September 22,2014


PALO ALTO, Calif. — I’m out here in the Bay Area, in part because Intel-GE Care Innovations invited me to be one of six judges of its first-ever “hackathon” this past weekend. (Full disclosure: Care Innovations paid my travel expenses, but placed no editorial demands on me.)

On Saturday, I sat down with CI CEO Sean Slovenski to discuss a number of issues in digital health and health reform, but I found myself most curious about CI’s new Validation Institute, launched in late June, which looks to bring some truth to some outrageous claims made by entrepreneurs in the untamed world of digital health, telehealth and population health management. I turned on the voice recorder, and this short podcast is the result.

(Sorry for the bit of background noise. We both live in the Midwest, and just had to do this outside on a gorgeous California morning.)

Podcast details: Interview with Sean Slovenski, CEO of Intel-GE Care Innovations, on the company’s new Validation Institute. MP3, stereo, 192 kbps,  9.2 MB. Running time 6:38


Somewhere in the past, an article put the value of a health record at $50. I’m really not sure who or what wrote the original article or set the price at $50, but that value has been perpetuated in article after article on the internet. Yes, that’s one of the features of the internet. It perpetuates misinformation (kind of like an EMR).

When people make the claim that a compromised health record is worth $50, they usually then say that it’s more valuable than a credit card which is only worth $5 (probably something else that’s debatable). When I hear this, I’ve always wondered how they got the $50 price tag. The reality is that the value of a health record is only what someone is willing to pay. You can say something has a certain value, but without a market to validate that people will consistently pay that price, then does it really have that value?

I’ve always wanted to dig into the black market of health records to try and validate the $50 price tag that everyone likes to claim for health records. However, there are some obvious reasons why I don’t want to dig around in the black market of health records. So, I’ve avoided touching that story.

The good news is that HIStalk discovered a great story by Krebs on Security that puts a value on the health record. Here’s an excerpt from the story:

How much are your medical records worth in the cybercrime underground? This week, KrebsOnSecurity discovered medical records being sold in bulk for as little as $6.40 apiece. The digital documents, several of which were obtained by sources working with this publication, were apparently stolen from a Texas-based life insurance company that now says it is working with federal authorities on an investigation into a possible data breach.

When you read the rest of the article, it’s amazing the sophisticated methods they’re using to sale, pay for and distribute these records. Reminds me of how many incredible things society could create if these smart people turned their efforts to good instead of bad, but I digress.

I love the last line of the article, “Incidentally, even at $8 per record, that’s cheaper than the price most stolen credit cards fetch on the underground markets.”

Like most markets, prices fluctuate based on supply and demand. So, I’m sure we could find various prices for health records. However, I hope we can do away with the blanket statement that health records are worth $50 and worth more than credit cards. Articles like this illustrate why I’m not sure that’s the case.


20 Questions for health it 16

Question number 16 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Jon Mertz, vice president of marketing at Corepoint Health:

What will raise health IT literacy?

Attention to health IT is the straightforward answer. Being attentive means, as patients, we take the time to learn what a electronic health record (EHR) is and how it relates to our own personal health record. We take the time to ask questions during our physician visits and inquire what is being typed into our EHR and then ask for an electronic copy to be sent. Our attentiveness to what systems are being used and then asking “why” to understand their role in our health care.

Beyond our personal attentiveness, device and application vendors need to be better attuned to better design. Enhancing usability and exchange of data will better engage patients in their health IT literacy. Vendors need to raise their attentiveness to deliver great design, which should include patients in the process.

A generational change is underway, and we need to embrace this shift to raise health IT literacy in an effective and healthy way.

