October 22,2014

18:00
22 - 24 April 2015, Luxembourg.
Join Med-e-Tel 2015 - 13th edition - and actively participate in the educational and information program of presentations, workshops, demonstrations and interactive panel discussions on eHealth, Telemedicine and ICT applications in medicine, health and social care. Med-e-Tel is the official event of the International Society for Telemedicine & eHealth, the international federation of national associations who represent their country's Telemedicine and eHealth stakeholders.
18:00
Agfa HealthCareAgfa HealthCare announces that it has been successfully installing two new DX-G digitizers and seven CR 30-X computed radiography (CR) systems as part of a digital radiography update at Salisbury NHS Foundation Trust. The digitizers support both standard phosphor plates and needle-based detectors, providing state-of-the-art image quality for the next generation in digital radiography across a broad range of applications.
14:03

I recently heard Elliot Lewis, Dell’s Chief Security Architect, comment that “The average new viruses per day is about 5-10k appearing new each day.” To be honest, I wasn’t quite sure how to process that type of volume of viruses. It felt pretty unbelievable to me even though, I figured he was right.

Today, I came across this amazing internet attack map by Norse which illustrates a small portion of the attacks that are happening on the internet in real time. I captured a screenshot of the map below, but you really need to check out the live map to get a feel for how many internet attacks are happening. It’s astounding to watch.

Norse - Internet Attack Map

For those tech nerds out there, here’s the technical description of what’s happening on the map:

Every second, Norse collects and analyzes live threat intelligence from darknets in hundreds of locations in over 40 countries. The attacks shown are based on a small subset of live flows against the Norse honeypot infrastructure, representing actual worldwide cyber attacks by bad actors. At a glance, one can see which countries are aggressors or targets at the moment, using which type of attacks (services-ports).

It’s worth noting that these are the attacks that are happening. Just because something is getting attacked doesn’t mean that the attack was successful. A large majority of the attacks aren’t successful. However, when you see the volume of attacks (and that map only shows a small portion of them) is so large, you only need a small number of them to be successful to wreak a lot of havoc.

If this type of visualization doesn’t make you stop and worry just a little bit, then you’re not human. There’s a lot of crazy stuff going on out there. It’s actually quite amazing that with all the crazy stuff that’s happening, the internet works as well as it does.

Hopefully this visualization will wake up a few healthcare organizations to be just a little more serious about their IT security.

6:18
I thought I would take a few rough notes for readers here. E & O E! Relevant Section -Outcome 7 - E-Health Started 08:34 pm. Lots of waffle on NICNAS and FSANZ. (Chemicals and Cosmetics!!) 8:58 pm Moved on to TGA. Refused to discuss medical cannabis….. Questions since June from all sorts of Senators. Australian Medical Devices are now more able to get easier conformity assessment if approved in EU or, I assume, US. Outcome 7 - Finished at 9:14pm. We know where e-Health is heading now - Into Oblivion! Sleep Well and what a farce - zero accountability! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
0:36
This alert was sent out today. I am told many system providers (not just Genie) are affected. Potential issue with PCEHR overviewsWe have been alerted by the Department of Health about a potential risk identified within the PCEHR system. This is impacting the way a small number of documents can be viewed in an eHealth record. This issue results in some Medicare, prescription and dispense documents presenting in the Document List but not appearing in the Medicare Overview or the Prescription and Dispense View. A permanent solution for this issue has been identified and will be implemented in December 2014 by the Department of Health. In the meantime, please do not rely on the Medicare Overview or Prescription and Dispense View within the Genie PCEHR-viewer to necessarily provide a complete list of information from a patient's eHealth record. It is recommended that you use the Document List to view all documents. Here is the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
0:23
To watch go to the following link: http://www.aph.gov.au/ Then select the Watch Parliament Tab and click on Senate Estimates / Community Affairs Hearing. Enjoy! David. Late Update - Committee is running very, very late. D.

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

October 21,2014

18:00
HIMSS Europe6 - 7 November 2014 , Amsterdam, The Netherlands.
This year, the second annual HIMSS Amsterdam event will be taking place at the Hotel Okura. The 2013 conference, presented by HIMSS Europe, was the first HIMSS event in The Netherlands and brought together nearly 400 healthcare IT leaders from across Europe.
18:00
CarestreamMSC Cruises has become the first cruise line to offer a 24/7, multilingual pediatric telemedicine service on board its entire fleet thanks to an agreement with the renowned Instituto Giannina Gaslini Children's Hospital in Genoa, Italy.
15:59

EHR interoperability has been a hot topic lately and I have posted a number of notes about it. Here's a couple of the latest (see: What Will Motivate Hospital CEOs to Seek HIT Interoperability?Revisiting EHR Interoperability; Standardized Content and Vendor Strategy). The major EHR vendors have been unable or unwilling to provide broad interoperability solutions, particularly between their systems and "foreign" systems by which is meant systems from competing vendors. A new and perhaps unexpected player has emerged to provide an interoperability solution -- e-prescribing giant Surescripts (see: E-Prescribing Giant Surescripts Emerges As A Player In Push For Interoperability). Below is an excerpt from the article about this news:

With health care providers scrambling to meet a government deadline this year to electronically send and receive patient information, an unlikely actor has emerged to facilitate that transaction. As the country’s largest electronic prescribing network, processing 1 billion prescriptions last year, Surescripts has amassed information on more than 200 million patients—from phone numbers to birthdate. Capitalizing on its network, it started four years ago offering health care providers the ability to exchange clinical messages using government-sanctioned standards. The service, slow to take off, has quadrupled since March, with health care providers exchanging nearly 1 million clinical messages in August. Jeff Miller who heads clinical network services, says that number is rapidly rising. Surescripts has signed up 130 health systems, including Geisinger Health System, Mount Sinai Health System, and St. Joseph’s Hospital Health Center....Becomes The second phase of meaningful use calls for health care providers to transmit a patient summary electronically in order to qualify for financial incentives. Instead of fax or phone, a doctor at Mount Sinai can now forward to another physician on a different electronic health record a patient’s discharge instructions, medications list, and diagnoses, among other things. Mount Sinai uses electronic health records from multiple vendors....Giving Surescripts a major boost is Epic. The dominant electronic health record connects to Surescripts’ clinical messaging service, and many of Surescripts’ clients are on Epic. Other major vendors that use Surescripts include Siemens (now part of Cerner) and Meditech. Surescripts says it added 1,000 hospitals to its network this year. The more it adds, the more likely it makes its clinical messaging service indispensable.

