J.P. Jones?  Well, clearly he is not the same patient as John Paul, as they have different last names, right? Wait, wasn’t one a Captain in the U.S. Navy and another an Admiral in the Russian Navy?  Well, at least we can be assured that John Paul Jones is the one buried at the U.S. Naval Academy.

ECRI also reminds on the chaos that follows default values. I saw a great institution routinely send critical patient information to a deceased physician with the help of the auto-population function during registration.

The 2015 Hazard Report offered four recommendations for data degradation:

  • Understand the end user work flow
  • Test, test and test some more (which works for ICD-10, too)
  • Train the users and make super-users/experts available
  • Monitor and report HIT adverse events

I’d like to add a fifth recommendation: Embrace data governance.

And by the way, John Paul and a Russian Admiral are also buried at Annapolis.

Categories: Influential , All
8:59

Having returned recently from the NJ/Delaware HIMSS Fall meeting in Atlantic City, I am recalling multiple conversations and sidebars on the topic of data governance.

But here’s the thing. To my knowledge, there wasn’t a single presentation on the topic.

Now I admit I may have had a glass or two of Cabernet at the reception. But my clear recollection is that data governance, while not on the official agenda, seemed to be the unofficial theme of the meeting in the minds of many attendees.

What is data governance and why is it claiming our attention? These are good questions to ponder.

In healthcare, as in other industries, data is seen as a valued asset, and data that is inaccurate is recognized as a lethal (sometimes literally) liability. As data is transformed into information for decision makers, in healthcare enterprises there is a rising appreciation of the need to have “right” data all the time.

Innocently, one may think data is data. Why the need for governance, meetings, committees and enterprise attention on data?

Well, the temperature of the room is the temperature of the room, right? But is the temperature in degrees Centigrade, Kelvin or Fahrenheit? And who measures the temperature? How is it measured?  Who records it and where? Is there a backup record? And who decided we should measure room temperature anyway?

And to further the need of a structure, suppose different end users had different meanings for the word “temperature.” Expressions such as “Admission Time” and “census” have different meanings for HHS and those staffing hospitals.  Admission Time for HHS is when the attending physician writes the order to admit the patient. Some patients are admitted and never occupy a licensed hospital bed, spending three days in a bay in the ER. What is your census then?

The challenges of responsible data management seem endless. Even when a parameter is defined, i.e., serum sodium, enterprises need stewardship of the metric. Depending on which chemical analyzer is used in a lab or system, the range of normal values will be different. Data governance demands a prominent place in the enterprise that values and uses data.

Industry definitions
Data governance has multiple definitions. The May 2011 Oracle white paper, Enterprise Information Management: Best Practices in Data Governance, nicely summarizes some of them.

In distillation, data governance is the formalized authority and responsibility for managing the enterprise’s data assets. This management addresses definitions, standards, processes, security, integrity, recognizes stakeholders and supervises the creation, reading, updating and deletion (CRUD) of data.

There is another similar and also increasingly popular term, information governance. As data and information are different concepts but occasionally used interchangeably, so are data governance (DG) and information governance (IG) innocently interchanged. Data governance and information governance, while reasonably having some overlap, are different, as Robert Smallwood points out in his August 2014 post.

I see the simple distinction as follows: Information governance is the enterprise’s front end, strategic, 30,000-foot view, and data governance is back end, tactical and granular.

Where IG and DG intersect seems to be in the area of security and confidentiality. Information arising from PHI data, duties the controllers of information to the same HIPAA confidentiality requirements.

The interests in data governance shared by the Atlantic City meeting participants were timely, confirmed by the release on November 25 by ECRI of their Top 10 Technology Hazards for 2015.  Validating the concerns in Atlantic City, ECRI identified as the number-two hazard for 2015, “Data Integrity: Incorrect or Missing Data in EHRs and Other Health IT Systems.”

The ECRI report highlights the complexity of the data integrity challenge, “What makes this problem so troubling is that the integrity of the data in health IT (HIT) systems can be compromised in a number of ways, and once errors are introduced, they can be difficult to spot and correct.” This is the classic dilemma – you don’t know what you don’t know – and a call for data provenance.

Drilling down on corrupted data, the report identifies patient data appearing in wrong patient EHR.  Before there were electronic records, unique name identifiers challenged and still challenge our brightest wits.  Who is John Paul Jones? Is he the same patient as J.P. Jones?  Well, clearly he is not the same patient as John Paul, as they have different last names, right? Wait, wasn’t one a Captain in the U.S. Navy and another an Admiral in the Russian Navy?  Well, at least we can be assured that John Paul Jones is the one buried at the U.S. Naval Academy.