Categories: News and Views , All
Do you have trouble remembering proper names? Do you start to say something and then stop because you can’t remember what it was you were going to say? Are you always misplacing your car keys or eyeglasses? Do you walk across your house into another room...(read more)
Source: HealthBlog
Here are a few I have come across the last week or so.Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General CommentAnother quiet week with a lot of activity in specialist Health IT sectors and little happening with the National E-Health Program. It’s now 3 weeks since consultation on the fate of the PCEHR and no idea revealed as to what was learnt and what future plans are. We wait and watch….The SAI-Global / Standards Australia imbroglio seems to have resolved itself without resolution and so we await Plan B!Interesting to see lots of reporting on the Apple HealthKit.I wonder where this will all go over time and what difference this will make in the longer term?----- Australian Defence Force e-health...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
I have just been told the above wiki is going to cost me $US 5 per month to keep alive. You can visit the wiki from this link: I think this is a useful resource for those wanting to understand what has happened in National and GP Health IT. An obvious gap is input from each of the States and Territories. The money is not an issue but I would be keen for a few others to become editors and improve the contents. That would make the cost even less important if this were possible. Please have a look and apply to be an editor if you have something you feel you can add. It would be great if this can become a useful resource for all who are interested. Many thanks. 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

September 21,2014

Using advanced computer models, neuroscience researchers at the University of Copenhagen have gained new knowledge about the complex processes that cause Parkinson's disease. The findings have recently been published in the prestigious Journal of Neuroscience.
We have had news of two/three new Health IT systems this week. First we had this for NSW Prisons:Orion Health system underpins medical records in NSW 15 September 2014 By  Peter Dinham The Justice Health & Forensic Mental Health Network (JH&FMHN) has gone live with an electronic medical record suite from e-Health technology company Orion Health to support the delivery of complete electronic medical records across the New South Wales public health system.Justice Health’s goal is specifically to provide a critical platform for the Justice Health electronic health system’s (JHeHS) migration to a computerised record of a patient’s medical history related to the clinical care received while in JH&FMHN. This will contain a subset of information previously held in paper medical records including patient details, medical conditions, appointments, pathology results, electronic forms and medicines prescribed.  The data is now held in one consolidated place and available...

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

September 20,2014


I just tested the Oculus Crescent Bay prototype at the Oculus Connect event in LA.

I still can't close my mouth.

The demo lasted about 10 min, during which several scenes were presented. The resolution and framerate are astounding, you can turn completely around. I can say this is the first time in my life I can really say I was there.

I believe this is really the begin of a new era for VR, and I am sure I won't sleep tonight thinking about the infinite possibilities and applications of this technology. and I don't think I am exaggerating - if anything, I am underestimating



Categories: All , News and Views
Here are the results of the poll.Given That After A Year The Government Was Elected, It Has Yet To Figure Out What To Do With The PCEHR Should The Program Simply Be Abandoned And A New Plan For National E-Health Developed?Yes 83% (190) No 9% (21) I Have No Idea 7% (17) Total votes: 228 This is a pretty clear and enthusiastic outcome. The Federal Government is getting a clear fail on not making its mind up about what to do. 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
Here are a few I have come across last week. Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.----- to Congress: 3 actions to improve health ITSeptember 12, 2014 | By Susan D. HallHIMSS has presented three "Congressional Asks"--formal requests to Congress to accomplish specific goals to advance health IT.These proposals will be presented to Congress during the annual HIMSS Public Policy Summit Day, Sept. 18, as part of National Health Information Technology Week, according to an announcement.The three requests include:1. Minimizing disruption in our nation's health system emanating from federally-mandated health IT program changes. This request notes that various federal agencies are involved in regulating aspects of...

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

September 19,2014


20 Questions for health IT 15

Question number 15 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Scott Mace, senior technology editor at HealthLeaders Media:

Who should define the concept or process of a standardized patient ID?

The lack of a commonly-agreed upon patient ID remains a serious headache for healthcare IT. Without such a common patient ID standard, healthcare providers spend considerable time, effort and money aligning various patient IDs in various silos created by healthcare IT vendors, providers, payers and government, and few if any of these silos are talking to each other.

Part of this originates from amendments to HIPAA that forbid the federal government from defining a national patient identifier. Privacy advocates inserted this prohibition and fear that increasing government surveillance makes it imperative that patients not be required to use someone else’s credentials, but should be able to self-assert their identities, so they may use their own pseudonymic identities in a way that maximizes privacy yet minimizes the potential for patient fraud or thwart such efforts as eluding prescription drug monitoring programs.