I posted a note two years ago that suggested that this could happen (see: Surescripts May Capture the Health Information Network (HIN) Business). Here's a quote from the Surescripts web page that provides more information about the Surescripts interoperability solution (see: What Is the Current State of Interoperability? – Part One).

Surescripts....will demonstrate how Surescripts’ Record Locator & Exchange (RLE) service can connect other EHR systems and HIE networks. This new offering from Surescripts will locate patient records stored in disparate locations, support electronic patient consent, and facilitate the exchange of information with the requesting care provider’s EHR, adding significant value in a streamlined process.  With RLE, care providers receive comprehensive information about a patient with appropriate consent at the right time, in the right setting, and with the right context, improving care while saving time and money.  

How was Surescripts able to pull all of this off with the EHR companies, who should have deployed broad interoperability solutions, twiddling their thumbs? As noted above and despite government pressure, the major EHR vendors did not want to provide interoperability solutions with competing EHRs. Surescripts was in the e-prescribing business and therefore had a deep understanding of how to interface with hospital EHRs in order to transmit drug prescription data to pharmacies. The company then exploited a new business opportunity by serving as a third-party to enable inter-hospital EHR communication. It looks like Epic is playing ball with Surescripts, at least for now, in terms of supporting its clinical messaging service. However and at least to me, there's something a little looney about an e-prescribing company providing this service.

15:44

I’ve been writing about the need to do a HIPAA Risk Assessment since it was included as part of meaningful use. Many organizations have been really confused by this requirement and no doubt it will be an issue for many organizations that get a meaningful use audit. It’s a little ironic since this really isn’t anything that wasn’t already part of the HIPAA security rule. Although, that illustrates how well we’re doing at complying with the HIPAA security rule.

It seems that CMS has taken note of this confusion around the HIPAA risk assessment as well. Today, they sent out some more guidance, tools and resources to hopefully help organizations better understand the Security Risk Analysis requirement. Here’s a portion of that email that provides some important clarification:

A security risk analysis needs to be conducted or reviewed during each program year for Stage 1 and Stage 2. These steps may be completed outside OR during the EHR reporting period timeframe, but must take place no earlier than the start of the reporting year and no later than the end of the reporting year.

For example, an eligible professional who is reporting for a 90-day EHR reporting period in 2014 may complete the appropriate security risk analysis requirements outside of this 90-day period as long as it is completed between January 1st and December 31st in 2014. Fore more information, read this FAQ.

Please note:
*Conducting a security risk analysis is required when certified EHR technology is adopted in the first reporting year.
*In subsequent reporting years, or when changes to the practice or electronic systems occur, a review must be conducted.

CMS also created this Security Risk Analysis Tipsheet that has a lot of good information including these myths and facts which address many of the issues I’ve seen and heard:
CMS HIPAA Security Risk Analysis Myths and Facts

Finally, it’s worth reminding people that the HIPAA Security Risk Analysis is not just for your tech systems. Check out this overview of security areas and example measures to secure them to see what I mean:
CMS HIPAA Security Risk Analysis Overview

Have you done your HIPAA Risk Assessment for your organization?

9:05

First, do no harm.

Four simple words that are synonymous with healthcare. It’s a principle that everyone in the industry – not just physicians – should adhere to.

So shame on us all for our part in allowing an EHR vendor to shut off a practice’s access to their patients’ medical records and for recklessly putting patients at risk.

Background: Full Circle Health Care in Maine purchased an EHR from HealthPort in 2010. Originally the maintenance fees were $300 a month. A few months later CompuGroup Medical purchased HealthPort and increased the maintenance fees to $2,000 a month. The practice protested the price increase and claimed CompuGroup failed to deliver hardware upgrades that had been paid for. The parties spent several months arguing and for 10 months the practice did not pay its maintenance bills. Finally in July, CompuGroup shut off the practice’s access to its medical records.

The details as to why the fees jumped so much and whether CompuGroup had the legal right to do so are a little unclear. What is clear is that multiple parties are at fault for allowing such a mess to occur.

Let’s start with the government, which created the HITECH program and promised thousands of dollars for providers willing to adopt and meaningfully use EHRs. Though the objectives were admirable, CMS failed to adequately address all the “what if” scenarios in its rush to move the program forward. The legislation and final rule provide no guidelines for protecting patient records in the event of a vendor/provider disagreement, financial hardship, or business discontinuance. Undoubtedly we’ll see plenty more disputes like this one in the coming years.

Tdo no harmhe practice also gets a share of the blame. The owner should have invested in legal advice before signing a $72,000 contract for something as critical as an EHR system. Did she skip this step in her haste to achieve Meaningful Use and earn incentive payments? Furthermore, even if she disputed the increase in maintenance pricing, shouldn’t she, at a minimum, have continued paying the $400 a month fee she believed was the correct amount? Perhaps the vendor would have been more willing to come to an acceptable agreement if she hadn’t stopped paying altogether.

