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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From Kit Carson: “Re: Fletcher Flora. I’m interested in knowing what’s going on with shareholders. The final distribution statement was supposed to go out in November 2011.” We broke the news in November 2010 that Merge Healthcare had acquired the LIS vendor (I forget how I found out, but it must have been sneaky since I worded it as “HIStalk has learned,” which means I was snooping.) I don’t know anything about its shares, but I’ll run an update if anybody has one.

From Adele: “Re: HIStalk. As a sponsor, thanks for all of your hard work toward making HIMSS as productive as possible for your subscribers and for your sponsors. We are grateful that you all actually make the time to track our news and offer your suggestions to us when there are so many larger ‘fish to fry’ in your universe. HIStalk is one of the only places that provides for an equal voice for all of its sponsors, regardless of size, revenues, or politics. As a smaller company, we just can’t write a fat check simply to pay to play in some other channels. Moreover, we wouldn’t. For us, that is just not responsible stewardship of our clients’ resources.” Sometimes Inga and I need a little boost and this gave us one. Thanks.

From Vendor_Neutral: “Re: Epic. Wondering if you came across the online discussion spurred by the NYT piece?” I did see it, but like a lot of Internet discussion, I found it to be mostly hot air pontificating by industry sideliners and self-referencing, self-appointed experts who have never used Epic, aren’t clinicians, and don’t even work in healthcare IT (if you’re going to criticize a restaurant, at least eat there a couple of times.) Some of the least-informed comments drone on about Epic’s outdated technology, a clear signal that the authors have no experience in a business software environment, where customers value applications that are solid, scalable, and expertly managed over the latest iPad app or cool Web site. To dismiss the business and software savvy of hospitals that are buying Epic in droves is ludicrous, even if you (as I) doubt that most of them have the organizational fortitude to get the rosy ROI and patient benefits they expect when they fork over mega-millions. Somehow I doubt that Judy is losing sleep worrying that all the armchair quarterbacks will redirect their expertise into building a better mousetrap that will renders hers as obsolete as the company’s persistent detractors claim it already is.

From CDS Observer: “Re: FDA regulation of clinical decision support. This could be serious since it could involve a wider range of systems to be regulated, such as EMRs and simple apps. This would be a big blow to many smaller companies. Our company has joined CDS Coalition to make our voice heard and to keep members informed in case their product ends up getting included in the regulatory net.” I found the CDS Coalition’s Web page here. Companies pay $1,200 to $30,000 per year to join.

From Ambergris: “Re: KLAS scores of publicly traded companies. Didn’t you post something at one time?” That was actually Evan Steele of SRS, who made the point in October that five of the six top-rated EHR products are offered by privately held vendors, while eight of the nine lowest-ranked products are offered by publicly traded companies. To be fair, he’s only looking at customer support rankings of a specific ambulatory EHR category. However, I will add from experience, having had a few incumbent vendors go public or be acquired by publicly traded companies, that every one of them got worse afterward (I’ve written many times on the KLAS “first to worst” product phenomenon.) Investors replaced me as the company’s most important customer. I’d like to say it doesn’t have to be that way, but I can’t think of many exceptions. On the other hand, if you buy from the company after they’re public, at least you know what you’re getting and have less reason to be disappointed compared to the folks who knew them before.

From Jess: “Re: fast track clinic model for expediting medical services to patients coming to the hospital. I was hoping I could tap into your vast knowledge base to see what you know about this model.” I think you are overestimating the vastness of my knowledge base since it’s coming up empty on this topic (although come to think of it, “vast” usually means big but empty.) I will call in the assistance of expert readers to fill my void.

From The PACS Designer: “Re: Jobs biography. The biography Steve Jobs by Walter Isaacson has some interesting comments. Jobs said of Microsoft’s Bill Gates, ‘Bill is basically unimaginative and has never invented anything, which is why I think he’s more comfortable now in philanthropy than technology.’ Isaacson said this about Steve: ‘He was not the world’s greatest manager. In fact, he could have been one of the world’s worst managers. He could be very, very mean to people at times.’" I think that’s what I enjoyed most about the book – trying to figure out how someone so narcissistic, uncaring, and downright nasty could not only create arguably the world’s greatest company, but run it as a publicly traded company CEO almost until the day he died despite seemingly lacking all the important skills for the job. The only other example I could think of was Neal Patterson of Cerner. And Bill Gates. I guess the bottom line is that if you’re a visionary who started the company (see: Mark Zuckerberg), you can mold it to your bizarre personality, unlike the typical gunslinger, committee-vetted musical chair CEO that big corporations love who are loaded with MBA school bean-counting competency but short on anything resembling risk-taking, innovation, and vision.

The good news about offshore programming is that half of responding readers don’t automatically assume it means shoddy work. The bad news is that the other half do. New poll to your right, and this should be fun: who is most responsible for the glut of clinically useless EMR information?

Inga and I forget ever year just how busy we get in January and February in the HIMSS build-up period: interviewing, plowing through increasing numbers of pointless press releases to find the occasional newsworthy tidbit, adding new sponsors, and planning HIStalkapalooza. If we’re slow to respond, that’s why. I came home from a nine-hour day at the hospital Friday, chowed down the Wendy’s salad and baked potato helpfully provided by Mrs. HIStalk on her way home from work since she knew I was overwhelmed and had approximately 15 minutes of free time to eat, and worked eight straight hours on HIStalk stuff without even leaving my chair. Six hours later, I was back up and at it for another long day Saturday, where emerged like Punxsutawney Phil only long enough to see my own shadow during a brief lunch with Mrs. H, then get back to work. That grind won’t end for us until the conference is over. I will need (and am taking) a vacation afterward, assuming I survive until then, and Inga will be away the week after. The worst thing is that, like a crack user, I enjoy it and can’t see cutting back even though it’s probably unhealthy. While I’m away, I’ll plan my self-improvement for the rest of the year, so if you have ideas of books I should read, conferences I should attend, or things I should do, let me know.

Speaking of HIStalkapalooza, thanks again to ESD for putting together an outstanding event. It’s a big effort to have planners visit potential sites, work out food and entertainment details, handle logistics like registration and decorations, and of course write a huge check when it’s all over. They have been outstanding to work with, and since they get what HIStalk is about, they suggested some fun surprises that I heartily approved. If you need consulting help with your clinical systems projects (training, implementation, support, optimization, Meaningful Use, etc.) I’m sure they wouldn’t be opposed to taking your call. If you got an HIStalkapalooza invitation, please thank them when you get there. I wasn’t even sure I wanted to do another event this year, but I think it’s going to be cool.

Also fun: Medsphere is bringing over its 1971 VW open source bus, which Chairman Mike Doyle tells me will be available “to shuttle HIStalk groupies to your event on Tuesday.” I don’t know what they’ve planned for routes and all that, so maybe just flag it down if you see it if you need a ride to the Palazzo.