ECRI also reminds on the chaos that follows default values. I saw a great institution routinely send critical patient information to a deceased physician with the help of the auto-population function during registration.

The 2015 Hazard Report offered four recommendations for data degradation:

  • Understand the end user work flow
  • Test, test and test some more (which works for ICD-10, too)
  • Train the users and make super-users/experts available
  • Monitor and report HIT adverse events

I’d like to add a fifth recommendation: Embrace data governance.

And by the way, John Paul and a Russian Admiral are also buried at Annapolis.

Categories: Influential , All

December 16,2014

18:00
Training older people in the use of social media improves cognitive capacity, increases a sense of self-competence and could have a beneficial overall impact on mental health and well-being, according to a landmark study carried out in the UK. A two-year project funded by the European Union and led by the University of Exeter in partnership with Somerset Care Ltd and Torbay & Southern Devon Health and Care NHS Trust gave a group of vulnerable older adults a specially-designed computer, broadband connection and training in how to use them.
16:44

Neuroprosthetics is a relatively new discipline at the boundaries of neuroscience and biomedical engineering, which aims at developing implantable devices to restore neural function. The most popular and clinically successfull neuroprosthesis to date is the cochlear implant, a device that can restore hearing by stimulating directly the human auditory nerve, by bypassing damaged hair cells in the cochlea.

Visual prostheses, on the other hand, are still in a preliminary phase of development, although substantial progress has been made in the last few years. This kind of implantable devices are designed to micro-electrically stimulate nerves in the visual system, based on an image from an external camera. These impulses are then propagated to the visual cortex, which is able to process the information and generate a “pixelated” image. The resulting impression has not the same quality as natural vision but it is still useful for performing basic perceptual and motor tasks, such as identifying an object or navigating a room. An example of this approach is the Boston Retinal Implant Project, a large joint collaborative effort that includes, among others, the Harvard Medical School and MIT.

Another area of neuroprosthetics is concerned with the development of implantable devices to help patients with diseases such as spinal cord injury, limb loss, stroke and neuromuscolar disorders improving their ability to interact with their environment and communicate. These motor neuroprosthetics are also known as “brain computer interfaces” (BCI), which in essence are devices that decode brain signals representing motor intentions and convert these information into overt device control. This process allows the patient to perform different motor tasks, from writing a text on a virtual keyboard to driving a wheel chair or controlling a prosthetic limb. An impressive evolution of motor neuroprosthetic is the combination of BCI and robotics. For example, Leigh R. Hochberg and coll. (Nature 485, 372–375; 2012) have reported that using a robotic arm connected to a neural interface called “BrainGate” two people with long-standing paralysis could control the reaching and grasping actions, such as drinking from a bottle.

Cognitive neuroprosthetics is a further research direction of neuroprosthetics. A cognitive prosthesis is an implantable device which aims at restoring cognitive function to brain-injured individuals by performing the function of the damaged tissue. One of the world’s most advanced effort in this area is being lead by Theodore Berger, a biomedical engineer and neuroscientist at the University of Southern California in Los Angeles. Berger and his coll. are attempting to develop a microchip-based neural prosthesis for the hippocampus, a region of the brain responsible for long-term memory (IEEE Trans Neural Syst Rehabil Eng 20/2, 198–211; 2012). More specifically, the team is developing a biomimetic model of the hippocampal dynamics, which should serve as a neural prosthesis by allowing a bi-directional communication with other neural tissue that normally provides the inputs and outputs to/from a damaged hippocampal area.
 

Categories: All , News and Views
12:56

Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.

US Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
Flappy Bird
ALS Ice Bucket Challenge
ISIS
Ferguson
Frozen
Ukraine

Global Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
ALS Ice Bucket Challenge
Flappy Bird
Conchita Wurst
ISIS
Frozen
Sochi Olympics

Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:

ICD-10 Delay
EHR Penalties
Wearables
Meaningful Use Stage 2
Epic
Obamacare
FHIR
Cerner-Siemens
HIPAA Breaches
Patient Engagement

What do you think of the list? Would you order it differently? Are there terms you think should be on the list?