CompuGroup, of course, looks like the really bad guy here. The multi-national company has annual revenues of about $600 million. Did they really need to pull the plug on this practice over a piddling $40,000? The company’s general counsel says the situation is similar to an electric company shutting off power when a customer fails to pay. Perhaps, but many municipalities and some states have laws that prohibit the discontinuance of services under certain conditions, such as in extreme cold weather or when a child or sick person is in residence. In other words, there are laws to protect consumers against potentially harmful actions. (See: EHRs And The Law: When Interoperability Isn’t a Choice)

Which brings us to the seemingly forgotten patient, who arguably is – or should be – the owner of his or her own record. We do have federal and state laws that give patients the right to access and inspect their medical records. Perhaps the practice’s 4,000 patients should all send CompuGroup a written request for a copy of their records. Maybe an attorney who is smarter than me should look into that.

Until the mess is settled, we have a practice seeing patients without the benefit of medication and allergy lists, details on previous treatments, or lab and test results. And everyone involved is hoping that no patients are harmed.

Whether our role in healthcare is policy maker, technology developer, provider, or HIT geek, we really need to do better.

Categories: News and Views , All
3:50
Gough, For getting rid of conscription (yes I was sucked in), providing major changes to health and education (yes I really benefited) and getting rid of the death penalty - many thanks! We won't see his likes again I believe. The meanness we now see in public policy just shows how badly we are presently led - IMVHO. We can care and fund things - but no one wants to try! Pity about that. 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
2:46

In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn’t available for an interview in time for that report, but he was last week, so I got him for a new podcast.

Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. “Suboptimal system design could lead even careful users to make mistakes,” Silverstein said in this interview.

During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity and Responsibility in Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.

Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.

1:10 How this interest came about
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR’s role in Texas Health Presbyterian Hospital’s initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 “Postmarket surveillance” of “medical meta-devices”
18:50 EHRs now more like “command and control” systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 “Critical thinking always, or your patient’s dead”
25:05 Lack of health/medical experience among “disruptors”
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of “experimental” technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT “bubble”
36:10 Good health IT vs. bad health IT

 

1:30
This appeared a day or so ago.CDC, ONC Target EHR-Based Ebola ScreeningGreg Slabodkin OCT 17, 2014 7:30am ETAn initiative launched last year by the Centers for Disease Control and Prevention and the Office of the National Coordinator for Health IT to help providers meet Stage 1 and 2 meaningful use public health objectives is now focusing its efforts on Ebola electronic screening tools.In August 2013, CDC and ONC established the Public Health Electronic Health Records Vendors Collaboration Initiative. However, with recently confirmed cases of Ebola in the United States, the initiative—which includes public health practitioners and EHR vendors—is currently aimed at trying to get vendors to configure EHR systems to support screening protocols for the deadly disease.“The overall goal here is for us to explore ways in which the electronic medical record can serve as a prompt to help our healthcare professionals around the country identify individuals that may be at risk for Ebola,” said...

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

October 20,2014

18:00
PhilipsRoyal Philips (NYSE: PHG, AEX: PHIA) has reported Q3 sales of EUR 5.5 billion and operational results of EUR 536 million. Healthcare comparable sales grew by 1% year-on-year. The EBITA margin, excluding restructuring costs and various charges, was 12%, a decrease of 2.6 percentage points year-on-year.
17:21

On October 17, 2014, I posted a note discussing the usefulness of a reverse feed of clinical data from the EHR to the LIS (see: Reverse Feed" of Clinical Data from EHR to the LIS -- Will This Ever Happen?). I commented that I had first heard about the "reverse feed" from Dr. Ulysses Balis who is the Director of Pathology Informatics at the University of Michigan Medical School. He submitted an interesting comment to my note which I am now elevating to the level of a note. --BAF

Indeed, I proposed on the fundamental need for reverse feeds (and also reverse-federation, specifically) from the EHR back to the LIS as far back as 2007. This need is made obvious, when one considers the present state, where pathologists and laboratorians are being compelled to sift through one or more clinical systems, in addition to the LIS, in order to review all the underlying diagnostic data needed to make a full and complete report or diagnosis. In the absence of having convenient access to such information, the outcome is both predicable and obvious: reports are generated where the clinical information in foreign/disparate information systems has not been reviewed [by the pathologists generating surgical pathology reports], sometimes leading to glaring errors and inconsistencies (e.g. a bone biopsy not being clinically correlated with the radiographic impression, which itself might be the primary pathognomonic body of evidence) because the pathologist didn't bother to look up the case in the EHR or RIS.

At [the University of Michigan], we are actively developing workflow models that are purpose-built around reverse EHR-to-LIS interfaces and plan to use one such interface from the EHR to enable a pathologist's cockpit for the evaluation of medical liver biopsies. Other exemplars will hopefully come into being in logical succession. In time, as the number of use-cases grow and as the need becomes obvious to all, from a workflow perspective, the hope is that this construct will become commonplace. An important distinction of this type of interface, as opposed to a traditional LIS outbound results interface, is that the incoming clinical data from the EHR to the LIS is ephemeral. As soon as the pathologist or laboratorian is finished in their review of such clinical data, it is discarded. This is done to ensure that the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise. Should the lab need subsequent access to clinical data, the reverse feed can again be utilized to refresh the view, with it always guaranteed to contain the most up-to-date data.

Ul raises an important point with regard to a proposed interface at the University of Michigan from the EHR to the LIS. He indicates that the clinical data copied to the LIS will be ephemeral. By this he means that it would be discarded after review in pathology so that the EHR would remain as the single source of truth (SSOT) for all clinical information. Here's a definition of SSOT from the Wikepedia (see: Single Source of Truth):

In Information Systems design and theory Single Source Of Truth (SSOT) refers to the practice of structuring information models and associated schemata such that every data element is stored exactly once (e.g., in no more than a single row of a single table). Any possible linkages to this data element (possibly in other areas of the relational schema or even in distant federated databases) are by reference only. Thus, when any such data element is updated, this update propagates to the enterprise at large, without the possibility of a duplicate value somewhere in the distant enterprise not being updated (because there would be no duplicate values that needed updating).