A group called the Internet Identity Ecosystem Steering Group (IDESG), established by the National Strategy for Trusted Identities in Cyberspace (NSTIC), created by President Obama in April 2011, is trying to solve these problems. The group is posing a series of interesting questions: Who gets to create databases of the activities of real people? Who gets to query those databases? Is everyone that is allowed to query real-person databases subject to federal regulation?

IDESG needs to attract more important stakeholders in order to solve this problem. Otherwise, the problem will be solved by others who may be dominated by vendors, such as the Commonwell Health Alliance or other particular interests that do not represent all important stakeholders.

Categories: News and Views , All

The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
In some ways, 2014 turned out to be not quite as cataclysmic. The early announcement of delaying the adoption of ICD-10 and the more recent announcement to allow hospitals/CAHs and Eligible Professionals participating in CMS’ Meaningful Use programs to attest using their existing Certified Electronic Health Record Technology (CEHRT) took the pressure off healthcare providers scrambling to upgrade their CEHRT to a version that was both ICD-10 and MU-compliant. However, this is only a temporary reprieve through the end of 2014 and there are other priorities that must be addressed before the year ends.

Navigating the ever-evolving healthcare environment will seem much less daunting if you focus on these four areas:

  • Meaningful Use
  • Value-Based Payment Modifiers
  • Transparency
  • Open Enrollment for ACA

Meaningful Use (MU)

If you were not able to upgrade to the 2014 Edition EHR, you will still be able to attest for MU using 2013 criteria. This provides reprieve from the 2014 criteria that requires the implementation of and patient enrollment in a patient portal.

In order to be MU-ready, your organization must proactively:

  • Determine your strategy based on the final rule. Gather data and be prepared to attest for MU by the deadline for the MU program you participate in..
  • Create an audit binder which should include screenshots of required EHR configuration during the reporting period. Should you get an audit 2 years from now, you can refer to this binder for accurate information.
  • Prepare a statement citing why you should be allowed to opt out of those MU measures that you think do not pertain to your practice. Auditors will ask for this on any audit preformed.

All organizations should be prepared to start collecting data for MU 2 by January 1, 2015. This includes having a strategy around the implementation of a patient portal and patient enrollment, sharing data amongst community and other healthcare providers, and radiology interfaces.

Value-Based Payment Modifier

The current Value Based Payment Modifier for providers who serve Medicare beneficiaries is a descendent of the Physician Quality Reporting System (PQRS). It is a way to keep the ACA cost-neutral, but there are some important things you need to know about this newer system. Value-Based Payment Modifier takes claims, Meaningful Use, and physician quality data and rates the quality of care you provide against your peers. Consequently,

  • When you report your Clinical Quality Measures or any clinical data to CMS, make sure your thresholds demonstrate that your practice is providing high quality care.
  • If your practice suffered from vendor problems with data accuracy in the past, this should be fixed.


Transparency is something all providers should be aware of. Although available only in a few markets right now, all patients will soon be able to look up information about physicians before deciding where they would like to have their medical procedures done. For instance, if a patient decides to have an ACL repair, s/he can go online to compare exact costs and quality measures (based on the Patient Quality Reporting System) for ACL repair. Practices need to be aware that their prices and quality are being reported publicly. The implications go beyond losing reimbursement. You can actually be delisted from an insurance network. To ensure that your practice remains a viable option for patients:

  • Market your own practice and post your own prices.
  • Make sure you are reporting good quality data.
  • Use sources such as MGMA or OPTUM to see what providers in your area are charging and how you compare.
  • Determine how your reimbursement ranks vs. your competitors on the Medicare website and ensure data accuracy.

Open Enrollment for the ACA

November 15 marks the beginning of the second Open Enrollment period for the Affordable Care Act and there is no indication that this time around will be any easier than the first. Patients will be choosing plans, dealing with things very unfamiliar, and perhaps unaffordable, to them, like deductibles. This directly impacts clinics and the bottom line, especially with those patients who cannot pay their share of the costs. Last year, patients became the number one payor for many practices, even more than insurance companies, because so much revenue came from deductibles. That all resets January 1, but there are things you can do to avoid a possibly painful Q1 of 2015:

  • Check and confirm all patients’ eligibility, what plan they are on, and what their deductible is prior to their scheduled appointment, preferably through an automatic batch eligibility service. Keep this information in the practice management system.
  • Notify patients about their deductibles before they come into the clinic, and make sure to collect payments upfront, or keep a card on file.

