Tuesday, January 28, 2014

Vaccines Don't Cause Autism - Vaccinate your Kids

It can be frustrating to be a clinician in the era of the internet and instantaneous availability of data especially when the reliability and accuracy is variable. But this is the world we live in and there is plenty of data showing that patients are accessing information in ever increasing numbers. The challenge has been helping patients filter the data for both relevance and accuracy.
Vaccination has been at the epicenter of a these challenges for some years - in fact long before the wide spread use of the internet thanks to a piece published in The Lancet in 1998  and unusually retracted. In fact the BMJ published a paper in 2011 declaring the paper fraudulent - as they noted in the discussion the lead author (now stripped of his medical degree and academic credentials) was clearly actively perpetrating the fraud
Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Moreover, although the scale of the GMC’s 217 day hearing precluded additional charges focused directly on the fraud, the panel found him guilty of dishonesty concerning the study’s admissions criteria, its funding by the Legal Aid Board, and his statements about it afterwards
Sadly despite repeated studies and investigations. Despite the retraction of the original article by the Lancet. Despite the other authors personally retracting the paper we still hear about a “link”. Sadly some high profile individuals continue to perpetrate the fraud (notably the model Jenny McCarthy and most recently the “reporter” Katie Couric).
I saw the posting by Aaron Carroll MD, MS is a Professor of Pediatrics and Assistant Dean for Research Mentoring at Indiana University School of Medicine (the Incidental Economist) last week when he posted this map of the real effects of this in Vaccine Preventable Outbreaks (click on the map button on the left if necessary)
In fact Dan Munro posted his own take on this piece: Big Data Crushes Anti-Vaccination Movement. As he sadly notes
Add a well known celebrity (or two) and the effects can be powerful, long term and hard to refute.
 And ss Dr Carroll notes the impact can be seen in the chart above:
  • All of that red, which seems to dominate? It’s measles. It’s even peeking through in the United States, and it’s smothering the United Kingdom.
  • If you get rid of the measles, you can start to see mumps. Again, crushing the UK and popping up in the US.
  • Both measles and mumps are part of the MMR vaccine.
  • Almost all the whooping cough is in the United States.
But the best part of this post is his accompanying video - included below - well worth watching the full 8 minutes
Expertly and accurately put.
Vaccinate your kids….please.

Monday, January 27, 2014

Security, Security, #Security.....Encrypt your Drives by Default #HIT #hcsm #privacy

I was reminded of there Jerry Maguire movie clip when I read the latest in a long line of security breach stories - this one emanating from Canada where this group is in hot water over a massive 620,000 patient data breach…taking 4 months to notify authorities. Apparently Canada does not have a national Breach notification rule like the US and the public “Wall of Shame"
Canada does not have a federal health data breach notification requirement. But the Canadian provinces have their own rules, including some that mandate notification. Under Alberta's Health Information Act, which was enacted in 2001, the reporting of health data breaches is voluntary, privacy experts say.
 They might want to change that...

In this latest release Medicentres Family Health Care Clinics, a 27-clinic medical group in Western Canada had an unencrypted clinic laptop stolen from one of the clinic's IT consultants.
The laptop contained 620,000 patient names, dates of birth, health card numbers, medical diagnoses and billing codes, officials said.
Here in the US the chart of complaints is depressing

How many more data breaches will we see before everyone understands the need to pay close attention to security.
Encrypting your hard drives for all machines that contain patient information and demanding all staff and consultants and anyone that has access to patient data encrypts their drive and data would have prevented this.

Wednesday, January 22, 2014

Integrating Clinical Documentation Improvement into the Doctors Workflow

We know doctors are under an ever increasing load may eventually break their backs..if nothing else its increasing the overall pain

In a recent study of physician attitudes toward clinical documentation technology and processes clinicians the majority of clinicians said they would be more responsive to Clinical Documentation Improvement (CDI) clarifications if they were delivered in real-time within their normal documentation workflow in the electronic health record (EHR). They report being "disrupted" by queries for additional information
after they’ve documented in a patient chart or worse, after the patient is discharged.  All believe that ICD-10 will make matters much worse
With #HealthIT a growing portion of how doctors do their jobs they want to be involved in technology decisions yet most were not involved in clinical documentation technology decisions for their organization. And timing is everything - going back to answer questions after you have left the patient or worse after the patient has left "the building".

So what is the difference between success and failure of a CDI program

As the study points out physicians’ growing dissatisfaction in being
saddled with processes that distract them from clinical care, while being excluded from the decision-making process of choosing things that impact them every day
Technology should be simple and work for physicians and the key to changing the experience is to eliminate rework
Rework in clinical documentation is the enemy of efficiency
As Brian Yeaman, MD CMIO for Norman Regional Health System puts it
Using things like CLU and applying that to the ICD-10 code book to help me refine that diagnosis or ask me whether it’s the left or right or an upper or lower extremity are tremendous because it has a significant impact on our bottom line, and it’s also a physician satisfier … and on the back side we are not getting so many coding queries

And Reid Conant, MD President and CEO of Conant and Associates says
“Now we can provide our physicians with tools to get real-time feedback to not only change that document, but also change their behavior for the next document. That’s what organizations are looking for, and frankly, that’s what the doctors are looking for.”

We can achieve ICD10 compliance without breaking the back of clinicians

Tuesday, January 14, 2014

Are you "Under Observation"

This is not news for many in the healthcare profession as they face the challenges of billing rules and regulations and the sometimes obscure idiosyncrasy - but as you can see form this piece on NBC for many patients this is a surprise and a costly one at that

Visit NBCNews.com for breaking news, world news, and news about the economy

Hospitals are told that they "have to" use this status (Under Observation) if the patient doesn't meet a host of criteria for "Admission" all being driven by a series of guidelines that are publicly available although not well known and much of it in response to the RAC audits
All this is set to get worse with the “Two Midnight” rule (you can see some guidance here and some of the issues on this here)

Friday, January 10, 2014

Just what the Doctor Offered #NLP #artofmedicine #hcr #HealthIT #hcsm

This piece in Wired Natural Language Tech and Medicine: Just What the Doctor Ordered by our very own Joe Petro (SVP of Engineering) as he puts it
Somethings gotta give!
Yes it does. Healthcare and in particular doctors are juggling far too many changes
And like the picture of Aaron Gregg who achieved the world record of the most catches of chainsaws in 2008 (88 btw) doctors are doing their best to keep up but they are reaching their limits. We continue to ask doctors to do more with less, their focus is forced further away from the physician-patient interaction.
Technology can help and Natural Language Processing is transforming how consumers interact with technology in a more conversational, natural way. And in Healthcare we have taken this approach and applied it calling it Clinical Language Understanding (CLU) and importantly will allow physicians to get back to the Art of Medicine
Amongst other things we can:
  • Simplify Interactions with the EHR
  • Balance the Need for Patient Narrative and Structured Data
  • Increase Documentation Specificity in Real-Time
Much like NLU has helped drive intelligent, natural interactions between consumers and technology, CLU will help re-humanize healthcare. By enabling physicians to focus on the patient, not the technology, providers can begin to embrace a next-generation approach to healthcare that will drive efficient, intelligent clinical decisions that impact each and every facet of patient care.
It’s an exciting time with CLU and NLP as a critical enabler in helping doctors be more productivity in the new digital era of healthcare and maintain focus on what matters most: patient care.