When test results are transferred to from the LIS to another system such as the EHR, the process is always prone to errors. Some of these errors will be caught during the periodic validation of the LIS-EHR interface but such validation is never foolproof. Ul Balis has referred to the HL-7 interface between two systems as a data shredder (see: The EMR as a Data Shredder: Implications of a Single-Source-of-Truth Policy). As one example, formatting errors are common in the transfer of microbiology test results that are often in tabular format.

The most important interface for the LIS is the one to the EHR because this latter database is usually the only source of lab test results for hospital clinicians. This interface should only be validated by lab professionals because only they are trained to understand lab data in terms of accuracy and correct formatting. Let's assume that, in addition to the EHR, a hospital has a clinical data repository or warehouse that contains lab data. Such a database can not be used for patient care unless the lab data stored there is supplied by the LIS with the interface validated by pathology personnel. Ul understands this SSOT principle because he states, with regard to the reverse feed to the LIS, that "the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise." Another important reason for mandating that the clinical data that is copied from the EHR to pathology is ephemeral, as Ul point out, is that clinical data that is acquired later may be modified or updated.

16:57

I’ve been interested in the new “wearables” segment for a while. I reached out to Cameron Graham, the managing editor at TechnologyAdvice where he oversees market research for emerging technology, to give us some evidence-driven advice about wearables that entrepreneurs, innovators, healthcare providers, and payers can use for decision making. Specifically, what does the current research show and what are the actionable insights for how to incentivize patients to use them and figure out why patients might pay for them? Cameron thinks that wearable health technology could help improve patient outcome monitoring, if insurance companies and providers work together. He elaborated:

Wearable health technology (or mHealth as some call it) is one of the emerging frontiers in medicine. Fitness tracking devices could allow the healthcare industry to better measure patient outcomes, monitor patient populations for emerging trends, and give preventative healthcare advice based on quantitative measurements (such as daily step counts or heart-rate). We surveyed 979 US adults about their fitness tracking habits, in order to determine current the usage rate for this technology. We then further surveyed 419 of those adults, who identified as non-trackers, about what incentives would convince them to use wearable health monitors. Here are some of our takeaways for vendors and providers:

1. The wearable health market remains small, but is growing steadily

In order to gauge how many adults are currently generating personal health data that would be useful in either patient treatment or preventative medicine, we asked a random, nationwide sample of adults whether they currently tracked their weight, diet, or exercise using a fitness tracking device or smartphone app.

74.9 percent of respondents indicated they did not track any of those variables using either a fitness tracker or smartphone app. 25.1 percent reported tracking such stats.

Out of the roughly one quarter of adults who do track their fitness, 14.1 percent said they used a smartphone app, and 11 percent said they used a fitness tracker. There is currently little data on such demographics, although the Pew Internet Research Project conducted a survey in 2012 looking at similar trends. In their report, they noted that seven percent of adults tracked health indicators using an app. Combining these results, we can see that the market for health tracking applications has approximately doubled over the last two years.

As more consumers adopt such technology, and rely on it for monitoring their health, providers need to become involved in the discussion. There is limited data that can be draw from a sample of just 25 percent of a patient population. If providers can encourage adoption among a majority of their patients however, they will gain greater insight into current health habits, and be able to provide more tailored advice.

2. Physicians can play a large role in encouraging tracking but there are are few incentives in place for them to do so

Looking into what incentives could convince non-tracking adults to use such devices, we found great potential for healthcare providers to encourage tracking habits among their patients. It appears patients want their physicians involved more in monitoring but our healthcare system doesn’t have the right incentives or payment structures available to compensate providers.

48.2 percent of adults said they would use a wearable fitness tracker if their physician provided one. While this may be financially unrealistic for smaller practices, wearable activity trackers (like the FitBit or Jawbone UP) will likely become cheaper as more sophisticated, multi-purpose devices enter the market, such as the forthcoming Apple Watch.

If physicians were able to get half of the three-quarters of non-tracking adults to start measuring their fitness with wearable devices, it would create huge amounts of patient-generated data for the healthcare industry to analyze.

The infrastructure for handling this data is largely in place. The most popular electronic health record provider, Epic Systems, recently announced a partnership with Apple that will allow hospitals to easily integrate wearable data through Apple’s HealthKit platform into patient portals and records.

Promoting the use of such devices should now be a goal for physicians looking to gain greater insight into their patient population. The question would be why Physicians would do this without additional compensation either directly from their patients or indirectly through insurers.

3. Insurance companies and providers need to form partnerships

While a significant portion of adults would use physician-provided devices, health insurance companies may be the ultimate key to promoting widespread fitness tracker adoption.

A total of 57.1 percent of respondents said they would be more likely (or much more likely) to wear a fitness a tracker if they could receive lower health insurance premiums. In fact, this was a more compelling incentive than the possibility of receiving better healthcare advice from their physician (just 44.3 percent of respondents said that would make them more likely to use a tracker).

By agreeing to use a fitness tracker, insurance customers would become eligible for special discounts, perhaps for walking a set number of steps each day, or raising their heartbeat for a certain period of time. Discounts could be given out directly or through an employer.

Some companies are already experimenting with such systems. Humana insurance has a new Vitality program that allows employees to opt-in to fitness tracking in exchange for possible discounts. Car insurance companies have also found success by offering lower rates for safe-driving, as measured through in-car tracking devices.

If providers want to encourage fitness and health tracking among their patients, they should evaluate the possibility of providing devices to their patients, either for free or at a reduced cost. At the very least, they should make patients aware of the benefits of such devices, and encourage them to automatically share such data through their patient portal.