December 15,2014

18:00
Agfa HealthCareAgfa HealthCare has announced that the Cremona Hospital and the Oglio Po Hospital, both part of the Azienda Ospedaliera 'Istituti Ospitalieri' di Cremona, in Italy, are upgrading to direct radiography (DR) with Agfa HealthCare's Fast Forward program. The wireless DX-D 100 was chosen for its image quality, potential dose reduction capability and ergonomic, easy-to-use design.
15:35

I have been reluctant in the past to write much about Theranos because the founder, an entrepreneurial prodigy named Elizabeth Holmes, does not speak to the press much. I have posted some information about the company in connection with its relationship to Walgreen's (see: Retail Chain Drug Stores Ramp-Up Their Healthcare Delivery Services). At any rate, a long article about Theranos and Holmes by Ken Auletta has recently been published in the New Yorker and it contains some very important details (see: Blood, Simpler). It's a very long piece so I have copied some significant quotes from it below in italics followed by my analysis and interpretation of the quote:

  • The phrases “disruptive technology” and “the future of medicine” come up a lot. Holmes, who is thirty, is the C.E.O. of Theranos, a Silicon Valley company that is working to upend the lucrative business of blood testing.
    • Holmes in on a mission to disrupt at least two major healthcare industries: (1) IVD equipment manufacturers; (2) the major national reference labs (Quest and LabCorp). Her plan may also disrupt portions of the healthcare software industry.
  • [Theranos] has also opened centers in forty-one Walgreens pharmacies, with plans to open thousands more. If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there....In 2013, Theranos announced a “long-term partnership” with Walgreens that will eventually establish its wellness centers in most of the eighty-two hundred Walgreens stores. The Walgreens in Palo Alto has one, as do forty Walgreens pharmacies in Phoenix. Holmes envisages wellness centers in most Walgreens and Duane Reade stores, which would put Theranos “within five miles of every American.” Theranos also could sign up the rival drugstore chain CVS, which has seventy-eight hundred outlets.
    • Part of the brilliance of the Theranos business model is that it avoids a build-out of the patient service centers (PSCs) maintained by Quest and LabCorp, leveraging instead its alliance with Walgreens. In so doing, it legitimizes direct access testing (DAT) about which I have posted numerous notes in the past. I am strongly in favor of DAT.
  • A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents.
    • Part of the disruptive nature of Theranos is that it's technology is inherently more efficient and part of its mission is to drastically reduce the costs of lab testing. Part of this low cost may involve losing money per test but its cost structure is inherently lower than that of Quest or LabCorp.
  • Holmes thinks that getting a blood test should instead be a “wonderful” experience, and the aim of Theranos is to lower the barriers. She told the crowd that between forty and sixty per cent of people who are ordered by their doctor to get a blood test do not.
    • Part of Holmes' story is that a finger puncture is a less traumatic than a venipuncture. It's certainly cheaper because of the lower cost of disposables. I think that her reference to creating a more wonderful experience for blood testing is over-hyped. I do think, however, that she is trying to make the experience more efficient for the patient. I am not surprised that a high percentage of tests ordered for ambulatory care patients are never performed.
  • Investors have valued the company at more than nine billion dollars, comparable to the two major diagnostic labs. Holmes owns more than fifty per cent of the company; she was profiled last spring in Fortune and subsequently featured in Forbes as “the youngest self-made female billionaire in the world.”
    • Part of the strategy of Quest and LabCorp in the past has been to buy out its competitors. This won't work with Theranos. On paper, the company is worth more than them combined. She also plans to take over their mission-critical ambulatory care market. Even if Theranos were worth much less, she does not seem the type to relish a buy-out offer regardless of its size.
  • The board of her company is stocked with prominent former government officials, including George P. Shultz, Henry Kissinger, Sam Nunn, and William H. Foege, the former director of the Centers for Disease Control and Prevention. Dr. Delos M. Cosgrove, the C.E.O. and president of the Cleveland Clinic, is an avid supporter.
    • She is going to be well advised by her board and other well-placed individuals who undoubtedly have large financial stakes in the company. She will be a formidable competitor.
  • Cosgrove predicts that blood tests for many common health issues, including high cholesterol and diabetes, will be initiated by patients as well as by doctors. “The CVSs and the Walgreens and the Walmarts of the world are going to be taking a lot of things that currently go to primary-care physicians,” he said. 
  • Last year, the U.S. Food and Drug Administration barred 23andme from disseminating some information out of concern that consumers might misunderstand or misuse it. Some observers are troubled by Theranos’s secrecy; ....the company has published little data in peer-reviewed journals describing how its devices work or attesting to the quality of the results.
    • Ordinarily and to attack competitors with some new technology, Quest and LabCorp or IVD manufacturers would merely drop a note to the FDA. Unfortunately for them, Theranos manufactures its own analyzers, thus qualifying the company for an exemption for laboratory developed tests (LDTs) (see: FDA Issues Draft LDT Guidance Documents; Provides 120-Day Comment Period and will Host October Public Meeting). These other companies, in fact, also derive benefit from their LDT tests. The FDA is now trying to regulate LDTs but the final rules are far in the future. Moreover and by the time they are published, Theranos will undoubtedly be prepared to qualify under them.
  • Clarke [Quest’s senior scientific director for mass spectrometry, immunology, and automation] argues that finger-stick blood tests aren’t reliable for clinical diagnostic tests; because the blood isn’t drawn from a vein, the sample can be contaminated by lanced capillaries or damaged tissue. Holmes strongly disagrees: “We have data that show you can get a perfect correlation between a finger stick and a venipuncture for every test that we run.”....Holmes also pointed me to a pilot study published by Hematology Reports, an online-only peer-reviewed journal; she is listed as a co-author. The report, released in April, concluded that Theranos tests “correlated highly with values obtained” from standard lab tests.
    • Quest needs some powerful ammunition against Theranos than the possible contamination of blood samples with "tissue juice" due to a finger stick. Even if it can be proved that some of the Theranos samples are unreliable for analysis, the company can always revert to a venipuncture and microsample for selected tests. It's of interest, but clearly predictable, that Holmes chose to publish her results in a very obscure, on-line pathology journal.