I’ll put in just a brief placeholder for our Booth Crawl, which will offer provider attendees of HIMSS what I would guess is their best chance to impress the fam by bringing home an iPad 2. Think of it as a scavenger hunt where you visit the designated booths to get the answers to secret questions (you’re visiting booths anyway, so you might as well hit these and get in the running for a swell prize.) You enter those answers online by Wednesday evening and watch HIStalk to see if you are one of the randomly drawn winners. You don’t have to get stickers or stamps on a card, you don’t have to drop your entry into a hopper, and you don’t have to be present to win. We have 55 iPads to give away, so the odds should be pretty good, plus you’re supporting our sponsors just by playing (not to mention that I noticed that a couple of sponsors have added prizes of their own.) I’ll be posting the form shortly. Nobody’s making money off this since we’re doing the work on our end for free and the sponsors happily donated the prizes, so for everybody involved it’s all about putting iPads into the hands of readers.

One last HIMSS note: if you aren’t attending, we will try our best not to make you feel left behind even though we have to write a lot about it. I think I speak for most readers in saying that the more years you go, the less you enjoy it and the more it becomes work instead of fun. I stay up until all hours each night at the conference writing everything up so you won’t miss anything important. The educational sessions are always iffy if you don’t research the presenter’s credentials in advance – I should hire someone to help me put on independent Webinars that would provide similar education without the travel and time off expense, which I’ve been talking about doing for years.

I verified that RelWare has closed its office and let half the staff go, having lost the client for which it developed its EXR EHR, Henry Ford Health System. HFHS went live on the $100 million system, then decided less than a year later to have a $350 million fling with Epic instead (note to self: don’t ask HFHS for long-term IT strategic planning help.) RelWare is sitting on a certified EHR (Inpatient and Modular Ambulatory) that is running in six hospitals and 100 clinics that will soon be homeless, so they’ll consider licensing arrangements or outright sale of the source code to interested organizations. My RelWare contact is somewhat informal, so I guess you can e-mail me if you’re interested and I’ll forward.

Travis has been writing some really good stuff on HIStalk Mobile lately. The fun mixture of pieces includes, in the three most recent posts, (a) a hands-on review of the Zeo Sleep Manager; (b) a new post that contains a lot of items that I hadn’t seen elsewhere; and (c) his take on mobile strategies for pharma. He’s a doctor and an mHealth startup guy, so while I’ve seen splashier sites covering similar ground, I haven’t seen any doing it better.

Thanks to the following new and renewing sponsors that supported HIStalk, HIStalk Practice, and HIStalk Mobile in January (click a logo for more information). You have to admire them for mailing off a check to a post office box to an anonymous, smart mouth blogger without so much as a phone call to sooth any concerns they might have. They either sign up after reading the information sheet or they don’t, and we appreciate those who do.

Epocrates earns Ambulatory Complete EHR certification for its EHR v2. I had forgotten they had one, to be honest. They acquired the iChart mobile app a couple of years ago and rebuilt it into a full product, announcing GA in July 2011.

TrustHCS names Dianne Haas PhD, RN as executive director of its consulting services division.

Morton Meyerson joins the board of Encore Health Resources. He’s the former CEO of Perot Systems and runs Dallas investment firm 2M Companies, Inc.

Office for Civil Rights has cranked up their HITECH-mandated spot-check HIPAA audits, with the first 20 lucky organizations being notified in December that they had been chosen (with 130 more planned for 2012.) CynergisTek and ZixCorp are running a free Webinar next week featuring former HHS HIPAA enforcer and attorney Adam Greene and some folks who participated in those first 20 audits. If anybody has time to sit in, let me know the gist.

Vince’s HIS-tory lesson this week gets a bit more personal, honoring former SMS VP Jim Carter. Vince’s stuff isn’t just for the long-timers – whippersnappers can learn from the HIT history books, too.

McKesson acquires the oncology clinical decision support tools of Proventys.

Lawson announces that its Cloverleaf integration technologies have met the highest industry standards at the IHE Connecthon.

Joint Commission investigates a complaint against University of Michigan Health System that says it waited six months before telling police that child pornography had been found on a medical resident’s flash drive in the ED. Joint Commission is considering whether the delay qualifies as a sentinel event.

Revenue cycle vendor Accretive Health, already being sued by the State of Minnesota over a lost laptop, has its debt collections license suspended by the state until it provides information about how it was using patient information for collections and how its collectors interacted with patients.

Apple CEO Tim Cook, showing more support for charitable activities than his predecessor, says the company has donated $50 million to Stanford’s hospital, most of it for new building construction. Maybe he should have looked for charities that don’t run a hugely successful business already given that Stanford Hospitals and Clinics reported a profit of $186 million in its most recent government reports, paying its president almost $2 million and the CIO $680K. I’ll say this: when I donate to charity, it’s never to a hospital, including the several I’ve worked for. They are making plenty of money already, wasting significant amounts of it, and not really helping improve health as much as just providing more episodic healthcare encounters. I’d rather support public health causes that keep people from becoming their customers, such as those addressing obesity, disease management, and preventive care.

HIE vendor Sandlot Solutions names Joseph Casper, formerly  of MedPlus, as CEO.

Session # 55: Tale of Two Health Systems: Implementing an Enterprise Data Warehouse

• Two major health systems (Orlando Health and Essentia Health) present their lessons learned and benefits achieved via an enterprise data warehouse initiative.
• Rick Schooler, Orlando Health Ken Gilles, Essentia Health
• Tuesday, February 21, 12:15 PM – 1:15 PM

Session #31: Marketing the Healthcare IT Project

• Effective marketing is a crucial part of any IT project- We will discuss innovative ways you can market to end-users and provide real examples from premier health systems to amp up the marketing initiatives within your organization.
• Chuck Christian, CIO Good Samaritan Hospital Steve Bennett, VP Kirby Partners
• Tuesday, February 21 @ 11:00-12:00 Murano 3303

Session # 42: EHRs: The New Drug Safety, Liability and Efficacy Battleground

• The rapid adoption of EHRs by U.S. providers creates a new and powerful platform to improve patient safety, professional liability protection, drug efficacy and regulatory compliance.
• Edward Fotsch, MD, Chief Executive Officer, PDR Network David Troxel, MD, Medical Director, The Doctors Company
• Tuesday, February 21, 12:15 PM-1:15 PM (Marco Polo 803)

Session # 110: A Community HIE that Makes Cents while Improving Health Location

• MyHealth Access Network, a Beacon Community in Tulsa, is focused on improving health with a community-wide infrastructure for healthcare IT learn their approach and associated ROI evaluations.
• David Kendrick MD, MPH, CEO MyHealth Access Network, a Beacon Community
• Wednesday, February 22, 1:00 PM – 2:00 PM

Session# 211: Increasing Nurse Leaders’ Informatics Skills: Building from the TIGER Competencies

• Provides a discussion of the application of TIGER competencies to create institutional education programs to increase nurse leaders’ informatics skills.
• Melissa Barthold, MSN, RN-BC, CPHIMS, FHIMSS IT Senior Clinical Solutions Consultant University of Mississippi Medical Center Jackson, Mississippi
• Friday, Feb. 24th, 2012 10-11 AM

Session #66: Extreme Makeover – ICD-10 Code Edition: Demystifying the Conversion Toolkit

• ICD-10 translation engine tools, code mapping tools, crosswalks, GEMs, code simulation tools, medical language/content management tools, computer-assisted coding software, and more — what’s a healthcare organization to use?
• Deborah Kohn, MPH, RHIA, FACHE, CPHIMS Principal Dak Systems Consulting
• Wednesday, February 22; 8:30 – 9:30 am