The healthcare industry as we knew it for the past many years has ceased to exist. As we move into a new era of integrated delivery systems and a greater emphasis on value-based rather than volume-based reimbursements, the industry is going to remain in a state of flux before it stabilizes once again. The only way organizations are going to survive in this shifting landscape is by anticipating and planning for the next change so that they can stay ahead of the curve. The more an organization knows, the better it can be prepared to confront any potentially negative impact of the ever-evolving nature of the industry.

About Ben Quirk
Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

September 18,2014

European CommissionThe European Commission is committing €90 million to Open and Disruptive Innovation over the next 12 months. A new tool to help doctors communicate with non-responsive patients; a cloud-based irrigation controller to improve water efficiency on farms by up to 30%; an "electronic nose" to better determine how fresh your food is - these are a few of the 30 tech SMEs and start-ups to receive EU funding.
InterSystemsInterSystems, a global leader in software for connected healthcare, has announced that South Devon Healthcare NHS Foundation Trust has chosen the InterSystems HealthShare® health informatics platform for its health information exchange (HIE) and clinical portal for use throughout the South Devon and Torbay region.

It’s infographic time! In fact, it’s time for two infographics.

The first is from HIMSS, celebrating 25 years of the organization’s annual health IT leadership survey. Some interesting findings, as pointed out by a HIMSS publicist:

  • 1991- 75 percent say their institution’s financial health is helped by computers
  • 1994 – 14 percent predict that digital patient information will be shared nationwide in 1-3 years
  • 2000 – 70 percent of respondents say HIPAA is a top business issue.


The second infographic comes from Not surprisingly, the most lucrative jobs are in consulting, and those with experience get paid significantly more than newbies.


20 Questions for for health it 14)

Question number 14 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Rasu B. Shrestha, MD, Chief Innovation Officer at the University of Pittsburgh Medical Center

Where does innovation fit in at a time of ‘do more with less’ in healthcare?

It has been said that the trouble with our times is that the future is not what it used to be. There is no doubt that change is coming to the world of healthcare and healthcare information technology; both in the very way we practice the noble profession, as well as in the way information technology contributes back to healthcare. We live in an era in healthcare today of ‘do more with less’. Reimbursements continue to decline, whilst there continues to be a steady march from volume-based healthcare to one that celebrates value. Arguably, this is the perfect storm for us to push for more innovation.

The healthcare industry is currently experiencing one of the greatest periods of consolidation in the last century. Consolidation is happening across hospitals, physician organizations and insurance companies. Meanwhile, healthcare reform is here, and it’s here to stay. The Patient Protection and Affordable Care Act of 2010, also generally called the Federal Healthcare Law, represents one of the most significant regulatory overhauls of the U.S. Healthcare system since the passage of Medicare and Medicaid in 1965. Even if we look at these two massive market and industry dynamics together, we see a need – perhaps an imperative – for us as an industry, to do more with data, to innovate, and to think outside the box in the very ways that we are providing care to our patients. It is indeed at times like these that we need to “double down” on innovation and leverage healthcare information technology to truly transform the way we are practicing medicine. We have a dire need to use data intelligently to push the needle forward and embrace the opportunities of value based healthcare, where quality, collaboration and care coordination are of paramount importance.

Categories: News and Views , All

This week is National Health IT Week (#NHITWeek), but I think it might be better to call it National Health IT Infographic week. I’m not complaining. I love a good infographic. For example, I posted the Rise of the Digital Patient Infographic and the Healthcare IT Leadership Infographic – A 25 Year History already this week. I figured I might as well round out the week and post an infographic on EMR and HIPAA as well. Coalfire sent me the following infographic looking at HIPAA audits. I don’t think most people realize the HIPAA audits that are coming. HIPAA audits have had a slow start, but I think the momentum is growing. If you’re an organization that ever touches healthcare data, you better be ready. Enjoy the HIPAA audit infographic below.
5 Elements of an Effective HIPAA Audit Program


What are the trends in aging?