In summary, I don't see any flaws in the Theranos business model although it's quite radical when compared to the IVD and reference lab industry as it stands today. Holmes is going about her business in a quiet and methodical way. There's a lot more to discuss about Theranos. I will return to the company in subsequent notes. I am interested in their approach to IT. However and if I were the CEO of Quest or LabCorp, I would be very,very worried. 

14:07

If you’re like me and sometime gave your email to Healthcare.gov, then you’ve probably getting the daily reminders this past week about December 15th being the last day you can sign up on the Health Insurance Exchange if you want to get health insurance coverage starting January 1st. I wish they would have made the email system a little smarter and let us click a button that said “Already got my insurance this year.” Although, I appreciate that they’re just trying to make sure that everyone knows the timelines.

Based on the news coverage (or lack therof), it seems that Healthcare.gov has survived without any major issues this year. One thing that has annoyed me about the emails is they keep telling me how many people’s health insurance is getting subsidized on the exchanges. It seems that about 8 out of 10 people who get insurance from the exchange are getting a government subsidy.

I guess that means I’m in the 20%. Maybe their marketing is working great for those who can get the subsidy. However, it has the opposite impact on someone who does’t get the government subsidy. In fact, my insurance costs have nearly doubled since pre-Obamacare days.

Turns out, that because I wasn’t getting any government subsidies for my insurance, it was better for me to just go direct to the insurance company. That’s what I did and the process was super simple. In fact, I signed up for a plan that included ZDoggMD’s Turntable Health. I’m especially excited to do e-Visits and text message my doctor as needed. Plus, I’m going to have to see about tapping into the free yoga classes and demonstration kitchen. You can sure I’ll be writing more about this in the future.

I found this piece from HIStalk to be quite interesting:

A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.

Sorry if this post was a bit of a rambling rant. I just saw the deadline and needed to get it out of my system. I think the next 5 years we’re going to see a dramatic change in healthcare as we know it. As a blogger, that means I’ll have plenty to write about. As a patient, I have some cause for concern.

8:44

John Lynn, prolific blogger and health IT media magnate, and I are teaming up again for the second year to produce and deliver a marketing conference focused on helping digital health, health IT, and medical device  innovators. We’re going to be providing actionable advice and specific techniques you can use to cut through the noise when trying to market healthcare and medical tech products to physicians, hospitals, health systems, ACOs, patients, and similar customers. Called The Healthcare IT Marketing Conference, last year’s event covered very important subjects by some of the world’s best experts on those topics and we’ll continue the tradition again in 2015.

Learn the difference between Marketing, Advertising, PR, and Branding

Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers at HITMC know the difference and will teach you how to make sure you’re not taking the wrong steps.

Learn how to conduct appropriate market research

Lots of (even innovative) companies don’t do basic market research so we will cover:

  • Find the right search terms for your industry or product. Don’t be esoteric. Because most products will only be found through word of mouth or on the Internet, don’t choose terms to describe yourself that no one else understands. Selling to hospitals is not about creativity, it’s about value. If the customer doesn’t understand what you’re selling give up now.
  • Use competitive intelligence to locate your competitors and existing firms.