Session #153: How to Create a Care Coordination Team Using Spare Parts

• Learn about a primary care group’s innovative model of care coordination which combines standard EMR functionality + clinical checklists + low cost staff to make life easier for physicians and patients, while improving quality and saving time and money for everyone!
• Lyle Berkowitz, MD, FACP, FHIMSS Medical Director of IT & Innovation, Northwestern Memorial Physicians Group (NMPG) Associate Professor of Clinical Medicine, Feinberg School of Medicine at Northwestern University.
• Thursday, Feb 23: 9:45 AM – 10:45 AM (Marcello 4502)

Session #32: The New Millennium of Enterprise Patient Centric Care across the Revenue Cycle

• This presentation will review how the Cleveland Clinic is transforming traditional revenue cycle management by implementing an enterprise patient administrative management system, aligned to their Patients First Initiative.
• Lyman Sornberger, Executive Director Revenue Cycle Management, at Cleveland Clinic Health System, and Dawn Mitchell, Principal, Aspen Advisors
• Tuesday, 2/21 – 11:00am – 12:00pm

Session #406:  IT Governance for Hospitals and Health Systems

• Learn how to create an IT governance process that increases the number of projects that support your organizational strategy and are completed on-time and on-budget.
• Roger Kropf, PhD, Professor at New York University, Wagner Graduate School, and Guy Scalzi, Principal at Aspen Advisors
• 1 of only 12 HIMSS eSessions

Session #9: The People of Clinical Decision Support

• I’ll present results of a qualitative study I conducted along with OHSU’s POET research team at seven hospitals and health systems across the US focused on the types of people needed to carry out a clinical decision support program.
• Adam Wright from Brigham and Women’s Hospital in Boston
• Tuesday, February 21 @ 9:45 AM in Veronese 2503

Session #163: Applying Lean Principles to Ensure Clinician Productivity while Securing PHI

• In this session we will explore the process and results of applying Lean principles at Mahaska Health Partnership to measure clinician productivity and minimize waste when implementing security technologies.
• Kristi R. Roose Information Technology Director, Mahaska Health Partnership Dan Nikkel Continuous Improvement Director, Mahaska Health Partnership
• Thursday, February 23, 1:00 PM – 2:00 PM in Lido 3103

E-mail Mr. H.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Our first hospital to attest for EHR Incentives is expected to receive $3,173,094 for Stage 1. To qualify for that incentive we spent $381,133. This includes the cost for 5,219 hours of IT time to complete the work.

So, it surprised me when I was listening to a CIO discuss Meaningful Use on one of the hscio.com podcasts. He stated that Meaningful Use was an underfunded mandate. That is far from our early experience at Ministry.

I don’t think either of us are incorrect. We just appeared to be starting from different positions and we took different paths to attest for Stage 1.

In our pursuit of the EHR incentives provided under the stimulus bill we piloted one hospital to create a standard approach for the remaining 14. Our pilot site was our most technically sophisticated hospital, so the work to be done was less than typical. In fact, this hospital (Ministry Saint Clare’s Hospital in Weston, Wi) is an all digital hospital that has had virtually all orders entered by physicians since 2006. We have invested over $100M in IT at this hospital, it is rewarding to know that we made decisions that positioned us well to achieve Meaningful Use. This incentive money offsets a small portion of that investment.

I believe that the effort to get this hospital positioned to attest for Stage 1 was as close to minimal as any hospital in the country. In my mind this is a best case for return on investment. Our remaining hospitals will be closer to break-even.

One thing that is not significantly different between my experience and the CIO on the podcast is the software. We both use GE Centricity Enterprise as our core HIS system. However, we did self-certify Centricity (and a collection of other EHR technologies) rather than upgrade to GE’s certified version. This also saved us money and allowed us to move quickly.

Call for Papers



Full Papers, Position Papers and Posters International Symposium on Network Enabled Health Informatics, Bio-Medicine and Bioinformatics



HI-BI-BI 2012



http://hibibi2012.cpsc.ucalgary.ca



In conjunction with ASONAM 2012

Istanbul, Turkey

27 - 28 August 2012



For paper submission:…

After the chaos that the HIPAA 5010 implementation has created in the industry, there are multiple unanswered questions before us. It all revolves around two factors – Healthcare implementations and the day to day billing operations. Are we striking proper balance between the two? Are we taking the medical billing and coding implementations seriously? A genuine answer to the questions would be a big ‘no’ from most of us. We all try to cross the bridge as it comes, without analyzing the depth of impact it may have on the day to day operations and vice versa. We try to keep pace with the regular activities until we dodge them aside only to run behind any implementation, while it nears deadline.

Keeping pace with healthcare implementations while sustaining billing productivity:

Starting from HIPAA 5010, we have many other implementations like ICD10 and EHR on Queue that need be worked out before 2013 & 2015 respectively. Every day, it’s becoming tough for the healthcare professionals to adapt to the rapidly changing industry, with ‘uncertainty’ spreading across like an epidemic. Now, it’s high time we streamline the work flow and make room for advancements in our daily schedule.

Here are a few suggestions for physicians and medical billing companies to keep pace with implementations/projects:

• Allot specific time for gathering industry updates
• Enroll for daily email alerts from reliable healthcare organizations
• Discuss with colleagues, social networking peers about the latest developments in healthcare billing on  a regular basis
• Attend important events and meets that discusses on medical billing issues and developments
• Set up project plan & conduct weekly reviews for any implementation like ICD10
• Provide training to staff on a daily basis
• Testing is an important phase before any project goes live. Test every system before it goes live, find and fix the flaws in the system
• During the post implementation phase, monitor and maintain system. Analyze & measure user experience & efficiency with people involved. Document the observations which will provide input for future enhancements

When you are planned and well informed, you can easily manage the medical billing and coding operations and the implementations simultaneously without having to sacrifice the other.

Computers have come along way in the past two decades.  Health care facilities are switching from paper to computerized medical records every year.  Computerized medical records are very convenient.  I realize that they are very beneficial because they Allow All of patient’s info such as allergies, medical conditions, current medications, insurance details is easily compacted into a file on computer, The patient’s information can be easily transmitted to other health care professionals,…

The money keeps disappearing in one way or another and now there’s another question here with this settlement between of a balance of $25 million owed.  We remember the sad suicide and the real housewife star Taylor Armstrong as that was all over the news. 

MMR (MyMedicalRecords) Lawsuit Looking for Shareholder Answers With Taylor and Russell Armstrong–The PHR and Hollywood Suicide Connection, Where’s the Money?

Surgery Center Management, LLC issued a payment of $5 million and then took it back after they said MMR refused further negotiations.  This back link explains their biotech interest outside of the Health IT portion of the business.

Favrille Biotech and MyMedicalRecords.com, Inc. Announce Merger Agreement

In the meantime it appears business as usual with promoting their personal health record and have sold share overseas as well to internationally help market the PHR software and service.  Are they ready to step in to where Google Health left off?  BD 

Health IT Company MMRGlobal (MyMedicalRecord.com) To Sell 4 Million Shares To Chinese Investment Partner

LOS ANGELES, CA, Feb 02, 2012 (MARKETWIRE via COMTEX) -- MMRGlobal, Inc. MMRF -2.56% ("MMR" or the "Company") today announced that pursuant to the terms of its December 9, 2011 Settlement and Patent License Agreement (the "Agreement") with Surgery Center Management, LLC ("SCM"), the Company has filed suit to collect the initial payment of $5 million, due on December 23, 2011, along with an application to the court for a Right To Attach Order and Order For Issuance of Writ of Attachment. Pursuant to the terms of the Agreement, the remaining $25 million is due in annual payments of $5 million each, starting November 15, 2012.