1. More People, Living Longer, Living Independently

Baby boomers started turning 65 in 2011. By 2030, the number of Americans age 65 and older will double to about 71 million. In the U.S., we are also living longer. Compared to only 100 years ago, life expectancy has increased by almost 30 years.

Because we are living longer, two generations now make up the aging population. Currently, the fastest growing segment of the population is 85 and older, and by 2030, one in five Americans will be considered a senior citizen. What happens when we all live to 100?

Today, more people want to live independently, and stay in their home – the trend is called “aging in place.” But a new group of boomer seniors is bucking the trend and choosing houseboats, RVs, and even couchsurfing. Another trend for senior women is homesharing – women teaming up as “senior roommates” so staying in the home is financially feasible. In the U.S., four million women live in households where two women are at least 50 plus, and this statistic is expected to rise.

The Center for Disease Control defines “aging in place” as the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.

2. More People Living with Chronic Disease

Eighty percent of seniors have one chronic disease, and half, have two chronic conditions. By the time seniors reach the age of 85, they may have three or four chronic conditions. One area of particular concern is Alzheimer’s Disease. At current rates, the number of seniors with Alzheimer’s is projected to triple by 2050.

Caregiver Trends

More Seniors, Fewer Caregivers

As the population ages, the number of available caregivers in a senior’s informal network is expected to decline from eight people to four by 2030. Divorce and nontraditional family structures will also blur lines of responsibility.

At the same time, healthcare cost cuts have shifted responsibility from the hospital and longterm care to the home. So, while more seniors are at home, their family members are spread out geographically which makes coordinating care challenging.

Home Care Technology

“The home will become a major part of our health care,” says Unity Stokes of StartUp Health.

Technology is playing an increasing role, and Vadim Cherdak, founder of, sees a huge opportunity for disrupting senior care. He is currently working on building technology solutions specifically for home care. He says that while hospitals have leading 21st century technology, the majority of home care is stuck in the 19th century:

“This is a huge and growing market from a business point of view, and there is very limited amount of technology really applicable to seniors.”

His plans include an affordable remote monitoring system for family caregivers that will connect all types of medical devices, sensors, and wearables.

Update: The emerging trend is the Home-as-a-Platform (HaaP).

Wearable Tech and Sensors for Seniors

Digitally savvy millennials will increasingly look to sensors and wearable tech to keep track of parents and grandparents.

We are only at the beginning of understanding how wearable technologies and sensors can improve health, including managing chronic disease for the elderly. – 20 Questions for Health IT

In “How Will Millennials Face their Parents Aging?“, Michael Humphrey says that “the image is of devices (everything from wristbands to clothes to embeds) far surpassing the wellness and health-tracking they do now.”

Goode Intelligence forecasts that by 2019 there will be 5.5 billion users of mobile and wearable biometric technology around the globe. Apple is the leading manufacturer of biometric-mobile devices, and HealthKit is said to have an “Emergency Access” feature where medical information can be shared through the “Medical ID” app. Apple has also partnered with EPIC and their MyChart app to capture physical vitals and other patient data, and make this information available to physicians via the EHR.



Sensara is a remote monitoring system and app that uses small, unobtrusive sensors to keep on eye on elderly family members and friends who live on their own.


Lively Activity Sensors

Lively combines a safety watch and sensors for emergency response along with medication reminders and step counting.



BeClose says it takes less than 15 minutes to set up sensors to monitor a senior’s routine that can be viewed through a web dashboard. Emergency alerts are also provided via email, text message, or phone.

Keeping Seniors Connected and Social

Although we have made advances in keeping the body alive, one in eight people over 60 suffers from cognitive decline including changes in thinking and memory loss. Seniors are afraid of losing their quality of life, and the risk of attempted suicide is a real issue among people with dementia.

Keeping seniors connected and social is an important part of brain health.


Tyze enables a family to create a private network centered around a particular person, their care, and the special events in their family’s lives.

“My sister is a whole person, not a patient or a diagnosis.”


One Million Dollars to End Aging

As we look to the future, there are a number of initiatives focused on ending aging. Recently, Dr. Joon Yun announced the Palo Alto Longevity Prize:

“The Prize” is a $1 million life science competition dedicated to ending aging. Ours is one of a growing number of initiatives around the world pursuing this goal—the more shots on goal the better. Through an incentive prize, our specific aim is to nurture innovations that end aging by restoring the body’s homeostatic capacity and promoting the extension of a sustained and healthy lifespan.

Do you think technology should stop aging?


Categories: News and Views , All

Epic UGMWearing coveralls, a red flannel shirt, work boots and a John Deere hat, Epic Systems' CEO and founder Judy Faulkner made it clear during a keynote speech Tuesday during the annual Epic Users' Group Meeting (UGM) that the company was sticking to what it knows - developing its Epic Systems software and improving interoperability with other EHR vendors.

While Faulkner's theme-based costumes (this year, "Down on the Farm" was the theme for the annual conference) and Epic's announcements are typical conversation topics on social media, Twitter users attending focused on several other items that they observed during the three-day event. Here's our roundup of the most Epic tweets of Epic UGM 2014.

Folks were digging the Farm motif...

The lunchroom and snacks selections were impressive...

And of course, there were inevitable tweets about the traffic and congestion...

But it was all worth it to hear the latest from industry thought leaders at Epic UGM...

Did we miss any truly #Epictweets? RT them to us @hitleaders... and hey, while you are on Twitter, follow us and we'll follow you right back!


The post The Most Epic Tweets from Epic UGM 2014 appeared first on Healthcare IT Leaders.

Categories: Influential , All

Epic UGMWearing coveralls, a red flannel shirt, work boots and a John Deere hat, Epic Systems' CEO and founder Judy Faulkner made it clear during a keynote speech Tuesday during the annual Epic Users' Group Meeting (UGM) that the company was sticking to what it knows - developing its Epic Systems software and improving interoperability with other EHR vendors.

While Faulkner's theme-based costumes (this year, "Down on the Farm" was the theme for the annual conference) and Epic's announcements are typical conversation topics on social media, Twitter users attending focused on several other items that they observed during the three-day event. Here's our roundup of the most Epic tweets of Epic UGM 2014.

Folks were digging the Farm motif...

The lunchroom and snacks selections were impressive...

And of course, there were inevitable tweets about the traffic and congestion...

But it was all worth it to hear the latest from industry thought leaders at Epic UGM...

Did we miss any truly #Epictweets? RT them to us @hitleaders... and hey, while you are on Twitter, follow us and we'll follow you right back!


The post The Most Epic Tweets from Epic UGM 2014 appeared first on Healthcare IT Leaders.

Categories: Influential , All

Here's a story about a rapidly growing speciality reference lab, Health Diagnostic Laboratory, that paid physicians $20 per blood sample to ostensibly cover the labor costs of specimen handing but not for drawing the blood. In so doing, it has attracted the attention of HHS that has warned the lab the such payments presented a risk of being a kickback (see: A Fast-Growing Medical Lab Tests Anti-Kickback Law). Below is an excerpt from the article:

Health Diagnostic Laboratory CEO Tonya Mallory...founded the cardiac-biomarker-testing company after leaving a California lab in 2008...[This] fast-growing Virginia laboratory has collected hundreds of millions of dollars from Medicare while using a strategy that is now under regulatory scrutiny: It paid doctors who sent it patients' blood for testing. Health Diagnostic Laboratory...transformed itself from a startup incorporated in late 2008 into a major lab with $383 million in 2013 revenues, 41% of that from Medicare....HDL bundles together up to 28 tests it performs on a vial of blood, receiving Medicare payments of $1,000 or more for some bundles. Until late June, HDL paid $20 per blood sample to most doctors ordering its tests—more than other such labs paid. For some physician practices, payments totaled several thousand dollars a week, says a former company employee. HDL says it stopped those payments after a Special Fraud Alert on June 25 from the Department of Health and Human Services, which warned that such remittances presented "a substantial risk of fraud and abuse under the anti-kickback statute....

Its fee fairly compensated doctors for the labor cost of handling blood that went beyond the $3 that Medicare pays for each blood draw,...[an HDL spokesperson] says....Large established labs like Quest Diagnostics...don't pay such fees. They operate blood-draw sites and sometimes place blood-drawing technicians in physician practices—doctors get no financial compensation for the blood draw. At issue is a "safe harbor" exception to the federal anti-kickback statute. A vendor selling something to doctors may compensate them for certain related services. For instance, a lab could reimburse a doctor the partial cost of employing a blood-drawing technician who sends samples to the lab. Under the exception, payments must not offer a financial incentive for doctors to send more business the vendor's way. They must not exceed a "fair market value" for the service and must be a fixed amount set beforehand. The government is examining whether the labs' payments were excessive and encouraged doctors to send more samples because they were paid for each one. HDL and several other labs under investigation say that their payments were fair-market-value compensation for handling blood, that they had been a widespread industry practice and that the fraud alert represents new government guidance. 

I did not include in the excerpt above the cited examples of physicians racking up large handling fee payments for samples submitted to HDL. To me, $20 per tube seems excessive in terms of the labor involved so it's probably no mystery why the Medicare is looking closely at HDL. As noted above, a handling fee per tube also provides an incentive for physicians to order HDL tests for all of their patients even when not clinically indicated. Given that Medicare pays $1,000 or more for such test bundles, the testing costs of HDL policies dwarf the relatively small handling fees remitted to the test-ordering physicians. 


20 Questions for Health IT 13

Question number 13 of our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here

Question from Grahame Grieve, Principal at Health Intersections and chief architect of HL7 FHIR:

Pay now or pay later: how much consistency should EHR APIs have?

The JASON report calls for EHRs to expose all the data through an API. But variability is one of the key barriers to interoperability in healthcare. Vendors do things differently. Providers do things differently. Individual doctors do things differently. Exposing all the existing data merely exposes all this variation, and sorting through the data will be a gargantuan – and $$$Expensive – challenge. So instead, we could try and standardize things up front to reduce the variability, and therefore the cost of leveraging the data. But standardizing is expensive (and slow) – the more we try to standardize, the more it costs to get there – and what happens to the legacy data? The optimum is probably somewhere in the middle: standardise what you can achieve, and leave the rest. The problem is, in order to really find the optimum, we need to agree to what the use cases we’re going to focus on for leveraging the exposed data….

Categories: News and Views , All

September 17,2014

FICHeThe objective of Future Internet CHallenge eHealth (FICHe) is to accelerate small and mid-sized enterprises (SME) and startups that develop innovative applications in the eHealth market building upon the FIWARE technology, i.e. FIWARE generic enablers, specific enablers and/or domain specific platforms.
European CommissionThe European Commission has launched the FIWARE Accelerator Programme. €80 million will be awarded to SMEs, Startups and web-entrepreneurs using FIWARE Technologies. The FIWARE Accelerator is a network of European organisations which has already launched first calls for proposals earlier this month.

It’s safe to say that meaningful use is growing through its challenges right now. My post yesterday about killing meaningful use and the new Flex-IT Act should be illustration enough. While it’s easy to play Monday Morning Quarterback on meaningful use, I think it’s also valuable to consider what meaningful use could have been and then use that to consider how we can still get there from where we are today.

Many of you might have read my post on The Purpose of the EHR Incentive Program Accordign to CMS. CMS clearly stats that the purpose of the EHR incentive money and meaningful use is to move providers towards advanced use of health IT to:

  • Support Reductions in Cost
  • Increase Access
  • Improve Outcomes for Patients

This has very clearly been CMS’ goal and it’s reflected in what we now know today as meaningful use. Let’s think about those from a physician perspective.

Support Reductions in Cost – So, you’re going to pay me less for doing the same work?

Increase Access – So, you’re going to send me patients who can’t pay their bill? Or does this mean I have to do more work making my records accessible?

Improve Outcomes for Patients – Every doctor can support this. However, many are skeptical (with good reason) that the various elements of meaningful use really do improve outcomes for patients.

If I were to step back and think what a doctor might consider meaningful use of an EHR system, this might be what they’d list (in no particular order):

  • More Efficient
  • Improved Care
  • Increased Revenue

More Efficient – Will the technology help me see patients more efficiently? Will it allow me to spend more time with the patient?

Improved Care – Will the technology help me be a better doctor? Will the technology help me make better use of my time with the patient?

Increased Revenue – Will the technology help me get paid more? Will the technology lower the cost of my malpractice insurance and reduce that risk? Will the technology create new revenue streams beyond just churning patient visits?

I’m sure there are other things that could be listed as well, but I think the list is directionally accurate. When you look at these two lists, there’s very clearly a major disconnect between what end users want and what meaningful use requires. With a lot of the EHR incentive money already paid out, this divide has become a major issue.

I recently read that the App Association (aka ACT) is lobbying Congress to promote clarity in HIPAA regulations for app developers, based in part on the experience that health care systems "don’t understand the intersection of HIPAA and mobile, and...

You should follow me on Twitter: @healthblawg

David Harlow
Source: HealthBlawg

September 16,2014


Isn’t it nice that National Health IT Week brings people together to complain about meaningful use? Ok, that’s only partially in jest. Marc Probst, CIO of Intermountain and a member of the original meaningful use/EHR Certification committee (I lost track of the formal name), is making a strong statement as quoted by Don Fluckinger above.

Marc Probst is right that the majority of healthcare would be really happy to put a knife in meaningful use and move on from it. That’s kind of what I proposed when I suggested blowing up meaningful use. Not to mention my comments that meaningful use is on shaky ground. Comments from people like Marc Probst are proof of this fact.

In a related move, CHIME, AMDIS and 15 other healthcare organizations sent a letter to the HHS Secretary calling for immediate action to amend the 2015 meaningful use reporting period. These organizations believed that the final rule on meaningful use flexibility would change the reporting period, but it did not. It seems like they’re coming out guns blazing.

In even bigger news (albeit probably related), Congresswoman Renee Ellmers (R-NC) and Congressman Jim Matheson (D-UT) just introduced the Flexibility in Health IT Reporting (Flex-IT) act. This act would “allow providers to report their Health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year.” I have yet to see any prediction on whether this act has enough support in Congress to get passed, but we could once again see congress act when CMS chose a different course of action like they did with ICD-10.

This story is definitely evolving and the pressure to change the reporting period to 90 days is on. My own personal prediction is that CMS will have to make the change. I’d love to hear your thoughts.

Happy National Health IT Week!


I often share jokes and humorous videos here, sometimes because a product is worthy of ridicule, but also to illustrate how some health IT is going mainstream. I’m going to do it again today because two things happened in the last week that I had not seen before.

First, though Stephen Colbert has made fun of digital health and fitness products before, last week he took it upon himself to do so on consecutive nights.

On Sept. 8, he took down the forthcoming Pavlok fitness bracelet, a product that sends an electrical jolt to the wearer’s arm as a reminder to exercise. It also debits the user’s bank account and posts an embarrassing message on Facebook. No, really. “When you’re in a dark place, alone at home, out of shape and too tired, overweight or depressed to work out, it’s probably because you weren’t getting enough public humiliation,” Colbert said.


A night later, Colbert, like the rest of the world, was talking about the Apple Watch. After cheering wildly about the announcement, Colbert asked, “What does it do?” He then showed a picture of himself from high school and said it was finally cool to wear a calculator watch.


Then, on Friday, no less than America’s Finest News Source, The Onion, got into the act with its “American Voices” feature, in which common people (actually, the same five or six headshots recycled for years with different names and occupations) give their fake opinions on a newsworthy topic. That day, the subject was, “Patients Making Record Number Of Telehealth ‘E-Visits’ With Doctors,” with a reference to an actual Deloitte study on that very topic.

As one “commenter” said, “Until doctors can email me painkillers, I don’t see the point.”



Long before FitBit, Google Glass and Bluetooth headsets, wearables entered the world in a non-social media world. No one wrote an online review about the abacus ring, the first known wearable, but chances are that everyone did laugh when the first person tried to put an Apple II computer into a cut-out backpack. So at least that hasn't changed.

In the infographic below, we track the history of wearables, from their humble beginnings during the Qing Dynasty in the 1600s to their use in modern medicine to where they're going next (Hint: They're going to the dogs!).


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The post From Abacus Rings to Phone-Charging Pants: The History of Wearables appeared first on Healthcare IT Leaders.

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