Learn about the different kinds of of Business Models to consider

  • Software as a Service (SaaS) and subscription model  — best model for startups with something they can maintain in their own data centers
  • Consulting and Solutions model — when you can provide packaged help
  • Licensed model — when privacy or complexity requires solutions to be installed in house
  • Freemium model (and open source)

Learn about major healthcare industry fallacies

Selling to the healthcare community is very hard and there are many myths that our conference will dispel:

  • Healthcare folks are neither technically challenged nor simple techno-phobes. Because they are in the business of saving lives and improving health, they care about technologies that help them achieve their mission.
  • Most product decisions are no longer made by clinical folks alone, CIOs are fully involved. Don’t try to sell just to the clinical folks — make sure the IT side is engaged and on your side.
  • Complex, full-featured, products are not easier to sell than simple, stand alone tools that have the capability of interoperating with other solutions are much easier to sell. Software as a service is a good approach.
  • Hospitals will not buy unless one proves value. This seems obvious but many companies think that because they think something is important, their customers will just agree.
  • Selling into doctors offices is not easy. There were a few startups looking to sell to individual physicians’ offices. Selling to to your first dozen physicians is pretty easy since we all know doctors. Just be careful, though, since selling to the next dozen and beyond is where companies fall.

Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product

There are three distinct groups you’re marketing and selling your products to:

  • The payer or the person/entity that writes the check for your product.
  • The person or group that benefits most from the use of the product.
  • The person or group that actually uses the product.

I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through  Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.

Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.

Go home with many tips and tricks:

  • Make sure your company and its value is easy to explain
  • Make sure your value is defendable and differentiated (but without being esoteric)
  • Make sure that you have ability to attract partners and can either create or be part of an ecosystem
  • Ensure that you have word of mouth opportunity
  • Have scaleable staff and systems
  • Have a scaleable product — build once, sell many times
  • Have an uncomplicated pricing and deployment model
  • Be very focused — you can’t “solve healthcare” but you can solve very specific problems
  • Try to own the relationship with and information about customers — don’t rely on partners that won’t give you access to customers

 

8:16

Mike-HITIn my 17-year career, I’ve witnessed exponential growth in the QA field. Spending on quality assurance and testing now represents about a quarter of a typical IT organization budget, and the job opportunities and salaries for test professionals have grown as a function of this increased focus on software quality.

Frankly, some in IT are still dismissive of testing, but it’s an integral component of the SDLC and it can be a challenging and meaningful way to make a living. So if you are just starting out or considering a move to testing, I thought I would share some tips below from my own experience to help you grow in your QA and testing career.

Pick a path
You can take several paths in software testing. Manual testing is the most common role in software QA. This can be a rewarding career if you are detail oriented, have a natural curiosity and enjoy learning new things.

If you continually improve your skills, you can make a good living as a Manual Tester, and you can command a premium if you have specialized expertise in certain types of in-demand software (such as CRM, e.g., Salesforce, or ERP, e.g., SAP) or in-depth knowledge of certain industry verticals, like healthcare or manufacturing.

To move up in the QA organization after a few years of manual testing you can choose to follow a technical path or a test management path.

If you love testing and you have a knack for coding and scripting, consider learning automated, performance, mobile and/or security testing. If you want to grow in the technical path, you should keep up with the latest technologies.

On the other hand, If you like leading a team and motivating people to do their best, consider being a Test Lead or Test Manager. If you are a Talented QA Manager, your can move up to a Senior Manager, Director or Senior Director. With the increasing popularity of Testing Centers of Excellence (TCoE), more and more QA executive positions are opening up at the VP and SVP levels. Senior-level positions often require advanced degrees like an MBA or an MIS degree.

Be professional
I started as a QA intern, the lowest rung on the ladder, but I strove for professionalism in every task and all of my interactions. Often the biggest difference between the individual who gets promoted and the one who remains at the same level year after year is the ability to communicate clearly and succinctly and get along with others. Negative behaviors like whining and complaining and criticizing others can hold back testers from moving to the next level.

One of the most important traits of a QA professional is integrity. In order to be considered a trusted advisor it is important to be honest, dependable and transparent. When it comes to Quality Assurance, managing by facts and consistent metrics rather than emotions and opinions is the quickest path to providing value and earning trust.

Choose tough assignments
I have grown more when faced with challenging projects where I had to step outside my comfort zone. I recall the first time I was asked to set up an offshore team. After travelling to India, I gained a greater appreciation for the pros and cons of leading a globally distributed team. I learned a lot and gained confidence by doing something that I hadn’t done before. So I always recommend volunteering for tough projects if you are seeking professional growth.