Notwithstanding the existence of the lawsuits, SCM and MMR are attempting to work on a settlement. Presuming the parties are able to successfully settle this matter, MMR may conclude additional transactions with affiliates of SCM on terms that are beneficial to the Company's stockholders. According to Robert H. Lorsch, MMRGlobal CEO, "Based on the review of outside accountants, a business transaction could represent substantial benefits and significant valuation to MMRF shareholders at the conclusion of a transaction which I believe that both sides would like to accomplish."

On December 29, 2011, SCM issued the $5 million to MyMedicalRecords, Inc. in the form of a cashier's check based on the terms of the Agreement. Despite SCM's delivery of the cashier's check to the Company, SCM then retook possession of the check after MMR refused to renegotiate certain terms and conditions, including the termination provisions surrounding the remaining $25,000,000 owed under the Agreement. SCM has also withheld the money in an attempt to leverage MMR into a transaction on terms that MMR believes are not in the best interest of its stockholders.

The Patents include any issued or pending U.S. and/or foreign patent applications and/or issued patents, including, but not limited to, Singapore, Hong Kong, Israel, South Korea, Mexico, New Zealand, Canada, Germany, Japan, the United Kingdom, and the United States. The Agreement includes the settlement of any potential claims by MMR against SCM and its affiliates for any past patent infringement.

Despite the dispute with SCM, MMR is continuing to operate its business in the normal course and is working to further exploit its Health IT patents and other biotech intellectual property.

http://www.marketwatch.com/story/30-million-due-to-mmrglobal-under-non-exclusive-patent-license-agreement-2012-02-02?reflink=MW_news_stmp

The U.S. Army has been trying to improve first aid medical response of soldiers in the field, and has developed the latest Individual First Aid Kit, or IFAK, to meet the unique needs that presented themselves in Iraq and Afghanistan.

But the IFAK is bulky and gets in the way of other equipment, so developers at Natick Soldier Systems Center have completely redesigned the pack to store it in the small of the back while making it easily accessible from either side by the soldier injured or another trying to help him.

Read More

The U.S. Army has been trying to improve first aid medical response of soldiers in the field, and has developed the latest Individual First Aid Kit, or IFAK, to meet the unique needs that presented themselves in Iraq and Afghanistan.

But the IFAK is bulky and gets in the way of other equipment, so developers at Natick Soldier Systems Center have completely redesigned the pack to store it in the small of the back while making it easily accessible from either side by the soldier injured or another trying to help him.

Read More

In a previous Meaningful Use Monday we wrote about a bunch of the Meaningful Use 2011 statistics that were put out by ONC and CMS. I know that my readers love statistics and information about Meaningful Use. Carl Bergman sent me a PDF file that contained some really interesting data on Meaningful Use stage 1 in 2011. The first pages we basically covered in the previous post, but starting on about page 10 or so there are some more detailed numbers.

Take a look at let us know which numbers you find interesting and/or unique.

Related posts:

1. Meaningful Use Numbers from 2011 and Looking Towards 2012 – Meaningful Use Monday
2. Meaningful Use Stage 1 for 2011 and 2012
3. Some of the Thinking Behind Meaningful Use Stage 2 – Meaningful Use Monday

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2007.

What Paul McCartney Can Teach Providers about Contract Penalties
By Mr. HIStalk

This is top-secret provider stuff. If you work for a vendor, why not skip on down to the news items? I’m about to tell your prospects to take actions that you’ll dread.

As a hospital IT person, I would never sign a vendor’s software contract without including a variety of specific and severe performance penalties. From recent Inside Healthcare Computing articles, many or most hospitals will. I’m shocked. I like vendors, but money makes people (and companies) behave badly. Be friendly, but get everything in writing.

Vendors (software or otherwise) can say anything they want about their product’s performance and reliability. Those statements can have one of three possible outcomes:

• If the company is both knowledgeable and honest, you will be pleasantly unsurprised when their product works as advertised, but at least you won’t be caught unaware by a major meltdown. That’s the best (but not necessarily the most common) outcome.
• If the company is honest but doesn’t have broad enough experience with their product in a setting like yours, you’ll probably be miserable together, hoping they’re as responsive as they are honest. That’s bad. Sometimes you hit architecture or design flaws that can’t be fixed, in which case you’ll use resources to work around the problems.
• If the company is lying or has wildly oversold their wares, nothing else matters because you’ve been suckered into a long-term, expensive, and contentious relationship with a vendor that has already demonstrated its willingness to take your money under false pretenses. That’s the worst case.

The biggest mistake hospitals make is uncovering problems with previous implementations, but then buying the product anyway. The most common rationalization: “We’re smarter than those rubes who couldn’t make it work, plus we really like the product and the salesperson.” That combination of naiveté and misplaced bravado has lined many a sales rep’s pocket. It often benefits an executive recruiter, too, since the CIO who ignores a product’s well-known, spotty history often has plenty of free time to reflect after he or she has been shown the door.

Vendors may not be thrilled to see the list of penalties you want, but they aren’t your best buddies. They have their bottom line price and terms. You’ve got yours. Negotiation is meeting somewhere in that middle ground, fighting for the bigger chunk of the unclaimed territory on the table. If the vendor doesn’t visibly hate you during negotiations, you’re not pushing hard enough. Nice guys and gals don’t get good deals.

Contracts without penalties are binding only to the customer. If the software fails to provide value, crashes constantly, or can’t be used like you were told, you still pay unless you were smart enough to write in penalties. Your want their skin in the game with yours.

The most important eventualities to cover with penalties:

• If the software doesn’t do what you were promised in a way that makes it unusable.
• If you have problems that will cause you the most harm: downtime, poor response time, or cancelled development plans.
• If the software or vendor has weak areas that sound like trouble. If the salesperson’s teeth clench up when you lay out penalty terms for failing to deliver a richly functional ED package or a CPOE-to-pharmacy interface, maybe you haven’t heard the truth.

A hard-hitting, predefined penalty is your best hope for getting undivided attention when a problem arises. The cash won’t be much consolation, but it does create an automatic escalation path respected by all.

I know we all like to throw harmless little love words around like “partner” and “shared vision,” at least until you’ve signed the deal. Vendors pretend to be wounded when you sully the honeymoon bed with legal requirements. Take a lesson from Paul McCartney – maybe the vendor is a wonderful partner who loves you for something other than your money, but make them sign an air-tight prenuptial agreement just in case. Secretly, they’ll admire you for it.

Brian Sherin is president of Besler Consulting of Princeton, NJ.

Tell me about yourself and about the company.

I got started in healthcare accidentally. I was doing an internship while I was in college, in an accounting department of a hospital. I can still see the face of the controller who I worked for at the time when I walked in, that look of, “I’m going to deal with this kid all summer?” But we got along well and I did that for two summers. I got involved in a lot of aspects of accounting, although my major was finance, not accounting per se. 