Long term, providers will likely need to collaborate with insurance companies in order to establish a data sharing system for such information, which can allow for physicians to better monitor their patient population, and provide more accurate, tailored diagnoses. A universal patient record system would be ideal, although given current interoperability standards, an insurance-provider arrangement is more likely.

13:12

Last week I had the chance to attend the Craneware Summit in Las Vegas. It was a really interesting event where I had the chance to meet and talk with a wide variety of people from across the spectrum of healthcare. I love getting these added perspectives.

One of the sessions I attended was an E&M session which provided some really interesting insights into the life of an E&M coder and how they look at things. There’s a lot more to their job, but I tweeted these comments because they made me laugh and illustrated part of the challenge they face in a new EMR world.


I thought these immediate responses to the question were interesting. They came from a crowd of HIM and coding professionals. Overall, they were quite supportive of EMR it seemed.


Many doctors don’t understand this. That’s why so many coders still have jobs.


Too funny.


Said like a true coder.

8:14

Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All
8:14

Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All

October 18,2014

15:19

Via Medgadget

locked in detection New Technique Helps Diagnose Consciousness in Locked in Patients

Brain networks in two behaviourally-similar vegetative patients (left and middle), but one of whom imagined playing tennis (middle panel), alongside a healthy adult (right panel). Credit: Srivas Chennu

People locked into a vegetative state due to disease or injury are a major mystery for medical science. Some may be fully unconscious, while others remain aware of what’s going on around them but can’t speak or move to show it. Now scientists at Cambridge have reported in journal PLOS Computational Biology on a new technique that can help identify locked-in people that can still hear and retain their consciousness.

Some details from the study abstract:

We devised a novel topographical metric, termed modular span, which showed that the alpha network modules in patients were also spatially circumscribed, lacking the structured long-distance interactions commonly observed in the healthy controls. Importantly however, these differences between graph-theoretic metrics were partially reversed in delta and theta band networks, which were also significantly more similar to each other in patients than controls. Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

Study in PLOS Computational Biology: Spectral Signatures of Reorganised Brain Networks in Disorders of Consciousness

 

Categories: All , News and Views

October 17,2014

15:38

In a pathology informatics webinar delivered yesterday by Dr. Mike Becich and presented by API and Sunquest  (see: Free Informatics Webinar Tomorrow: IT Support for Pathology Research), I posed the question whether he knew of any cases of a "reverse feed" of clinical information from an EHR to an LIS. Ul Balis was the first informaticist who had used the term "reverse feed" in my presence but I am not sure if he originated it. A feed of clinical information to the LIS will be absolutely necessary for pathology to fulfill its evolving mission in molecular diagnostics and cancer genomics because it enables pathologists to refine their diagnoses and generate therapeutic recommendations. Pathologists obviously have manual access to the EHR but the volume of such data demanded by molecular and genomic pathology requires an electronic interface back to the LIS.

Dr. Becich said that he knew of no instances of reverse feeds of clinical information from the EHR to the LIS in any hospital. In my opinion, there are a number of reasons why such a reverse feed will never be allowed by EHR vendors. Here are some of the reasons for my statement:

  • The LIS, RIS, and PACS systems are viewed as "ancillary systems" with the sole purpose of sending diagnostic data to the EHR with which the clinicians interact. For an EHR vendor, there would be no rationale or justification for such a "reverse feed" to the LIS from a competitive or business point of view. They would never articulate such an argument, however. Instead they would say that there is no need for such an interface given the integrated nature of the EHR database. They would omit the fact that there are few available tools to perform "deep phenotyping" studies on the EHR. Below is a definition of deep phenotyping for precision medicine (see: Deep Phenotyping for Precision Medicine)
    • Deep phenotyping can be defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described....The comprehensive discovery of such subclasses, as well as the translation of this knowledge into clinical care, will depend critically upon computational resources to capture, store, and exchange phenotypic data, and upon sophisticated algorithms to integrate it with genomic variation, omics profiles, and other clinical information. 
  • An EHR vendor like Epic offers an enterprise-wide-solution with its own LIS and RIS. The company would thus not be inclined to participate in any process that enhances the functionality of a best-of-breed LISs like Sunquest, Soft, or Cerner and, in so doing, enhance their perceived value.
  • An EHR vendor will assume that any algorithms used for deep phenotyping would run on its own system. Although such processing would be very desirable, I don't personally think we will see the development of such algorithms in the foreseeable future for EHRs. Although EHRs store massive amounts of clinical data, they are destined to function primarily as archives of clinical data without advanced data processing features.

Dr. Becich went on to state that very sophisticated data integration and analysis (i.e., deep phenotyping) is now occurring within the Department of Pathology at Pitt. The clinical data that the department of pathology requires to support its clinical and research mission is obtained from medical center's clinical data warehouse or repository which is populated with data by the EHR (including lab data) and to which the LIS is interfaced.  At the end of the day, this may well be the best architecture for hospitals and medical schools because it spares the EHR the cycle burden of supporting interfaces back to the ancillary systems like the LIS and RIS. The downside of such an architecture is that the creation of a clinical data warehouse will probably be limited to the larger academic medical centers that are able to justify the expense by its research mission and the funds generated from it. Smaller hospitals will thus be deprived of the opportunity to integrate pathology test results with the relevant clinical data.

15:11

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15:05

The people at online physician community, QuantiaMD, recently sent me a list of the top 3 “Crazy ICD-10 Codes” that they got from their community. It was quite interesting to learn that when they asked their community for these codes, they yielded double the participation the company typically sees. No doubt, physicians have globbed on to these funny and crazy ICD-10 codes. I’ll be honest. I’ve gotten plenty of laughs over some of the funny ICD-10 codes as well. Seriously, you can’t make some of this stuff up. Here’s a look at the top 3 crazy ICD-10 codes they received (and some awesome color commentary from the nominators):

1. W16.221 – Fall into bucket of water, causing drowning and submersion. I didn’t realize mopping the floor was so dangerous!
2. 7. Z63.1 – Problems in relationship with in-laws. Really, Who does not?
3. V9733xD – Sucked into jet engine, subsequent encounter. Oops I did it again.

While these codes are amazing and in many respects ridiculous, they’re so over the top that they’ve branded ICD-10 as a complete joke. For every legitimate story about the value of ICD-10 there have probably been 10 stories talking about the funny and crazy ICD-10 codes. You can imagine which story goes viral. Are you going to share the story that talks about improvement in patient care or the one that makes you laugh? How come the story about their being no ICD-9 code for Ebola hasn’t gone viral (Yes, ICD-10 has a code for Ebola)?

Unfortunately, I don’t think the proponents of ICD-10 have done a great job making sure that the dialog on the benefits of ICD-10 is out there as well. Yes, it’s an uphill battle, but most things of worth require a fight and can easily get drowned out by humor and minutiae if you give up. If ICD-10 really is that valuable, then it’s well worth the fight.

My fear is that it might be too late for ICD-10. Changing the ICD-10 brand that has been labeled as a joke is going to be nearly impossible to change. However, there are some key people on the side of ICD-10. CMS for starters. If you can get the law passed, then the ICD-10 branding won’t matter.

One thing I do know is that doing nothing means we’ll get more and more articles about Funny ICD-10 codes and little coverage of why ICD-10 needs to be implemented. I encourage those who see the value in ICD-10 to make sure their telling that part of the story. If you don’t have your own platform to share that part of the story, I’ll be happy to offer mine. Just drop me a note on my contact us page.

12:21

This is not a nice story at all now the the patient died and the resultant series of events that have followed.  The military is currently using the machine in Liberia so we have not heard the end of this one.  Perhaps in the panic everyone forgot they had this machine sitting around? 

From the Website about the FilmArray:

“The FilmArray is an FDA-cleared multiplex PCR system that integrates sample preparation,image amplification, detection and analysis. It requires just a few minutes of hands-on-time and its turnaround time is just about an hour, giving you faster results which may lead to better patient care.

The FilmArray now has three FDA-cleared panels – the Respiratory Panel, the Blood Culture Identification Panel, and the Gastrointestinal Panel. Together, these panels test for more than a hundred pathogens. Thus, FilmArray is not only the fastest way to better results; it’s the fastest way to more results.”

The FilmArray is FDA approved but perhaps not for use in the US for detecting Ebola?  Hospitals have to agree to use the machine specifically for research projects only…and here’s another clip worth reading from this article:

“The FDA rules in what are called “research use only” machines are far more lax than for machines that must provide clinical diagnosis. According to representatives from BioFire, even after the FDA approved the use of the machine for Ebola screening and allowed workers at the hospital to acquire the proper kit for Ebola testing, a 10-20 day “validation” procedure would kick in before they could change the machine’s use from diagnostics to research — and the results would have to go to the Centers for Disease Control for confirmation.

Dr. Luciana Borio, assistant commissioner for counterterrorism policy and acting deputy chief scientist at the FDA, recently told National Journal that the agency was looking to speed up evaluation of new drugs to treat Ebola.”

Stay tuned as I’m sure we’ll here more about this and perhaps this is why we have a lawyer as the Ebola Czar now?  BD 


It’s a toaster-sized box called FilmArray, produced by a company called BioFire, a subsidiary of bioMérieux and it’s capable of detecting Ebola with a high degree of confidence — in under an hour.

Incredibly, it was present at Dallas Presbyterian Hospital when Ebola patient Thomasimage Eric Duncan walked through the door, complaining of fever and he had just come from Liberia. Duncan was sent home, but even still, FDA guidelines prohibited the hospital from using the machine to screen for Ebola.

The FilmArray retails for about $39,000 per unit and can screen for the genetic markers of a wide number of respiratory, gastro-intestinal and other illness, including Ebola, but only with the right “kit” in place. Current FDA guidelines would not have allowed Dallas Presbyterian Hospital to get that kit. That’s despite the fact that it can provide results with higher than 90 percent certainty and it’s one of the machines that the military is currently using to screen for Ebola in Africa.

BioFire Diagnostics, a Utah-based firm that produces disease detection technology, confirmed that the Dallas Presbyterian Hospital did in fact have one of the machines (possibly for as long as two years) sitting on the shelf when Duncan came in.

Speaking before a congressional panel Thursday, CDC Director Dr. Tom Frieden acknowledged that airport screening for Ebola was extremely limited. He also said that he was open to any strategy to reduce risks to the general population from Ebola. Other witnesses at the hearing said the U.S. is rapidly speeding up the development and deployment of new diagnostic systems.

http://www.defenseone.com/threats/2014/10/dallas-hospital-had-ebola-screening-machine-military-using-africa/96713/?oref=d-mostread

October 16,2014

19:19

We all know or maybe should know by now that Texas did not extend Medicaid and would that have made aimage different in his treatment?  That’s a big question and his nephew wrote a letter explaining such.  As he stated certain drugs were not available and his test took days longer than someone else who had their results in 24 hours.  Also is this why he was initially sent away?  There’s a lot of questions here to be answered, that’s for sure.

We know we have a broken system for sure and will it take Ebola to wake folks up?  His nephew said he was also denied experimental drugs.  This makes a case perhaps of how care is delivered in the US to the poor and those without insurance. 

Sadly It’s Ebola That’s Bringing the US Kicking and Screaming, To Our Knees–We Must Deal With the Real World Solutions, Not Virtual World Values This Time as They Won’t Work…

Now the next part is awful, the family had to hear of his death from the press?  BD 


Thomas Eric Duncan could have been saved. Finally, what is most difficult for us — Thomas Eric’s mother, children and those closest to him — to accept is the fact that our loved one could have been saved. From his botched release from the emergency room to his delayed testing and delayed treatment and the denial of experimental drugs that have been available to every other case of Ebola treated in the U.S., the hospital invited death every step of the way.

When my uncle was first admitted, the hospital told us that an Ebola test would take three to seven days. Miraculously, the deputy who was feared to have Ebola just last week was tested and had results within 24 hours.

The fact is, nine days passed between my uncle’s first ER visit and the day the hospital asked our consent to give him an experimental drug — but despite the hospital’s request they were never able to access these drugs for my uncle. (Editor’s note: Hospital officials have said they started giving Duncan the drug Brincidofovir on October 4.) He died alone. His only medication was a saline drip.

http://crooksandliars.com/2014/10/ebola-victims-nephew-speaks-thomas-eric

18:56

I’m thinking I need to start a new healthcare reality TV show called “Healthcare Data Hoarders.” We’ll go into healthcare institutions (after signing our HIPAA lives away), and take a look through all the data a healthcare organization is storing away.

My guess is that we wouldn’t have to look very far to find some really amazing healthcare data hoarders. The healthcare data hoarding I see happening in comes in two folds: legacy systems and data warehouses.

Legacy Systems – You know the systems I’m talking about. They’re the ones stored under a desk in the back of radiology. The software is no longer being updated. In fact, the software vendor is often not even around anymore. However, for some reason you think you’re going to need the data off that system that’s 30 years old and only one person in your entire organization knows how to access the legacy software. Yes, I realize there are laws that require healthcare organizations to “hoard” data to some extent. However, many of these legacy systems are well past those legal data retention requirements.

Data Warehouses – These come in all shapes and sizes and for this hoarding article let me suggest that an EHR is kind of a data warehouse (yes, I’m using a really broad definition). Much like a physical hoarder, I see a lot of organizations in healthcare that are gathering virtual piles of data for which they have no use and will likely never find a way to use it. Historically, a data warehouse manager’s job is to try and collect, normalize, and aggregate all of the healthcare organizations data into one repository. Yes, the data warehouse manager is really the Chief Healthcare Data Hoarder. Gather and protect and and all data you can find.

While I love the idea that we’re collecting data that can hopefully make healthcare better, just collecting data doesn’t do anything to improve healthcare. In fact, it can often retard efforts to leverage healthcare data to improve health. The problem is that the healthcare data that can be leveraged for good is buried under all of this useless data. It takes so much effort to sift through the junk data that people just stop before they even get started.

Are you collecting data and not doing anything with it? I challenge you to remedy that situation.

Is your healthcare organization a healthcare data hoarder?

6:00

Cuisinart DesignIndustrial designer Marc Harrison suffered a brain injury while sledding when he was 11-years old. The injury and years of rehabilitation would provide Harrison with insight and inspiration for his future work in industrial design.

Harrison would go on to develop the philosophy of Universal Design – the idea that products should be developed for people of all abilities, not just for people of average size, shape, and ability.

Harrison’s study of people with disabilities led to the iconic design of the Cuisinart food processor, a design still relevant today after more than 40 years. The simple, clean design would also come to be a major influence for Steve Jobs in the development of the Macintosh computer.

If you put the original Mac in 1984 side-by-side with an early ’80s Cuisinart, the influence on the physical design of the Mac is immediately obvious. Not only is the Mac designed with software for accessibility and more universal design, but its physical design had this perhaps unknown influence as well. – Dean Karavite

Designing for the “extreme user” vs. the average user results in more innovative designs.

A Podcast for Everyone

Click Image to play the podcast

I learned about Harrison from an exceptional interview with Dean Karavite, a Human Interaction Specialist in Clinical Informatics at Children’s Hospital of Philadelphia. Dean was interviewed by Whitney Quesenbery, co-author of the book, “A Web for Everyone”.

The podcast available on iTunes covers Dean’s work on “Accessible Designs for PHRs”. He discusses healthcare interoperability in layman’s terms, and provides answers to some valuable questions:

The Accessible Designs project seeks to unite accessibility and usability to inform the future development of health IT that will be effective for all users.

POWER USERS

It is important to point out that people with disabilities are not all people in poor health.

People with disabilities use the health care system a lot and in many different ways. –Whitney Quesenbery

Among study participants with various levels of disability, Dean found that people with the highest level of needs – those also with many chronic conditions – were the source of “the most detailed, sophisticated, and innovative ideas on what an accessible PHR should do.”

JUST ASK

Understanding what users want and the problem the application will solve should be the first step in any development process. How does user-centered design firm IDEO find people to interview for needfinding? While it is great to speak with average users, the most interesting interviews come from “extreme users.” This idea of extreme users is also explored in “Just Ask: Integrating Accessibility throughout Design” by Shawn Henry.

As part of our project exploring accessible Personal Health Records, one of the methods we have applied was performing a survey with 150 people with different disabilities. In that survey, we had our participants rate over 20 health topics in two ways.

First, in terms of how important the particular topic was to their health and healthcare, and second, their current level of satisfaction with a particular issue or topic.

The number one, most highly rated issue in terms of importance was the ability to share medical information between different providers’ offices, and hospitals.

The real underlying issue here isn’t just the transfer of data, but care coordination, which is the collaboration, not just communication, but collaboration between multiple healthcare providers. – Dean Karavite interview with Whitney Quesenbery

Assessment of Three PHR Systems

Another part of the “Accessibility Designs” project looked to assess the current state of PHR systems for accessibility, functionality and usability.

Unfortunately, vendors were reluctant to participate.

These results came from systems project team members used to manage their own health including a hospital PHR, an ambulatory PHR, and a consumer PHR.

PHR Assessment

According to the project,  “The hospital PHR was the least functional and least usable, yet was the most accessible. Meanwhile the ambulatory PHR was the most functional and most usable, yet failed to meet basic accessibility standards. The consumer PHR was quite usable despite failing to meet accessibility criteria, and failed one crucial accessibility requirement: the entry of dates by people with visual and/or physical disabilities, a critical action required by almost every task managed by the system.”

Now We All Have It, and We Absolutely Love It

Many of the technologies used today are the result of work used to meet the needs of people with disabilities:

“For example, touch screens, on-screen keyboards with word prediction, zoomable displays, speech recognition, text-to-speech. Think about it. It took about 10 to 15 years, and now we all have it on our computers, our phones and other devices, and we absolutely love it.” – Dean Karavite

Dr. David Do, MD says, “The healthcare industry has much to learn around the design and usability concerns espoused by Silicon Valley.” Whitney Quesenbery suggests,

Get out of your little box and look for inspiration all over the place.

Good ideas can come from anywhere!

Categories: News and Views , All
5:05

From TIME

Based on Facebook and Twitter chatter, it can seem like Ebola is everywhere. Following the first diagnosis of an Ebola case in the United States on Sept. 30, mentions of the virus on Twitter leapt from about 100 per minute to more than 6,000. Cautious health officials have tested potential cases in Newark, Miami Beach and Washington D.C., sparking more worry. Though the patients all tested negative, some people are still tweeting as if the disease is running rampant in these cities. In Iowa the Department of Public Health was forced to issue a statement dispelling social media rumors that Ebola had arrived in the state. Meanwhile there have been a constant stream of posts saying that Ebola can be spread through the air, water, or food, which are all inaccurate claims.

 

Research scientists who study how we communicate on social networks have a name for these people: the “infected.”

Read full story

Categories: All , News and Views
4:06

Here’s yet another one and being a former developer myself I look at all of these such groups andimage realize right up front that developers can’t be serious about this unless they have some other source of income to get involved, it just is what it is.  You can read the press release below.  I think we are reaching the tipping point as well where developers too are starting to see through some of this as gosh knows there’s been enough of them out there.  I call it “Cash for Code” and other big companies such as Verizon have run these as well.   You can innovate your heart out here if you can afford to eat and pay your rent. 

One More “Cash For Code” Innovation Center From Ex United Healthcare Executive
Verizon Latest to Enter “Code for Cash” Prize Format With $1 Million Top Pay Out for Writing Healthcare Apps That Use Their Platform, Is This the New “Corporate Business Model” To Yield Inexpensive Code?

Read between the lines and they want more monitoring apps for folks over 50.  You have a choice of nine categories to where you might want to spend some time and it’s the same old thing with a new cover basically.  We do at 50 dwarf the younger population a we are older and have a lot more data to harvest, that part is correct.  It’s not like there’s a shortage of these types of applications by all means, we have a glut of them actually. 

AARP is always a willing partner as they get paid from United for marketing, link below. 

UnitedHealthGroup and AARP Get Cozier, AARP Still Gets Paid for Marketing Use of AARP Name As AARP Becomes an Optum Labs Data Selling Promoter Amidst Doctor Complaints Received Relative To United Firing of 5500 MDs–Subsidiary Watch

So again another “Cheap Code for Cash” it appears here for all the glory and minimal compensation you may desire to participate for the young folks to figure out how to create some apps for us plus 50 that will collect data and monitor us.  Many folks anymore see most of this up front and are headed for the exits as privacy concerns today are becoming a much greater concern and we know United Healthcare and AARP are both data sellers and make some pretty big dollars doing it as well as being such a strong mentor with CMS over the years with a lot of their quantitated business models.  BD  


SAN MATEO, Calif.--(BUSINESS WIRE)--AARP and UnitedHealthcare, two of the leading organizations in senior advocacy and health care, today announced the launch of “The Longevity Network” to promote innovations in health care that will improve the quality of people’s lives as they age.

“The Longevity Network will help foster innovations across the consumer and health care landscape that will improve the health and well-being of the 50+ population”

AARP and UnitedHealthcare have focused on nine innovation “frontiers” that offer a framework for distinct innovation pipelines so entrepreneurs can focus their attention on these high-need areas. The nine frontiers are: medication management; aging with vitality; vital-sign monitoring; care navigation; emergency detection and response; physical fitness; diet and nutrition; social engagement; and behavioral and emotional health.

The Longevity Network will promote innovation by focusing entrepreneurial attention on these large, high-growth market spaces. The goal is to drive a national dialogue about the longevity economy and ensure everyone driving innovation in this country is asking themselves, “What is our 50+ strategy?”

The Longevity Network will include focused research, success stories and discussion groups, and will regularly publicize significant achievements in this area and the best innovations in each of the nine frontiers. The innovations will be evaluated for recognition based on their potential impact, marketplace viability, business model, originality, quality of design and consumer appeal.

The two organizations unveiled the digital platform, www.longevitynetwork.org, at the 2014 HealthTech Conference in San Mateo. The platform is a central hub where entrepreneurs, advocates and consumers can share information and access ideas, press and other media, social feeds and event invitations about health care innovation for the 50+ community.

Breakthrough technologies, innovative services and disruptive business models are expected to represent $30 billion in cumulative revenue over the next five years and benefit more than 100 million people 50 and older, according to a study from health research firm Parks Associates.

http://www.businesswire.com/news/home/20141015005233/en/AARP-UnitedHealthcare-Launch-%E2%80%9CThe-Longevity-Network%E2%80%9D-Encourage#.VD91v2cUzKc

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