Own your career growth
If you are fortunate, you will find managers or mentors that will take interest in you and help you along, and that’s great. But don’t wait until your manager asks you to learn a new skill or take a class. Proactively ask your company to invest in your skills and growth, and if it can’t (or won’t), then invest in yourself. Join a QA association and take on committee or leadership roles, attend testing meet-ups, read books and articles and apply to speak at conferences so you can attend for free.  Certifications are valuable early in your career to learn QA fundamentals.

Know when to move on
If you have hit a plateau in your career growth, or if you are consistently at odds with your supervisor, then it may be time to take on a new project or job. In technology careers, sometime you have to leave to move up. For some people, working as a contractor or consultant is the best ways to get a variety of work and industry experiences. One caution here:  If you jump from company to company too often, prospective employers may question your loyalty. You will need to find a balance between adding new skills and jobs, while demonstrating the stability that hiring managers seek.

Put customers first
Testers are always balancing the needs of multiple stakeholders. The objectives of business owners and product managers aren’t always the same—and can be in conflict with one another—especially on a critical software project.

Your job is to view software applications from the perspective of the end user and use your training and skills to improve that user experience. Is it important to consider the input of key stakeholders? Absolutely. But true testing professionals should always keep the customer at top of mind and be an advocate for their optimal experience.

If testing is your passion and career path, and you are interested in consulting opportunities, I’d love to hear from you. Drop me a resume at mike.cooper@healthcareitleaders.com.

Categories: Influential , All
8:16

Mike-HITIn my 17-year career, I’ve witnessed exponential growth in the QA field. Spending on quality assurance and testing now represents about a quarter of a typical IT organization budget, and the job opportunities and salaries for test professionals have grown as a function of this increased focus on software quality.

Frankly, some in IT are still dismissive of testing, but it’s an integral component of the SDLC and it can be a challenging and meaningful way to make a living. So if you are just starting out or considering a move to testing, I thought I would share some tips below from my own experience to help you grow in your QA and testing career.

Pick a path
You can take several paths in software testing. Manual testing is the most common role in software QA. This can be a rewarding career if you are detail oriented, have a natural curiosity and enjoy learning new things.

If you continually improve your skills, you can make a good living as a Manual Tester, and you can command a premium if you have specialized expertise in certain types of in-demand software (such as CRM, e.g., Salesforce, or ERP, e.g., SAP) or in-depth knowledge of certain industry verticals, like healthcare or manufacturing.

To move up in the QA organization after a few years of manual testing you can choose to follow a technical path or a test management path.

If you love testing and you have a knack for coding and scripting, consider learning automated, performance, mobile and/or security testing. If you want to grow in the technical path, you should keep up with the latest technologies.

On the other hand, If you like leading a team and motivating people to do their best, consider being a Test Lead or Test Manager. If you are a Talented QA Manager, your can move up to a Senior Manager, Director or Senior Director. With the increasing popularity of Testing Centers of Excellence (TCoE), more and more QA executive positions are opening up at the VP and SVP levels. Senior-level positions often require advanced degrees like an MBA or an MIS degree.

Be professional
I started as a QA intern, the lowest rung on the ladder, but I strove for professionalism in every task and all of my interactions. Often the biggest difference between the individual who gets promoted and the one who remains at the same level year after year is the ability to communicate clearly and succinctly and get along with others. Negative behaviors like whining and complaining and criticizing others can hold back testers from moving to the next level.

One of the most important traits of a QA professional is integrity. In order to be considered a trusted advisor it is important to be honest, dependable and transparent. When it comes to Quality Assurance, managing by facts and consistent metrics rather than emotions and opinions is the quickest path to providing value and earning trust.

Choose tough assignments
I have grown more when faced with challenging projects where I had to step outside my comfort zone. I recall the first time I was asked to set up an offshore team. After travelling to India, I gained a greater appreciation for the pros and cons of leading a globally distributed team. I learned a lot and gained confidence by doing something that I hadn’t done before. So I always recommend volunteering for tough projects if you are seeking professional growth.

Own your career growth
If you are fortunate, you will find managers or mentors that will take interest in you and help you along, and that’s great. But don’t wait until your manager asks you to learn a new skill or take a class. Proactively ask your company to invest in your skills and growth, and if it can’t (or won’t), then invest in yourself. Join a QA association and take on committee or leadership roles, attend testing meet-ups, read books and articles and apply to speak at conferences so you can attend for free.  Certifications are valuable early in your career to learn QA fundamentals.

Know when to move on
If you have hit a plateau in your career growth, or if you are consistently at odds with your supervisor, then it may be time to take on a new project or job. In technology careers, sometime you have to leave to move up. For some people, working as a contractor or consultant is the best ways to get a variety of work and industry experiences. One caution here:  If you jump from company to company too often, prospective employers may question your loyalty. You will need to find a balance between adding new skills and jobs, while demonstrating the stability that hiring managers seek.