When I came out of grad school, I ended up in a very a bad economy, pretty similar to now, and I didn’t have a job. One of the guys I worked with in the accounting staff there called me and said, “Are you interested?” and I said, “Well, sure.” So I did that, and then about eight months later the controller asked me if I wanted to take the business office manager position. I lost a lot of respect for them at that point [laughs] –I thought he had better judgment than that since after, all I had virtually no experience. But he told me he had confidence in me and I could do it, so away we went.

Over the next 11 years, I moved from patient accounting to managing the overall revenue cycle, worked closely with HIM and other clinical departments. I eventually I took over on more administrative responsibilities. To this day, I’m really grateful for the guy having confidence in me at the time. He gave me an opportunity to learn so much and to set me on my career path.

As you can tell by now, I’m not an IT expert in any way, but I think from the business perspective I am very much an advocate of using technology to every advantage possible. I guess I could stretch it and say that I’m an IT user expert, or maybe advocate is a better way to put it. As I look back at my career, some of the more positive and exciting experiences I had were overseeing several HIS system implementations for the hospital. I just found them really very rewarding once completed. I’d like to do some more of that, but I haven’t been involved with those for a while. 

While still at the hospital, I talked to Phil Besler one day. He had founded the firm back in 1986 — this was probably the early ‘90s. I joined him. It was really a reimbursement firm back then. That’s all we did except some charge master work. We began to expand that and we moved into doing hospital revenue cycle consulting in the mid ‘90s. Those areas grew pretty quickly. Finally we established a coding accreditation compliance service line, which rounded out our service offerings.

Now I would define us as a financial and operational consulting firm. We have about 200 customers in 20 states and roughly 50 employees. Most of our clients are hospitals, though we count physician groups as well as other types of providers as clients. A majority of our business has been traditional consulting. 

In 2002, we did a former company called Innovative Healthcare Solutions, which we began by taking the charge master review software we had developed in-house — which I believe was in FoxPro at the time — and we developed a Web-based tool that we marketed. It was pretty exciting. We’d never done anything like that. Eventually we developed other decision support products. IHS was eventually sold to Accuro in 2005, then Accuro became part of MedAssets, I believe in 2008. 

In the last two years, we began to focus on software again. We launched our BVerified line of solutions last year. Our latest two products were launched early in January. The idea behind getting back into software and creating these solutions is that we want to be able to provide our customers these software products that allow them to receive the benefits of our expertise we’ve developed over the years, while at the same time creating the potential to drive additional benefits for our client through that software.

Between your consulting opportunities and now you’re more productized offerings, what revenue opportunities do you typically find that even pretty good hospitals and even your competitors might miss?

Most of what we’ve been doing is on the consulting basis with regard to some of our revenue recovery opportunities. We do the majority of our work as the primary vendor. However, we have found pretty significant opportunities going in either behind just solely internal processes on the part of hospitals or after other vendors. Depending on the particular issue, whether it’s on the DRG transfer rule or IME, very often we find up to 30% or so of additional revenue.

I think a lot of that has to do with just our approach. We’ve refined it very much over the years. We’ve identified some areas that we think are often overlooked either through internal processes or by other vendors. But at the same time, we’ve focused very, very heavily on the compliance aspects of it. We also have seen some processes that are not very compliant. We had a lot of input from our clients that they wanted something that they could be assured was entirely in compliance with all the rules and regs. We put a lot of effort and resource into that.

Is there a lot of concern out there about the RAC audits and all the other audits that the CMS is talking about doing?

I think there is, but my sense is it depends on what part of the country you’re in. Here in the Northeast, we haven’t seen a lot of RAC activity, but it’s almost like everyone’s waiting for the other shoe to drop. They know it’s coming — they just don’t know when. With their hands full with what they already have — with all the organizations out there doing audits and all the other demands they have on them, especially from the IT perspective — they’re very concerned, yes.

Do you think it will be like the IRS, where they will take a small sampling and make a high-profile example of any problems they find?

I don’t think that’s the way it’s necessarily going to go. Even on the RAC side, they’re still finding their way as well. I think some of it will come to that, where they’re going to realize that it’s so labor intensive to get through some of this. If you look at the recent demonstration project that CMS put out where if you want to join on, you’re essentially giving up your right to appeal short stays that are denied as inpatients, but they will allow you to bill them as outpatients. My guess is that one the reasons they’re going forward with that demonstration project is just because of the volume of appeals they’re experiencing. 

I think it’s going to take some time for everything to settle out. Eventually, you may find more of the old style initial teaching hospital audits from way back in the ‘80s, when they looked at 30 claims or 100 claims and decided that they were due $18 million. I don’t think it’s going to be quite that bad, but I think there’ll be more of that practice as we go forward.

Describe the problem with hospital readmissions and what clients are asking you to do to prepare them for that.

CMS is going to begin looking at data with regards to readmissions. They’re going to essentially identify the top quartile in hospitals in terms of unnecessary readmits or related readmits. It’s going to reduce your overall Medicare-based payment. A lot of hospitals are looking at that. It’s fairly easy to look at the Medicare data that’s out there to determine where you fall yourself within the three categories of diagnosis they’re going to be looking at. It doesn’t really necessarily tell you where you fall in relation to what quartile you’re in.

It seems to us from talking to a lot of hospitals, those who have a problem know they have a problem. In a lot of ways, they feel like they’re in a situation where there’s not a whole lot they can do to effectuate any real change in those patterns quickly. Another factor is that a lot of people don’t realize is that the readmissions include if you discharge a patient and they get readmitted to another facility. You don’t even know that, but that counts towards your readmission number. And that data is not generally available to everybody.

I think it’s something that everyone is trying to do a better job of coordinating care. Once patients leave the hospital, they’re trying to do a better job of communicating with patients, making sure patients are following through on physician orders and seeing their physician within a specified timeframe and so on. But there’s limited resources to be able to do that, and there’s limited ability to really change people’s behavior in that way.

With the emphasis on making clinical care delivery less episodic, the billing stayed episodic and only now is moving toward billing for non-piecemeal work. Are hospitals going to be able to adjust quickly with the emphasis on ACOs?

I think that’s a real problem. Physicians have had that issue over the years too, where in some situations, they’re expected to manage care well beyond when they see the patient. It’s difficult. There’s really no reimbursement for that aspect of it. I think that ultimately hospitals understand that that’s the way it’s going. Whether you believe in ACOs or feel that they’re going to be the panacea some people think they’re going to be, nonetheless, that is the way things are going.

I don’t think anyone will argue the fact that a better process to manage patients once they leave the hospital — make sure they are following certain care plans, make sure they are seeing the right types of providers in the proper timeframe — is going to reduce readmissions, it’s going to reduce inappropriate admissions, it’s going to cut down on emergency room visits, and it’s going to overall have the great potential to lower the cost of healthcare. But we’re asking a lot of providers out there that are not going to be reimbursed in any way for a lot of those activities to take that on. I think that the funding for that is going to become a really critical issue.

There’s probably not much appetite to pay more for care, and not much ability since the government’s such a large payer. I guess it’s the equivalent of telling a steakhouse, “As of next week, you’re going to offer the same menu except as a one-price buffet.”

I agree. I don’t think there’s going to be much appetite at all for the government to put out any more money for this kind of thing. I think they feel that through some of these programs such as ACOs, with some of the incentives and whatnot, that’s going to effectuate some of this. And it may, for those who decide to become ACOs or maybe are positioned to do that.

The fact is that most providers are not really positioned to become ACOs and the incentives that are there for them. Even some of the premier facilities in the country have indicated that they don’t see the advantages to going to that ACO model and getting involved in that whole program. If they don’t see the value, it’s hard to believe that any inner city hospital is going to have the funds or the abilities to be able to put any kind of model like that in place unless they’re somehow funded for it.

Hospitals are imitative. If one does it, everybody does it. If a consultant starts recommending it or it shows up in a magazine, everybody jumps in line to do it. Do you think they’ll experiment with the ACO and either back out quickly or lose their shirts before they realize maybe it wasn’t as good as it sounded?

I don’t know. I’ve done some speaking engagements and have been in a number of meetings where someone would ask, “Who here from a provider side is going to plan for being an ACO?” Almost everyone raised their hands. I think that was just because it was early on — the rules weren’t defined.

As more and more comes out with regard to what’s expected from ACOs and what the cost is going to be and the type of infrastructure you had to have in place to effectively manage an ACO, I think you’re seeing more and more back away from it. My guess is there’s not going to be a whole lot of organizations that actually go all the way through and become an ACO and actively participate in that project. So we’ll see. My guess is that as providers dig through it, they’re going to realize that there’s really not a whole lot of advantage to them.

Do you have real-world examples of what you’ve found with your BVerified process?

The very first client we had for the screening verification tool, which was really the first BVerified product we put out there, we immediately found something which looked … I won’t get into the details, but it looked very questionable. We immediately called them and it was something that they were aware of. They were actually pretty impressed that we came up with it so quickly.

Everyone’s had some kind of finding. Sometimes as you go through those, you identify that there are things that were corrected or maybe it was incorrect information that was submitted to do the verification and whatnot. But our clients have been very happy with it thus far. To them, it’s a one-stop shop. They don’t have to have multiple screening tools in place. They’ve been happy with the product and the results they’re getting out of it.

It’s to check the HHS’s database for excluded parties, correct?

Yes. It goes through and checks both federal and state databases. We can adjust that, because with regard to some state databases, there are timeframes and “how often” rules in terms of how often you have to check. We built all of that into it. Essentially it’s looking for excluded individuals. It also has some additional functionality — it allows you to verify licensure and things like that as well.

You’ve done services related to point-of-service collections. Money is being left on the table by letting patients walk away without, but consumers are pushing back about being asked for a credit card before they’re seen. How do the hospital know that they’re ready to initiate that planning for point-of-service collections and what’s involved with transitioning to that?

The time is well past when those programs should be in place. In talking to our clients, I’ve always maintained – and this goes back quite a ways – you need to start this now, because it’s not like you just put someone with a cash register at the door. It doesn’t work that way. Most hospitals serve a pretty much a specified community, and it’s a matter of changing that community’s understanding of how you function. There’s a lot of communication that has to go on with both the patient population as well as the referring physician population. They need to understand what you’re doing and why you’re doing it.

Physicians have been doing this very effectively for a long, long time. Maybe it’s not some of the same dollars that are involved in terms of physicians who are merely collecting co-pays, but I defy you to find anyone who’s covered by any kind of a managed care or a PPO plan who’s gone to their physician who’s gotten to see that doc without paying their co-insurance first. They’ve done an effective job of that, so physicians understand the need for it. 

The dollars are significantly more on the hospital side, but that can be worked through in terms of an arrangement with the patient. It takes a long time. It’s an educational process, it’s a community educational process. It’s not something you just turn the switch on overnight. What I’ve seen mostly is that hospitals have implemented it in maybe a few different areas within the hospital, but not universally. They do get pushback.

There has to be a commitment all the way up the management string, right up to the CEO and the board, that this is what we’re doing and this is how we’re going to do it. They’ve got to resist those calls that come in and say, “I was there the other day and I’ve been coming there for 30 years and now you’re asking for payment up front.” Everyone has to be on board, because as soon as you start making exceptions, it quickly loses its effectiveness.

What do you see as major areas of concern in the next five years and what should hospitals be doing now?

We’re addressing a lot of things on our end. With some of the other software tools we’ve developed, we’re trying to come up with ways that hospitals can take our expertise and our experience with a lot of things. We put them into a software tool so that the hospital can internalize them and gain greater control over some of those functions. Instead of doing it on a consulting basis, they have the ability to do it on their own. That works for some, doesn’t work for others. 

We understand that a software solution isn’t automatically the solution for everybody. We’re trying to do that because what we’re hearing from some of our clients is that they need to bring some things internally and they want to reduce their costs a little bit. That’s why we’ve done those things with the transfer DRG tool and the Medicare advantage IME tool and our revenue integrity auditor.

At a higher level, my feeling is that over the next five years, hospitals have to begin to fully integrate their clinical and their financial operations. There’s still a separation there to a large degree with a lot of hospitals. While everyone’s moving in that direction, I think it needs to be looked at more as a business. There has to be a way to bring together those two aspects of the operation in one cohesive whole.

While obviously patient care is the business you’re in and you want the highest possible quality you can get, there needs to be some control over that, in terms of how you best do that. I think that’s the whole ACO concept, which is good. I’m not convinced on the ACO model, but I think the ACO concept is good in that it makes you bring it all together, operate more cost-efficiently, and coordinate care across the whole spectrum of the services the patient’s going to receive in their inpatient, outpatient, physician, physical therapy, specialists, whatever it may be.

The most important thing over the next five years is to start looking at healthcare delivery – and I don’t mean this in any kind of impersonal way — as a business, bringing together the financial delivery of care and the clinical delivery of care so that you’re getting the most sufficient product you can.

Any concluding thoughts?

We’re experiencing the most interesting and fast-paced changes we’ve ever seen in this industry. More so than ever, the changes we’re seeing now will dramatically alter the way healthcare is delivered and managed from this point onward. Everyone’s got to be ready for it, because I don’t think there’s any turning back. There may be some stumbling along the way, but everything that’s been started now is going to move forward. As Bob Dylan said, “You better start swimming or you’ll sink like a stone, because the times they are a-changing.”

We’re changing our approach and trying to meet the changing needs of our clients. We continue to focus on trying to find all the revenue we can for our clients. We won’t stop that. That’s the reason for developing some of these software tools — to give something to our clients that has a demonstrable, compelling ROI.

It’s pretty exciting times, but they’re also very challenging times. I think the pace is only going to pick up. We’re going to see incredible rate of change over the next few years.

GE has announced investing into an Israeli company called Check-Cap that’s developing swallowable endoscopic capsules for imaging the insides of the GI tract.  Check-Cap seems to be a direct competitor of the better known Given Imaging, also an Israeli firm, that’s been producing its own PillCams for visualizing everything from the esophagus to the small intestine and beyond.

While PillCams use light in the visible spectrum and a traditional image sensor, the Check-Cap delivers low energy X-rays that provide a much different look at the internal anatomy.  Because X-rays penetrate through soft material, food intake shouldn’t be a problem for the device, and all the typical preparation for a GI tract analysis may not have to apply.

Read More

GE has announced investing into an Israeli company called Check-Cap that’s developing swallowable endoscopic capsules for imaging the insides of the GI tract.  Check-Cap seems to be a direct competitor of the better known Given Imaging, also an Israeli firm, that’s been producing its own PillCams for visualizing everything from the esophagus to the small intestine and beyond.

While PillCams use light in the visible spectrum and a traditional image sensor, the Check-Cap delivers low energy X-rays that provide a much different look at the internal anatomy.  Because X-rays penetrate through soft material, food intake shouldn’t be a problem for the device, and all the typical preparation for a GI tract analysis may not have to apply.

Read More

Drs. Billy Cohn and Bud Frazier at the Texas Heart Institute were faced with a patient last March who’s heart was about to succumb to the point that even a left ventricular assist device wouldn’t be sufficient to keep him alive. Described as a story of “two visionary doctors from the Texas Heart Institute who in March of 2011 successfully replaced a dying man’s heart with a ‘continuous flow’ rotor-driven device of their own design, proving that life was possible without a pulse or a heartbeat,” the film was directed by Jeremiah Zagar, whose feature-length documentary “In A Dream” was nominated for two Emmy’s in 2010.

Read More

Drs. Billy Cohn and Bud Frazier at the Texas Heart Institute were faced with a patient last March who’s heart was about to succumb to the point that even a left ventricular assist device wouldn’t be sufficient to keep him alive. Described as a story of “two visionary doctors from the Texas Heart Institute who in March of 2011 successfully replaced a dying man’s heart with a ‘continuous flow’ rotor-driven device of their own design, proving that life was possible without a pulse or a heartbeat,” the film was directed by Jeremiah Zagar, whose feature-length documentary “In A Dream” was nominated for two Emmy’s in 2010.

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TearScience of Morrisville, NC received FDA clearance for the new version of the LipiFlow Thermal Pulsation System for evaporative dry eye. The condition leaves patients with too few tears, making the remaining ones feel too salty. The system heats and massages the eyelids, helping unblock the flow of lipids from the meibomian glands found under the eyelids.

The new generation of LipiFlow provides the ability to two treat both eyes simultaneously, cutting treatment time in half, to about 12 minutes. It also sports a new interface that displays treatment temperature, pressure sequence and treatment time remaining, while recording all the data for easy sharing with the clinic’s electronic medical record system.

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TearScience of Morrisville, NC received FDA clearance for the new version of the LipiFlow Thermal Pulsation System for evaporative dry eye. The condition leaves patients with too few tears, making the remaining ones feel too salty. The system heats and massages the eyelids, helping unblock the flow of lipids from the meibomian glands found under the eyelids.

The new generation of LipiFlow provides the ability to two treat both eyes simultaneously, cutting treatment time in half, to about 12 minutes. It also sports a new interface that displays treatment temperature, pressure sequence and treatment time remaining, while recording all the data for easy sharing with the clinic’s electronic medical record system.

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In the past, I’ve written volumes about hospital attempts to lock in doctors by offering them access to a free or deeply-discounted EMR. I haven’t heard much about this strategy of late — either the approach was dropped or it’s gone underground — but it seems that other players are still giving it a shot.

This time, in what seems to be a fairly logical step, Quest Diagnostics has kicked off a program offering medical practices a steep 85 percent discount off of the retail price of its Care360 EMR and practice management bundle.  The announcement follows up on its 2011 regional giveaway program, which Quest says attracted thousands of physicians.

The deal, which reduces the physicians’ out of pocket cost to less than $100 per month,  also includes training, hosting, maintenance and 24/7 support for Care360. The lab giant says physicians can get Care360 up and running in about 45 days.

I can’t think of a reason why this wouldn’t make great sense for Quest; if my contacts are to be believed, it has no better reputation than its key competitors when it comes to customer service and follow-through on clinical testing.

On the other hand, if I were a doctor I’d think long and hard before agreeing to a deal like this, even though the software is just about free. There’s simply too much at stake to plunge in.

Yes, Care360 is CCHIT certified and, intriguingly, has incorporated the Direct Project specs allowing doctors to share information with patients and hospitals. And yes, it seems to have made efforts to support EMR access via mobile devices. This is all good. And of course, the price is right.

On the other hand, I’m not sure I’d want to make this big of a commitment to any particular service provider, be it a reference lab, a radiology provider or the people who stock my vending machines with sodas.

I’d argue that the more important the service is, the less you want to be beholden to the vendor. After all,what if Care360 isn’t your cup of tea?  Do you really want to disrupt your relationship with a critical provider like Quest?

Not only that, it’s risky to lock in an EMR just because it’s cheap. If Care360 takes 45 days to get installed, it’s not going to be possible to uninstall it in a day or two, and that could mean misery on wheels if the product doesn’t work for you.

Besides, it’s possible to get Web-based, easy to adopt or drop EMRs for only a couple hundred dollars a month more. It wouldn’t make sense to go for an EMR that might not work just to save that little. (If your margin is tight enough that a savings of $200 or $300 a month is critical, you have worse problems than finding the right EMR!)

I guess I’m saying that even if the EMR is nearly free, caveat emptor. You don’t want to get saddled with an albatross system just because the price was right.

Related posts:

1. Quest Launches Care360 EHR
2. HIMSS EHR Association Offers HIE Strategy, World…Yawns?
3. Doctors, Is Meaningful Use That Important?

The event truly did wake up the American public on how women’s health is understood today or rather should I say “misunderstood” as you read the news the last few days, it was pretty vicious and I read enough of it myself.  We live in a world of business analytics today, algorithms that give us parameters to digest information and we make our decisions based on them.  I watched the original video from Komen on why the decisions were made and that was exactly what I came away with.  Again doing this blog I read so much of similar press releases and stories on the web and this was just one more but unfortunately politics jumped in here big time.

In essence this a big awakening to the American public on how we are attacked by some algorithms (software is nothing but a bunch of algorithms working together in the words of Bill Gates) that are defined for “desired” results perhaps instead of “accurate” results.  It happens all the time in the business world and as long the two are the same we don’t have a problem but sadly it doesn’t work that way. 

This was a rather big awakening to remind us that “ethics” need to play a big role today and you can’t use mathematical formulas to mow people over when the lines cross.  You won’t read this anywhere else on the web as most don’t understand or make an attempt to understand coding and math, but this is how I see the long and short of it without putting a big OMG spin in here.  They still have this issue I think under political discussion to maybe look at too as we all know this one won’t die either as it will continue to come up over and over.

Komen Has Also Stopped Funding for Embryonic Stem Cell Research–Politics and Some of Business Intelligence Algorithms At Work Here?

I also do hope they have stopped their activity from last year of suing smaller charities for using the word “cure” as this again is counter productive of what philanthropy is supposed to be and $1 million can certainly pay for a lot breast cancer screens rather than lawsuits. 

We do have other advocates in Healthcare and Wendell Potter is one that has to come to mind as he was one that had been there and done in a prior occupation and speaks out about how people get sucked in to the corporate brain washing that occurs and in his own words he said he found that he to was looking at algorithms and reports as numbers and forgot they were people until his awakening day with finding some missing ethics.  You can can read his material all over the web to find out more and I think this is a bit of what we had going on here, folks were lost in the algorithms and all of a sudden when the “teeth” came out and made those decisions, people woke up. 

Our new consumer protection chief, Richard Cordray has his hands full to in unwinding and getting the bottom of how ethics and business intelligence algorithms need to work in harmony so as not to harm consumers.  At the link below are some links to some the prior Attack posts I have here that are defined with all pubic information and give some real glaring examples of discrimination by the algorithm.

President Appoints Richard Cordray as New Consumer Financial Protection Chief - Hope He Knows And Understands Correcting Flawed Math and Formulas To Battle the “Financial Attack of Killer Algorithms” On Consumers With Banks and Corporate USA

In one final thought here too as I always do talk about this, we have this big sense of digital illiteracy in Congress today and whenever things get over their heads with comprehension levels, they all go back to this “default” topic of abortions and you see it in the news all the time so some smarter Congressmen would definitely be in order here as they accomplish nothing and basically lead up to this big issue here with lobbying and trying to control where they have none.  BD

Digital Illiteracy Still Plagues Law Makers–Severe Focus on Abortion Rights Proves It–Is This Where Our Lawmaking Knowledge Leaves Off or Even Begins? Scary…

This was truly a sad state of affairs but maybe some of those who are stuck in their “default” rhetoric will have the chance to take a look at themselves and see how the rest of the educated digital world views them.  Again, sad that this methodology was unbalanced and even the Komen organization was snowed under with the rationale with being blind sided on the ethics and unintentional consequences that occurred. 

No doubt when you see the NYSE stock exchange lit up in pink it does make you wonder where the powers of influence like and how mathematics are marketed and spun to where reality is such a far sight away. 

This is yet one more chapter in the Attack of the Killer Algorithms.  BD 

We want to apologize to the American public for recent decisions that cast doubt upon our commitment to our mission of saving women's lives.

The events of this week have been deeply unsettling for our supporters, partners and friends and all of us at Susan G. Komen. We have been distressed at the presumption that the changes made to our funding criteria were done for political reasons or to specifically penalize Planned Parenthood. They were not.

Our original desire was to fulfill our fiduciary duty to our donors by not funding grant applications made by organizations under investigation. We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political. That is what is right and fair.

Starting this afternoon, we will have calls with our network and key supporters to refocus our attention on our mission and get back to doing our work. We ask for the public's understanding and patience as we gather our Komen affiliates from around the country to determine how to move forward in the best interests of the women and people we serve.

We extend our deepest thanks for the outpouring of support we have received from so many in the past few days and we sincerely hope that these changes will be welcomed by those who have expressed their concern.

http://thescoopblog.dallasnews.com/archives/2012/02/komen-apologizes-for-recent-de.html

28 yo s/p GSW to left thigh on Saturday Jan 28, 2012.  Reports evaluation at (outside hospital) showing bullet lodged in muscle.  States this morning, having BM and heard "clink", dug through stool and found bullet.

Researchers at Mayo Clinic in Florida have shown that cerebral optically-based near infra-red spectroscopic oximetry applied to patients who have suffered a stroke can help monitor regional cerebral perfusion in real time, and thus “may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner.” The study looked at the device called Fore-Sight from Casmed of Branford, CT, that measures blood oxygen, similar to a finger clip pulse oximeter. The Mayo study results have been published in Journal of Neurosurgery this month.

Regional cerebral blood flow monitoring devices such as Fore-Sight are already in wide deployment in cardiac surgery, where they are thought to prevent brain ischemia in patients undergoing major surgeries on bypass (valve replacements, aortic arch surgeries, etc.).

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Researchers at Mayo Clinic in Florida have shown that cerebral optically-based near infra-red spectroscopic oximetry applied to patients who have suffered a stroke can help monitor regional cerebral perfusion in real time, and thus “may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner.” The study looked at the device called Fore-Sight from Casmed of Branford, CT, that measures blood oxygen, similar to a finger clip pulse oximeter. The Mayo study results have been published in Journal of Neurosurgery this month.

Regional cerebral blood flow monitoring devices such as Fore-Sight are already in wide deployment in cardiac surgery, where they are thought to prevent brain ischemia in patients undergoing major surgeries on bypass (valve replacements, aortic arch surgeries, etc.).

Read More

Here's an interesting observation. Chile ranks first in the world for deaths from testicular cancer, according to the World Health Organization (WHO) and Chile’s Ministry of Health (see: Highest death rates for testicular cancer found in Chile). Read on, if you are interested, in the following excerpt from the article:

In 2009, 121 Chilean men died from the disease and 63 of those were 15 to 30 years old, the age group most at risk from the disease. In the U.K., however, where the population is three and a half times the size of Chile, there were only 70 deaths from testicular cancer in 2008, according to the Cancer Research U.K.’s figures. “Testicular cancer figures are low in Chile in relation to the other types of cancers found here, but yes, the figures are high in comparison with the rest of the world,” [said a cancer specialist ].....Testicular cancer has a 95 percent cure rate if caught and treated in time. Such treatments have been available in Chile for over two decades. Cancer experts in Chile recognize that the country has an unusually high rate of testicular cancer, but no one is sure why. “Less than 5 percent of cases can be explained by exclusively genetic or hereditary causes,” [according to a Chilean urologist] “Neighboring countries with the same ‘culture’ have much lower reported mortality rates from the disease than in Chile,” [according to a cancer expert]. [Another cancer expert offered]...a different theory altogether. “This is only a theory and I have no evidence to support this but there’s a lot of natural contamination of water in Chile, by various metals especially arsenic, and perhaps this could have something to do with the high numbers of cases,” he said. “Really, though, no one knows for sure.”

Heavy metal exposure as a possible etiology seems to be a stretch for me. It occurred to me, however, that an infectious etiology might be possible. There was not much current work on this idea but I did find one abstract that draws an epidemiological parallel between testicular cancer and Hodgkin's disease among young males (see: (see: Viral etiology of testicular tumors). Here is an excerpt from the abstract from this older article:

Testicular carcinoma and Hodgkin's disease are among the most frequent malignancies afflicting young men in the 15 to 39-year age group. These malignancies share other epidemiological characteristics as well, including multiple histological tumor types, higher rates of occurrence in white, urbanized populations and upper social classes, relative infrequency among black populations, low but definite familial occurrence and an early geographically acquired lifetime risk irrespective of later migration. Both diseases are increasing in this country. This epidemiological similarity suggests exposure to an infectious agent early in life. The Epstein-Barr virus is known to be oncogenic and neonatal exposure with early infection is believed to be associated with Burkitt's lymphoma in African children. High titers of antibodies to the Epstein-Barr virus capsid antigen also have been reported in a series of studies comparing patients with Hodgkin's disease and controls. Because testicular cancer is epidemiologically similar to Hodgkin's disease and, therefore, might be expected to manifest similar Epstein-Barr virus findings, we performed a viral screen (Epstein-Barr virus, cytomegalovirus, and hepatitis A and B viruses) on blood samples from 56 consecutive patients with clinical stage I germ cell tumors of the testis who had received no active therapy after orchiectomy. Our results show a high incidence (80 per cent) of previous exposure to Epstein-Barr virus and support the hypothesis of a possible infectious origin for testicular carcinoma.

The problem with this theory is that it doesn't explain the lower incidence for testicular cancer in culturally similar neighboring countries where the males would presumably be exposed to similar viruses. I suppose there is also the possibility of some sort of anomaly of cancer data collection or diagnosis in Chile.