Put customers first
Testers are always balancing the needs of multiple stakeholders. The objectives of business owners and product managers aren’t always the same—and can be in conflict with one another—especially on a critical software project.

Your job is to view software applications from the perspective of the end user and use your training and skills to improve that user experience. Is it important to consider the input of key stakeholders? Absolutely. But true testing professionals should always keep the customer at top of mind and be an advocate for their optimal experience.

If testing is your passion and career path, and you are interested in consulting opportunities, I’d love to hear from you. Drop me a resume at mike.cooper@healthcareitleaders.com.

Categories: Influential , All
8:00
The Accountable Care Organization regulations were first promulgated under authority of the ACA's Medicare Shared Savings Program in 2011. Three years later, the regs are in the shop for a tune-up. Farzad Mostashari MD was one of the authors of...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg

December 14,2014

18:00
eHealth Week 201511 - 13 May 2015, Riga, Latvia.
Taking place during the Latvian Presidency of the Council of the European Union, eHealth Week 2015 comprises of two main events: the High Level eHealth Conference organised by the Latvian Ministry of Health and the Latvian Presidency of the Council of the European Union and WoHIT (World of Health IT Conference & Exhibition) organised by HIMSS Europe.

December 12,2014

19:10

On 11/9/14, I posted a note suggesting that wearable health monitoring devices might be a means to lower health insurance costs (see: Wearable Health Monitoring Devices: a Means to Lower Insurance Costs?). I drew a parallel to the electronic monitoring device offered by Progressive Insurance called Snapshot that plugs into your car, monitors your driving habits, and then enables you to a reduced premium if your drive safely. Oscar Health Insurance is now bringing this idea to reality for health insurance (see: This Insurance Company Pays People to Stay Fit):

Oscar Insurance bills itself as a “new kind of health insurance company,” one that uses a combination of technology and transparency to bring the stodgy insurance industry out of the Dark Ages. And now, it’s giving the industry a particularly firm kick towards the future. ...Oscar [has] unveiled a new initiative that will provide every Oscar member with a free Misfit fitness band. But in an industry that’s infamous for nickel-and-diming its customers, what’s even more progressive is that Oscar is going to pay its members to actually use them....Counting steps with a fitness tracker like Misfit, he says, is a good place to start. In recent years, fitness trackers have grown beyond the cottage industry of quantified selfers, so much so that even Apple is ready to seize on the opportunity. But having an insurance company...recognize these devices as an actual health intervention lends the entire fitness tracking industry a new level of legitimacy. Oscar members can order their new Misfit on the Oscar iOS or Android app. It syncs to the app automatically, so users only need to strap it on and get to walking. Users who already have a fitness tracker can also connect it to the Oscar app using Apple HealthKit, but that takes a bit more set up. Oscar’s algorithms determine how many steps each member should aim for in a day, based on that person’s health data. Each day a member surpasses that goal, he gets $1. When he accrues $20, he can cash out in the form of an Amazon gift card.

I don't know anything about the Oscar Insurance Company and am not recommending the company. I also don't know anything about its coverage or cost of its insurance. I do think that the idea of paying the holder of a health insurance to walk daily is very smart. All of this reminds me of a note I posted related, in part, to the fact that people who had dogs and took the trouble to walk them were healthier (see: Learning from the Demographics of Doggie Death). Here's a quote about dog-walking in Australia:

46% of households in [New South Wales, Australia] had a dog and, overall, dog owners walked 18 minutes per week more than non-dog owners. However, more than half of dog owners did not walk their dogs, and were less likely than non-owners to meet recommended levels of physical activity sufficient for health benefits. If all dog owners walked their dogs, substantial disease prevention and healthcare cost savings of $175 million per year might accrue.

So, if you are not interested in the Oscar insurance approach, another alternative would be to buy a dog and walk it daily. This should also improve your mood.

December 11,2014

15:15

For the last few years, the major retail pharmacy chains (i.e., Walgreens, CVS, and Rite Aid) have taken steps to position themselves as the first rung of the healthcare delivery system. They have begun to offer various types of walk-in, low-intensity services staffed by nurses or nurse practitioners. Pharmacists have also begun to provide flu shots and other type of vaccinations. CVS recently made a very bold statement by no longer selling cigarettes. Walgreens is offering lab testing on a pilot basis with Theranos (see: CVS Stops Selling Tobacco; Walgreens Works with Theranos for Lab Testing).

Similar entry-level healthcare services are also being offered in free-standing urgent care centers staffed by physicians that are competing, in part, with hospital emergency rooms. These facilities offer imaging and care of minor trauma (see: Rapid Growth of Urgent Care Clinics; Cost Competition for Hospital ERs).

The major retail drug store chains are thus going "all in" as convenient, local health centers and now also providing telemedicine-based physician services in selected stores in collaboration with MDLIVE (see: Walgreens moves into telemedicine with MDLIVE deal). For further reading, here's an article discussing the relationship between Obamacare and telemedicine: With ACA, Telemedicine In 'Perfect Storm' For Coverage). Below are some more details from a recent story about the wide range of services being offered by  the retail drug chains:

Drugstore chains have been expanding healthcare services to provide a way for patients to see doctors outside of normal physician hours without having to go to an emergency room for non-emergencies. Walgreens’ move to adopt MDLIVE as a telemedicine provider echoes similar moves by rivals such as CVS and Rite Aid, but it also supplements the company’s other initiatives.....Customers will be able to access doctors by email, text and video through Walgreens’ app for various acute conditions. Although the service is initially available to customers in California and Michigan, the plan is to roll it out to other states in the next year. MDLIVE got started in 2006 in Sunrise, Florida and has provided telemedicine services through employers such as Cigna. It also has a HIPAA-compliant system that helps payers and providers collect and share clinical data from patient medical records, lab results and in-home biometric devices for real-time risk assessments and wellness advice. Last month... [MDLIVE] acquired behavioral health “teletherapy” company Breakthrough Behavioral to add more specialized services. Several telemedicine companies have added mental health services and teledermatology to make them easier to access from home. It also offers a second opinion service. Walgreens has been developing a healthcare strategy with a goal of complementing physician services and to provide a way to share these touch points with physician practices. Last year, Walgreens began offering a service to diagnose and treat chronic conditions in its clinics. Diabetics visited the store an average of 20 times a year....It is also collaborating with Theranos to roll out physician-ordered diagnostic test collection centers at stores around the country. Rite Aid partnered with telemedicine provider HealthSpot for a pilot in its Ohio stores, CVS is doing a telemedicine pilot at 28 sites in California. Walmart is collaborating with Humana.

One of the most interesting questions from all of this is to what extent the competition from drug store chains will affect local hospitals and physician practices. I think it's really going to hurt, particularly in smaller towns for smaller hospitals. With this increasing competition in healthcare and CMS ratcheting down Medicare reimbursements, many small hospitals can no longer compete and are even declaring bankruptcy (see: Some Hospitals Experiencing Financial Distress and Even Bankruptcy). That's why many of them are seeking affiliations or mergers with larger regional hospitals. Such arrangement create referral possibilities for specialized care with patients returning to their home turf for primary care (see: Big hospital merger increases pressure on the little guys). Here's a quote from this latter article that helps to explain what is going on:

The economics of health care are shifting against hospitals as the payment model moves from the traditional fee-for-service, which rewards administering more care, to models that pay based on outcomes and reward providers for keeping people healthy. Individual hospitals and small systems have a harder time competing in such an environment because they lack the scale to reduce per-patient costs significantly.

14:13

The thing about the Internet is that you never know when something is going to go viral or spark heated debate. (Actually, it’s a fairly sure bet that anything involving politics, religion or sports will lead to heated debate, generally of the lowbrow variety.)

Less common is informed, intelligent discussion on the Internet. Something I wrote early yesterday for Forbes.com has, happily, fallen into this category.

My post, “Hype Around Healthcare Wearables Runs Into Reality,” is far from the most inflammatory piece I’ve written about overblown hype in healthcare innovation, or, as Dr. Joseph Kvedar called it, “irrational exuberance,” borrowing a line from former Federal Reserve Chairman Alan Greenspan.

It’s also far from the most-viewed item I’ve had on the Forbes.com platform since I started about six months ago. However, it’s generating a lot of discussion on Paul Sonnier’s Digital Health group on LinkedIn. As of this writing, there are 28 comments, or more than one per hour since the original post went up at 9:54 am EST Wednesday.

If you’re one of the more than 30,000 members of that group, I encourage you to join the discussion. If not, you might want to join the group, or comment on the original post at Forbes.com.

I haven’t decided yet if I’ll throw in an additional two cents, since I did, you know, already give my opinion in the actual post.

12:33
Is it the best thing since sliced bread? Is it really a better mousetrap? Does it really have that special sauce? The term "disruptive innovation" gets bandied about quite a bit, and in recent weeks and months, it has been...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg

Follow Us: