Getting Value from the EHR - Yes it is Possible

I have the privilege of spending a lot of time on the road interacting with clinicians around the country (and world). I hear with too much frequency many doctors complaining about the Electronic Medical Record and how it fails to help them and in many cases makes their work harder. Some of this is a hangover from the past and the inadequate technology and in some cases hardware at the time
In fact I’ve told this story a number of times that I can date to around 1995/6 and in this piece: Clinical documentation in the EHR

Many years ago, an excited friend who worked for one of the electronic health record (EHR) vendors at that time — it was really more of a billing and patient tracking and management system than an EHR — was desperate to show me some of their latest applications. In particular, a new module they had developed to capture clinical data.
My friend pulled out his laptop, fired up the application, selected a patient and proceeded to enter blood pressure (BP). Some 20-plus clicks later, he had entered a BP of 120/80. While he was excited, I was dumbfounded. When it comes to patient care, doctors didn’t have time for 20 clicks to record BP years ago and they definitely don’t have that luxury in today’s demanding medical environment.

There is still some of that going on and not enough focus on the User Interface design and turning the technology into a barrier - this is the focus of the Art of Medicine campaign we launched some weeks ago



This article on Government HealthIT Are electronic health records already too cluttered? highlights a rising problem and one I hear about frequently. This is not just a healthcare problem and it is the focus of the work by Edward Tufte an American statistician and professor emeritus of political science, statistics, and computer science at Yale University who is well known for his books on information design which are bets acquired by attending one of his frequent courses on data visualization
Here is a recent overview of visualization on the iPhone



He has a section on healthcare but many of his principles apply

For Brian Jacobs the problem was even more acute working in a Pediatric ICU:

The ICU is a very toxic and tech-laden environment….because of that, it offers the opportunity to make a lot of mistakes

As he points out much of the cutter derives form the multiple notes entered into the EHR every day. "It’s not uncommon in teaching hospitals to have six to seven notes per day on one patient, by the time the attending physician, residents, consultants, other doctors and fellows check on the patient."
So they instituted a policy of One Note per day

Actually its

It’s actually one note per team per patient per day; one giant multi-contributor note. They still may be all writing their components, but it’s one note

With a template to hold the content generated each morning by the resident and then everyone contributing to that one note, adding and amending as necessary

So in addressing the issue clutter they also addressed usability and design turning the note into a living breathing document that is updated and maintained by the team that now takes care of patients
But he addressed some other important issues - especially when it comes to quality of care and the quality of the medical note

Copy Forward is subject to some warranted scrutiny from a billing and audit standpoint. Much of the repetitive and “clutter” in the note comes form the copying forward of past information. But:

These notes should never be the same

And as part of that message they moved to an "End-of-day note” that was a fresh summary of the patient.
Add to that an updated and well maintained Problem List and integration with the billing system to allow doctors to select their code for the work carried out that day and they moved to a valuable addition to the healthcare team in delivering quality healthcare with their EHR

EHRs are: more complete, legible, accessible and can be auto-populated and searched. They can provide diagnosis codes and they’re good for billing. On the other hand, they can sometimes lack quality information and are by far, too cluttered.

I said this back in 2003 (yikes!) - The Future of Technology is already here - Who’s on Board the train and who’s left at the station. I still believe it and understand that the technology does need to get better and be more integrated into the existing workflow

The next generation of health care technology is here, with visionaries and futurists pushing the envelope to enhance, create and generate the newest cutting edge in health care delivery. Advances in technology, like advances in medicine, are a shared entity that enhances life expectancy and the quality of life.

Technology and Focusing on the Patient

Always enjoying talking with John Lynn (Founder of the HealthcareScene.com (he goes by @techguy and @ehrandhit) and great discussion yesterday on "Technology and Focusing on the Patient" using a Google Hangout

 

 

 

Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman

Brian Klepper

Brian Klepper, Health Care Analyst and TDWI Writers’ Group

Glen Tullman

Recently-fired Allscripts CEO Glen Tullman waxed progressive in a self-promotional Forbes article last week, describing the ways past and forward for electronic health records (EHRs) and health information technology (HIT). It may have been a way of trying to recover from a damning New York Times article that clearly illustrated the relationships between campaign contributions, influence over health information technology policy, and business success.

Tullman recalls building EHRs that moved many physicians away from paper and the errors it fosters. He calls out David C. Kibbe, MD as an example of the forces wanting to preserve paper and opposing EHRs, with quotes from a 2008 blog post suggesting that the current crop are “notoriously expensive,” “difficult to implement” and unable to demonstrate care quality improvements. He predicts that, in the future, the industry will leverage open platforms and interoperability, yielding new monitoring and management utilities that can facilitate better care at lower cost.

Tullman’s forecasts are hardly news, and there are two problems with his portrayals. The first is the dissonance between what he says now and actually did. Tullman became a multi-millionaire crafting products and policy that delivered intentionally costly, unfriendly and incompatible systems. Under his leadership, Allscripts products never embraced a national standard for health information exchange, even though those standards were available, or developed the capacity to seamlessly trade information with other systems.

As a Trustee of the Certification Commission for Health Information Technology (CCHIT), a quasi-governmental credentialing agency and offshoot of the Health Information Management Systems Society (HIMSS), he oversaw policies that favored large, established HIMSS members and set up roadblocks to innovation by technology startups. I testified on this topic to a Health and Human Services (HHS) panel in July, 2009. HHS subsequently rescinded CCHIT’s monopoly on EHR certification, and CCHIT’s Executive Director, Mark Leavitt, resigned shortly afterward.

Tullman’s strong support of and relationship with President Obama facilitated his role as one of the architects of the Meaningful Use (MU) subsidies. Those actions brought billions of dollars to EHR vendors between 2010 and now, but these EHR systems still can’t talk with one another. As I’ve described elsewhere, even while the health IT industry extolled the benefits that would come from easy sharing of health data, they nearly unilaterally resisted interoperability. (If you can’t easily move your data to another vendor’s platform, you’re less likely to make them your vendor.) The result is that our inability to seamlessly exchange health information continues to undermine our ability to coordinate care, costing America thousands of lives and hundreds of billions of dollars a year.

Tullman also paints Kibbe and the American Academy of Family Physicians (AAFP) as obstacles to HIT progress, when in fact it was Tullman and his EHR vendor colleagues who engineered the barriers to interoperability. The quotes by Dr. Kibbe are taken out of context and misrepresent him as an opponent of EHRs. In fact – and Mr. Tullman knows this – Dr. Kibbe has been in the vanguard of EHR use. He was the lead architect of the Continuity of Care Record (CCR) standard, the forerunner of the Consolidated Clinical Document Architecture (CCDA) which has become the standard of choice for MU data structure during health information exchange. When he was Executive Director of the American Academy of Family Physicians’ Center for Health Information Technology (AAFP CHIT), his campaigns resulted in a five-fold increase in the percentage of family physicians with EHRs, from 10 percent to 50 percent between 2003 and 2007. Today, he spearheads DirectTrust, an approach to securely and privately transfer health information by email, independent of platform. If anyone has moved health information generally and EHR technology specifically forward in this country to the common benefit, it is Dr. Kibbe. By contrast, Mr. Tullman has represented the special interest, blocking advances to make as much money as possible.

Physicians, purchasers and patients should take umbrage at Tullman’s article. Along with EPIC, Cerner, NextGen and other old guard EHR vendors, Tullman and Allscripts are directly responsible for most current EHRs’ outrageous costliness, lack of usability and interoperability, and their limited clinical decision support. Through their scale and influence over policy, they have effectively manipulated the EHR market, gouging purchasers and delivering marginally capable products. Health care costs more, and outcomes have suffered as a result.

Most Forbes readers won’t have enough health industry background to place Tullman’s comments into context. They are opportunism masquerading as good policy. Past performance is indicative of what we can expect in the future. Caveat emptor.

Tagged as: Allscripts, CCHIT, CDA, Continuity of Care Record Standard, Electronic Health Record Technology, Glen Tullman, health information technology, HIMSS

via thedoctorweighsin.com

Nice piece responding the the disingenuous quotes and references taken out of context suggesting David Kibbe is against implementation of EHR's. HE like many of us is in favor but has long been an advocate of and vanguard of EHR use

Dr. Kibbe has been in the vanguard of EHR use. He was the lead architect of the Continuity of Care Record (CCR) standard, the forerunner of the Consolidated Clinical Document Architecture (CCDA) which has become the standard of choice for MU data structure during health information exchange. When he was Executive Director of the American Academy of Family Physicians’ Center for Health Information Technology (AAFP CHIT), his campaigns resulted in a five-fold increase in the percentage of family physicians with EHRs, from 10 percent to 50 percent between 2003 and 2007. Today, he spearheads DirectTrust, an approach to securely and privately transfer health information by email, independent of platform. If anyone has moved health information generally and EHR technology specifically forward in this country to the common benefit, it is Dr. Kibbe

Quite! Long standing advocate and unlike many of the commercial interests who spend much time, energy and resources blocking open access.

There remain challenges and the competing interests embedded in commercial incentives but to call out an icon in #HealthIT and unnecessary

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Why Even Radiologists Can Miss A Gorilla Hiding In Plain Sight

Enlarge image i

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn't notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn't notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

This story begins with a group of people who are expert at looking: the professional searchers known as radiologists.

"If you watch radiologists do what they do, [you're] absolutely convinced that they are like superhuman," says Trafton Drew, an attention researcher at Harvard Medical School.

About three years ago, Drew started visiting the dark, cavelike "reading rooms" where radiologists do their work. For hours he would stand watching them, in awe that they could so easily see in the images before them things that to Drew were simply invisible.

"These tiny little nodules that I can't even see when people point to them — they're just in a different world when it comes to finding this very, very hard-to-find thing," Drew says.

 

YouTube

In the Invisible Gorilla study, subjects have to count how many times the people in white shirts pass the basketball. By focusing their attention on the ball, they tend to not notice when a guy in a gorilla suit shows up.

But radiologists still sometimes fail to see important things, and Drew wanted to understand more. Because of his line of work, he was naturally familiar with one of the most famous studies in the field of attention research, the Invisible Gorilla study.

In that groundbreaking study, research subjects are shown a video of two teams of kids — one team wears white; the other wears black — passing two basketballs back and forth between players as they dodge and weave around each other. Before it begins, viewers are told their responsibility is to do one thing and one thing only: count how many times the players wearing white pass the ball to each other.

This task isn't easy. Because the players are constantly moving around, viewers really have to concentrate to count the throws.

Then, about a half-minute into the video, a large man in a gorilla suit walks on screen, directly to the middle of the circle of kids. He stops momentarily in the center of the circle, looks straight ahead, beats his chest, and then casually strolls off the screen.

The kids keep playing, and then the video ends and a series of questions appear, including: "Did you see the gorilla?"

"Sounds ridiculous, right?" says Drew. "There's a gorilla on the screen — of course you're going to see it! But 50 percent of people miss the gorilla."

This is because when you ask someone to perform a challenging task, without realizing it, their attention narrows and blocks out other things. So, often, they literally can't see even a huge, hairy gorilla that appears directly in front of them.

That effect is called "inattentional blindness" — which brings us back to the expert lookers, the radiologists.

Drew wondered if somehow being so well-trained in searching would make them immune to missing large, hairy gorillas. "You might expect that because they're experts, they would notice if something unusual was there," he says.

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they're searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

But they didn't: 83 percent of the radiologists missed it, Drew says.

This wasn't because the eyes of the radiologists didn't happen to fall on the large, angry gorilla. Instead, the problem was in the way their brains had framed what they were doing. They were looking for cancer nodules, not gorillas. "They look right at it, but because they're not looking for a gorilla, they don't see that it's a gorilla," Drew says.

In other words, what we're thinking about — what we're focused on — filters the world around us so aggressively that it literally shapes what we see. So, Drew says, we need to think carefully about the instructions we give to professional searchers like radiologists or people looking for terrorist activity, because what we tell them to look for will in part determine what they see and don't see.

Drew and his co-author Jeremy Wolfe are doing more studies, looking at how to help radiologists see both visually and cognitively the things that hide, sometimes in plain sight.

via npr.org

In a well documented aspect of the human mind and one we have all probably experienced in one form or another:
 

Inattentional Blindness
If you have seen the gorilla video before (there is a whole web site dedicated to this here) and their video

And the original version of this (I think more compelling) can be seen here

So important in so many areas - in the cockpit of airplanes many of the accidents can be traced to failure to identify what may seem clear indications of the fault or problems. The most recent example in the cockpit of air france Flight 447. My favorite detailed report came in Popular Mechanics: What Really Happened Aboard Air France 447 that highlighted the fact the aircraft was in a user induced stall

during its entire 3 minute 30 second descent from 38,000 feet before it hit the ocean surface

Despite multiple warnings from the onboard systems (visual and audible)

In healthcare the same challenges exist and this was aptly demonstrated in this study by Drew who:

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they're searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

83% of radiologists missed it.

A problem when we are asking our radiologists (and doctors) to speed through even more images (and patients in less time)

I suspect technology is going to have to help in catching some of these instances and provide additional backup to the human mind. In fact "Assure" is one example of soem of the steps being taken towards this goal

Posted via email from drnic's posterous

Bitter Pill: Why Medical Bills Are Killing Us

via healthland.time.com

THere is something fundamentally wrong and flawed with a system that bills patients at highly variable rates, the highest to those with no "insurance" or poor "insurance".
Insurance in this instance seems like a poor term to describe a system that even with full standard coverage still costs patients thousands if not tens of thousands of dollars of unexpected cost.

It has gotten worse and as the McKinsey study cited in the article highlights

we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart

There are many drivers but central to them are the disconnect between the payers and the people accessing care. Without any personal accountability it is easy to access the care with no thought of the cost or the possible alternatives and better choices.

Some of the reasons behind this are vested in the history of healthcare and how we got here - but just because that was the way it was done before does not mean it is the way we have to do it now.

There has to be a better way - the same as there has to be a better way of compensating the healthcare providers fairly for the work they do. The system currently is designed to pay for things done not for outcomes and results. And clinicians are locked into a system that forces them to document in great detail, oftentimes repeating information that is already in the medical record - because if they don't they don't get paid
Many wi ll tell you the information is unnecessary and we see some of the effects with reports of duplicate data. So much better to capture decision making, real information and allow the documentation to be the communication tool between clinicians (which was always the original intent) and then determine the care provided and a fair compensation for the hospital, the provider and everyone involved for delivering that care (and importantly linked ot results not to just delivering the care)

I know I am hoping this is on a pathway to getting fixed. At some point I will be facing bills and challenges such as these - and since the education system (thats a whole other blog posting on the meteoric rise of education costs) has essentially stripped me of any savings and value in my one big investment (my house) I like many others are probably tapped out and have little to call upon when we will inevitably face these challenges. That puts me rooting for major change in healthcare, the system with a move to pay for performance much of which is embodied in the ACO initiative.

Posted via email from drnic's posterous

NY Times rewrites Health IT History

The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand.

But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.

While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.

None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.

Mr. Tullman, who left Allscripts late last year after a boardroom power struggle, characterized his activities in Washington as an attempt to educate lawmakers and the administration.

“We really haven’t done any lobbying,” Mr. Tullman said in an interview. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives.”

Between 2008 and 2012, a time of intense lobbying in the area around the passage of the legislation and how the rules for government incentives would be shaped, Mr. Tullman personally made $225,000 in political contributions. While tens of thousands of those dollars went to the Democratic Senatorial Campaign Committee, money was also being sprinkled toward Senator Max Baucus, the Democratic senator from Montana who is chairman of the Senate Finance Committee, and Jay D. Rockefeller, the Democrat from West Virginia who heads the Commerce Committee. Mr. Tullman said his recent personal contributions to various politicians had largely been driven by his interest in supporting President Obama and in seeing his re-election.

Cerner’s lobbying dollars doubled to nearly $400,000 between 2006 and last year, according to the Center for Responsive Politics. While its political action committee contributed a little to some Democrats in 2008, including Senator Baucus, its contributions last year went almost entirely to Republicans, with a large amount going to the Mitt Romney campaign.

Current and former industry executives say that big digital records companies like Cerner, Allscripts and Epic Systems of Verona, Wis., have reaped enormous rewards because of the legislation they pushed for. “Nothing that these companies did in my eyes was spectacular,” said John Gomez, the former head of technology at Allscripts. “They grew as a result of government incentives.”

Executives at smaller records companies say the legislation cemented the established companies’ leading positions in the field, making it difficult for others to break into the business and innovate. Until the 2009 legislation, growth at the leading records firms was steady; since then, it has been explosive. Annual sales growth at Cerner, for instance, has doubled to 20 percent from 10 percent.

“We called it the Sunny von Bülow bill. These companies that should have been dead were being put on machines and kept alive for another few years,” said Jonathan Bush, co-founder of the cloud-based firm Athenahealth and a first cousin to former President George W. Bush. “The biggest players drew this incredible huddle around the rule-makers and the rules are ridiculously favorable to these companies and ridiculously unfavorable to society.”

This industry, which was pioneered in the late 1970s, first gained widespread attention in 2004 when President Bush in his State of the Union speech called for digitizing national health records.

“After that, every technology C.E.O. wanting a piece of health care would have visited me every day if I had let them,” said David Brailer, whom President Bush appointed as the nation’s first health information czar. Over the next few years, Cerner and many of the other health care data companies increased their presence on Capitol Hill.

The records systems sold by the biggest vendors have their fans, who argue that, among other things, the systems ease prescribing medications electronically. But these systems also have many critics, who contend that they can be difficult to use, cannot share patient information with other systems and are sometimes adding hours to the time physicians spend documenting patient care.

“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center, which eight months ago turned on its $160 million digital records system from Epic. Michael Blum, the hospital’s chief medical information officer, said a majority of doctors there like the Epic system.

Whatever the case, the legislation has been a windfall to top executives at the leading health records companies. Neal L. Patterson, who grew up on a farm near Manchester, Okla., population 100, co-founded Cerner in 1979. As Cerner’s sales have soared in recent years, so have Mr. Patterson’s fortunes. From 2007 to 2011, he received more than $21 million in total compensation, according to the executive compensation research firm Equilar, and his stake in the company is worth $1 billion.

In recent years, Mr. Patterson and his wife, Jeanne Lillig-Patterson, who ran as a Republican for Congress in 2004, have emerged as social and business leaders in the Kansas City, Mo., area. Mr. Patterson is also co-owner of a real estate development firm whose ventures include a 1,200-acre community near Kansas City called the Village of Loch Lloyd, featuring a Tom Watson-designed golf course.

A spokeswoman for Cerner said Mr. Patterson was unavailable for comment.

The medical records industry did not have much of a presence in Washington before President Bush highlighted it in 2004. Then in November that year, the industry created its first association, the Healthcare Information and Management Systems Society EHR Vendor Association, to make the case for electronic records. Its founding members included Allscripts, Cerner and Epic.

Four years later, in December 2008, H. Stephen Lieber, chief executive of the group, wrote an open letter to President-elect Obama calling for a minimum government investment of $25 billion to help hospitals and physicians adopt electronic records. The industry ultimately got at least $19 billion in federal and state money.

In the months after that windfall arrived, sales climbed for leading vendors as hospitals and physicians scrambled to buy systems to meet tight timetables to collect the incentive dollars. At Allscripts, Mr. Tullman soon announced what looked like a game-changing deal: the acquisition of another records company, Eclipsys, for $1.3 billion.

“We are at the beginning of what we believe will be the fastest transformation of any industry in U.S. history,” Mr. Tullman said when the deal was announced.

Last spring, some of the Eclipsys board members left after a power struggle; Mr. Tullman left in December. He is now at a company he co-founded that focuses on solar energy — another area that, after Obama administration and Congress expanded government incentives in the 2009 stimulus bill, has been swept by a gold-rush mentality, too.

This article has been revised to reflect the following correction:

Correction: February 20, 2013

An earlier version of this article omitted part of the name of the institution that employs Michael Callaham and Michael Blum. It is the University of California, San Francisco Medical Center, not the San Francisco Medical Center.

via nytimes.com

To use Paul Harvey's line....now here's the rest of the story
Yes the stimulus has increased uptake of technology but in so many respects money well spent - would anyone challenge that our old system of single access paper records that were full of redundant, duplicate information, much of it inaccessible and certainly of limited value to the care of complex clinical conditions and management of patient health....this time borrowoign from Monty Python...if we were lucky

No comment about the significant positive job impact - big increase in healthcare jobs and employment

And as one commentator put it in another thread:

There's a good bit of history rewriting in this article

As they pointed out much of the competitive landscape had been formed prior to the Act and they were delivering profits long before the stimulus package

We are seeing the benefits and value of these technologies. Many forget it was not the government that sent us down this track
1999 - To Err is Human
2001 - Crossing the Quality Chasm
2006 - Preventing Medication Errors
Not to mention other countries who have demonstrated the value of Healthcare Technology.

Is it perfect - probably not but if this was the tipping point to push everyone towards the same goal then it has had the desired effect, and like many technologies, its good for you on its own, but so much better if everyone participates.

I'm excited to be part of this "Tipping Point" and glad to be working with one of the top 50 disruptive companies in this space.

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Yoda's 1st Law Of Health Quality And Performance Improvement

Post a Comment

via statisticalmedievalist.blogspot.com

Great post on the challenges around pay for performance that highlights an interesting fact - Bill Clinton's heart surgeon Dr Craig Smith has some relatively poor outcome measures...not because he has bad outcomes but because his practice takes some of the most high risk patients.
It is hard to take account of these numbers in the performance metrics.

So the next time you see performance or quality criteria - take a step back and dig deeper into the number

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Restyling the Mundane Medical Record Could Improve Health Care

via wired.com

Too good to not follow up to the previous post as another great article on re-workign the medical record (perhaps medical "record" is not a great term?). Personal Health Story/Personal Health History/Personal Health Chronicle...
Whatever we call it this will be is the way our health information will be stored and shared

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Intensive Care Information retrieval system

via icims.com.au

Intensive Care Information retrieval system from our friends down under showing the value of Natural Language Processing to get into the detail of clinical notes, understanding the underlying content. The demo shows the ability to get to information even when there have been typographical errors or use of abbreviations that either have multiple meanings or are not approved/recommended for use.
This technology is now being applied at the point fo clinical data capture ot correct these errors and others and clarify the clinical documentation prior to commitment to the clinical database and Electronic Health Record

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Topol on 5 Devices Physicians Need to Know About

Welcome to this new series, Topol on The Creative Destruction of Medicine, which is named for my new book, The Creative Destruction of Medicine. I'm Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org. In this series I will detail the driving forces behind what I believe is the biggest shakeup in the history of medicine.

What I'll be doing in these segments is outlining the parts of my book that represent the digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. In this segment, I'd like to play the role of Dr. Gizmodo and show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

Let me just run through some of these. This is 2012, obviously, and this is something that we're going to build upon. You're used to wireless devices that can be used for fitness and health, but these are now breaking the medical sphere. One device you may have already noticed turns your smartphone into an electrocardiogram (ECG). The ECG adaptor comes in the form of a case that fits on the back of a smartphone or in a credit card-size version. Both contain 2 sensors. With the first model, you put the smartphone into the case and then pull up the app -- in this case I'm using the AliveCor app -- and put 2 fingers on each of the sensors to set up a circuit for the heart rhythm. Soon you'll see an ECG. What's great about this is you don't just get a cardiogram, which would be like a lead II equivalent; using the "credit card" version, you get all the V-leads across the chest as well. I have found this to be really helpful. It even helped me diagnose an anterior wall myocardial infarction in a passenger on a flight. It was supposed to be a nonstop flight, but, because of my diagnosis, it wound up stopping along the way. As an aside, after the passenger was taken off the plane to get reperfusion catheter-based therapy at a hospital, the pilots and flight attendants all wanted to have their cardiograms checked.

The second device I will show you is another adaptation of the smartphone, but this one is for measuring blood glucose. Obviously we do that now with finger-sticks, but the whole idea is to get away from finger-sticks. I'm wearing a sensor right now that can be worn on the arm. It also can be worn on the abdomen. What's nice about this is that I can just turn on my phone, and every minute I get an update of my blood glucose right on the opening screen of the phone. It's a really nice tool, because then I can look at the trends over the course of 3, 6, 12, or even 24 hours. It plays a big behavioral modification type of a role, because when you're looking at your phone, as you would be for checking email or surfing the Web, you also are integrating what you eat and your activity with how your glucose responds. This is going to be very helpful for patients -- not only those with diabetes, but also those who are at risk for diabetes, have metabolic syndrome, or are considered to be in the prediabetic state.

The third device I'd like to talk about is another device from the cardiovascular arena that comes in the form of an adhesive patch. It's called the iRhythm, and I tried this out on myself. It's really a neat device, because the results are sent by mail to the patient. You put it on your chest for 2 weeks, and then you mail it back. It's the Netflix equivalent of a cardiovascular exam. The company then sends the patient 2 weeks' worth of heart rhythm detection. I think it's a far better, practical way, as compared to the Holter monitor wireless device. It's not as time-continuous as the ECG or glucose device, but it's in that spectrum.

I want to now explain a fourth device, which I use on my iPad. This device allows physicians the ability to monitor patients in the intensive care unit on their iPads. I use it to monitor patients at the Scripps ICU. You can use it for any ICU that allows for the electronic transmission of data. Right now, I'm monitoring 4 patients simultaneously. You can change the field to monitor up to 8 patients simultaneously. This is a great way to monitor patients in the ICU because you can do it remotely and from anywhere in the world where you have access to the Web. This is just to give you a sense of what this innovative software sensor can do to change the face of medicine.

Finally, I wanted to describe is something that I've become reliant upon, and that's this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven't used a stethoscope for over 2 years to listen to a patient's heart. What's really striking about this is that it's a real stethoscope. "Scope" means look into. "Steth" is the chest. And so now I carry this in my pocket, and it's just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I'm sharing their image on the Vscan while I'm acquiring it and it only takes about a minute. We validated its usefulness in an Annals of Internal Medicine paper, in July 2011,^[1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation.

These are just a few of the gadgets that give you a feel for the innovative, transformative, and really radical changes that will be seen going forward in medicine. Thanks for watching this segment. We'll be back soon with more on The Creative Destruction of Medicine. Until next time, I'm Dr. Eric Topol.

via medscape.com

I am excited to be talking with Dr Eric Topol on Friday and hope you will be able to join me. To help prepare you for the conversation and the breadth of areas that Dr Topol covers I am posting his vide presentations from Medscape that provide quick intros to different areas. This one looks at 5 devices that will change the future of Medicine.

Smartphone as an ECG

Stickless Glucometers for Continuous Monitoring

The NetFlix Cardiovascular exam - worn for 2 weeks and mailed for Review

Mobile ICU Monitoring

The Mobile Ultrasound

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Turning the smartphone from a telephone into a tricorder

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Earlier this year, well known cardiologist Eric Topol published his highly successful book, “The Creative Destruction of Medicine.” In it he describes several examples where smartphones, particularly the iPhone, have been morphed into first-rate medical devices with the potential to put clinical-level diagnostics in the hands of everyday users. Coincidentally, Topol was on a flight not long ago, returning from a lecture where he had spoken about a new device made by AliveCor. The pilot intoned an urgent, “is there a doctor on board?” In response, Topol took out the AliveCor prototype, recorded a highly accurate electrocardiogram (ECG) of an ailing passenger, and made a quick diagnosis from 35,000 feet.

As the leader in the smartphone revolution, the iPhone has been the platform of choice for early adopters in the health and quantified self arenas. Even so, there are a few shortcomings to development on the iPhone which, at least among DIYers, has led to Android becoming the path forward. Apple’s single-vendor solution and sequestering of many low-level input/output details behind the premise of ease of use have made interfacing the device to external sensors both a difficult and expensive proposition.

While it can be nearly impossible to write an Android app that will work on every device out there, writing an app to work on one’s own smartphone or tablet is fairly straightforward. Another challenge to the smartphone as a medical device is that many important sensor variables are analog in nature. It is possible to use the analog-to-digital converter on the audio input for data acquisition, however in the absence of sophisticated multiplexing one is limited to a single channel (unless some kind of expansion device is used).

Run tracking and calorie counting apps can certainly be regarded among the successes of the smartphone, but without dedicated sensor hardware, the philosophy of “there’s an app for that” only goes so far. A host of products now available for Android let users with a little bit of technical know-how create powerful devices previously found only in the domain of hospitals and law enforcement. One of the most successful expansion boards that allows Android devices to control external instruments and to orchestrate the collection of a variety of sensor data is the IOIO board. The system works well in wireless mode with most Bluetooth dongles, and its on-board FPGA gives 25 I/O channels, including plenty for analog input. It also handles analog output via pulse width modulation (PWM).

Vendors like Sparkfun, a popular supplier for the Arduino developer market, have realized the power inherent in readily programmable smartphones. They provide inexpensive heart monitors, as well as CO² gas, dissolved oxygen, and blood alcohol content (BAC) sensors. These sellers provide documentation and, most importantly, access to the source code. With this information, interfacing with a BAC sensor, for example, is relatively straightforward and, if appropriately calibrated by the user, very accurate.

MK802 Android PC

USB stick computers running Android 4.0 (Ice Cream Sandwich) or newer, like the MK802, readily connect to boards like the IOIO, and can take the cost out of dedicating a phone or tablet to a sensor. They can log data to any of several storage mediums and cut a nice form factor when keyboards and displays are shed.

Despite the advances, a few ugly details in the smartphone-based health field are no longer capable of being ignored. The FDA will be increasingly faced with the task of deciding when a phone or tablet becomes a medical device that needs to be regulated as such, and when it is simply the front end for another device. Manufacturers of products for the seemingly straightforward task of monitoring glucose or insulin will have to tread carefully. Others seeking to enhance the absorption of medications through the skin by opening transient microchannels with current or ultrasound, perhaps built into a smartwatch, even more so.

In just a few years children wearing smart devices could become the norm. These gadgets could monitor variables like ambient peanut allergen using nanopore immunosensors with processing power to spare for forming dynamic early warning networks as conditions indicate. Without an efficient governance dispensing timely permission to use devices like the AlivecCor in humans, the initiation of life-saving care may too often begin with hardware designed and approved only for our pets. But if our regulatory structure organizes on the side of opening technological advancement, the future of these medical gadgets will be bright.

Now read: X Prize offers $10 million for a real-life Star Trek medical tricorder

Tagged In

• android
• tablets
• ios
• medicine
• smartphone
• fpga
• mhealth
• sensor
• FDA
• MK802
• AliveCor
• quantified self

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via extremetech.com

The X-Prize amanged ot jump start the commercial space program and has taken the same principles to medicine offering $10 million to create a real world Star Trek Tricorder
We are closer than you think

Alive Cor has the ECG monitor

Calorie and Activity Trackers (multiple but my personal favorite FitBit)

Glucose Monitoring for Diabetics, and

recently continuous vital sign monitoring

There are standards out there - notably the Continua Alliance

Exciting times as we add increasing functionality and capabilities to these devices and tremendous opportunities for engaging patients in the continuous management of their health.

I will be discussing this and related topics with my guest @EricTopol on my >a href="http://www.healthcarenowradio.com/programs/voice-of-the-doctor/">Nov 16 Voice of the Doctor Show

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Visualizing an e-Patient’s Medical Life History

via e-patients.net

What a great post from Katie McCurdy on the new age of medicine and the fact that the medical record needs to be more than single points of data recorded when we stop by a healthcare facility or clinical office.

Katie comes at this as an interaction designer so is able to create a coherent and easy to digest record which might be harder for others. But as she rightly points out

a patient-generated timeline, if that artifact makes the storytelling process easier for the patient & more coherent for the doctor, it adds a lot of value even if the doctor doesn’t want to take time to carefully analyze it.

Agreed - and as many of the e-Patients have demonstrated capturing and understanding data is helpful in the successful management of their care. And importantly as Edward Tufte has demonstrated repeatedly clear presentation of data is the key to understanding.

Doctors may not have the time to assemble the record in these formats and while there is a challenge presentation of multiple formats the process of capturing and documenting alone is valuable and likely to lead better understanding for the patient and the clinical care team.

What a great resource to have an engaged e-Patient who has a background in interaction design working on a project like this.

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Burning Health IT Issues - Discussion with John Lynn

Video interview wiht John Lynne (@Techguy and @EHRandHIT) on topics ranging from EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs (originally posted here):

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November Voice of the Doctor Guests

An exciting month for Voice of the Doctor with the following guests appearing

November 2: Terri Mitchell, MSN RN
Director, Clinical Informatics Solutions at Nuance Communications 

We will be talking about The Healthcare Data Imperative and the challenge of capturing Healthcare data and the importance of capturing information at the point of care when the information is fresh in the mind and the value this brings to affecting a postive change in healthcare quality outcomes and appropriate reimbursement. We will discuss the need to focus on real time vs retrospective analysis and how this can be achieved in our new digital world of electronic medical records and the value of patient engagement as part of this process.

 

November 9: Dr Ashish Jha, MD
The C. Boyden Gray Associate Professor of Health Policy and Management at the Harvard School of Public Health and blogs at An Ounce of Evidence

 

He wrote this piece:  Asking the Wrong Questions About the Electronic Health Record that was a response to the article posted recently on the Wall Street Journal: A Major Glitch for Digitized Health-Care Records that stated:

Now, a comprehensive evaluation of the scientific literature has confirmed what many researchers suspected: The savings claimed by government agencies and vendors of health IT are little more than hype.

And was subject to many active discussions on several of the listservs. Dr Ashish Jha and I will be discussing some of the fundamental issues of our broken system and the challenges faced in our archaic paper based system which most can agree do nothing to empower clincians to provide excellent care. Technology on its own cannot provide all the answers but must be part of a broader based solution.

The problem is that some Health IT boosters over-hyped EHRs.  They argued that simply installing EHRs will transform healthcare, improve quality, save money, solve the national debt crisis, and bring about world peace.  We are shocked to discover it hasn’t happened – and it won’t in the current healthcare system.

 We need to leverage the potential by asking and answering other related questions

• How do we create incentives in the marketplace that reward physicians who are high quality?
• How do we allow physicians to capture efficiency gains?
• What to do about fee for service - are ACO's the answer?
• How does technology play an effective part in this transformation

As Dr Jha said:

The debate over whether we should have EHRs is over.  Can we fix our broken healthcare system without a robust electronic health information infrastructure? We can’t.  Instead of re-litigating that, we need to spend the next five years figuring out how to use EHRs to help us solve the big problems in healthcare.

Should be a great discussion

And to close out November I am excited to announce that I will be joined by Dr Eric Topol, MD

November 16, Dr Eric Topol, MD
Professor of Genomics at The Scripps Research Institute
Follow him on twitter @EricTopol

He is also the author of
The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care and has named in the list of the Top 100 Most Influential Physician Executive in Healthcare, 2012 by Modern Healthcare

If you have not read the book, you should. You can read the First Chapter here: The Digital Landscape: Cultivating a Data-Driven, Participatory Culture to get a taste for the wide open opportunites many of which are here and even more coming in the very near future. With so many topics to choose from:

• The Current state of medicine and the challenges
• Individualized medicine vs Group Thinking
• Patient Engagement and the power of mobile Health technology
• The Genome and Sequencing (Dr Topol recently had his genome sequenced - one of an expanding number of people to do so):

We've got our genomes sequenced, now zooming in on them bit.ly/OWh6eW @illumina w/ @gholsonlyon @bradpatay

— Eric Topol (@EricTopol) October 22, 2012

And Posted some initial analysis with a 99c App!

 

So many topics and so little time. Focusing on the current challenges in Alzheimer's treatment makes much of this come into focus. A recent story on NPR: Treatment For Alzheimer's Should Start Years Before Disease Sets In raises one of the big challenges in this disease....How do we know if we need to commence treatment for a disease. It seems unlikley that any preventative treatment can be given to everyone so identyfying those at risk will become a major focus in the coming years. As Dr Topol noted in his book and in many of his presentations and discussions on the effectiveness of Plavix varies based on presentation of the genotype CYP2C19. This was subject to an extensive debate and included this posting on the Topolog posting An important miscue in clopidogrel pharmacogenomics and in a perfect example of the use of technology and engagement this videoif this works here otherwise download a verion here)

 

Since November 23 is the day after Thanksgiving we will have a re-run on November 23 and Nov 30 from a previous shows

Hope you can join me 

 

 

Join me on Friday at 2:30 ET on VoiceoftheDoctor

There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#

• HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk.

 

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Adding Voice Recognition To Mobile EHRs

via informationweek.com

The new world of Mobile Healthcare will include an integral component in efficiency - the power of he clinicians voice. Cerner and Epic are

The new mobile-native electronic health records (EHRs) systems of Epic and Cerner are being voice-enabled via recent deals with Nuance Communications

Not only easy access to the world's leading speech recognition platform but as Joe Petro (SVP for R&D at Nuance) puts it:

it's form-factor neutral and can be used with iOS, Android, or other mobile or desktop devices, as well as thick- and thin-client systems

Great news for the mobile platform making these devices as productive as they can be

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Will Nuance's Nina Do What Apple's Siri Won't? - Forbes

A series of  Forbes Insights profiles of thought leaders changing the business landscape: Gary Clayton, Chief Creative Officer, Nuance

Apple’s Siri iPhone voice-based App interface has forever changed consumer expectations of how to interact with their computing devices.  But Nuance’s Nina may represent an even bigger transformation—the consumerization of IT.  Nuance has over 10,000 employees, $1.4 billion in revenue in FY ‘11, $7.65 billion market cap company, headquartered in Burlington, Massachusetts and is best known for its Dragon Naturally Speaking voice recognition software. They just might be the biggest, most successful company you never heard of before. They describe themselves as “focused on developing the most human, natural intuitive ways to use your voice to take command of information.”

Gary Clayton, Chief Creative Officer, Nuance

Locu Seeks to Unlock the Power of the Mobile Web for Local Businesses

Bruce Rogers Forbes Staff

Will Wences Casares's Lemon.com Replace Your Wallet?

Bruce Rogers Forbes Staff

Lars Albright's SessionM is a Game Changer for Mobile Apps and Ads

Bruce Rogers Forbes Staff

Ujjwal Gupta's BenchPrep Poised to Revolutionize the Education Market

Bruce Rogers Forbes Staff

Siri is cool.  But Nina may represent a true leap forward in man-machine learning and artificial intelligence. I recently spoke with Gary Clayton, Nuance’s Chief Creative Officer about his role in bringing Nina to life and his thoughts on how Nina is already bringing a welcome change into how businesses put the tool he helped to create to work to better serve their customers.  He’s the guy responsible for turning some of the world’s most sophisticated software algorithms and artificial intelligence into engaging and user-friendly interfaces.  He also oversees innovation, strategy and design at Nuance.  “I wear a lot of hats,” said the understated Clayton.

The major innovation behind Nina is its capability to retain context over time.  People can interact with Nina, the virtual assistant for customer service apps, and carry on a complex set of instructions within the same conversation flow.  Its artificial intelligence learns and anticipates the user’s interests and requests over time—using natural language understanding.  For example: a person can ask Nina what their checking account balance is, then a person can ask Nina to show them the charges over $200 and then for the month of August, or one could go through the bill paying process by simply stating “I would like to pay the balance on my cable bill on Friday from my savings account.” Humans communicate through context, not through complex, detailed step-by-step instructions that have always been the hallmark of human to computer interaction.

Imagine calling your insurance company and having a pleasant and successful interaction with an always friendly voice.  No more yelling and swearing into the phone “Operator”!!  Nina can also interact across devices and applications, so that customers can choose to connect by voice, mobile device or web page or any combination and still retain the context of the interaction.  In fact, one such enlightened financial services company USAA, is implementing Nina to create a better customer experience.  “USAA is extraordinarily responsive to their customers; one of the very best in their field and represent a gold standard in managing the customer experience,” said Clayton.

“People like to anthropomorphize technology,” stated Clayton. He knows it’s a basic human need to understand and control the world around us. Nina is one expression of meeting that need. That’s what drives Clayton in what he calls his never-ending quest to understand the creativity behind science and art. He started his quest as a physics undergrad at SUNY and later ventured to San Francisco for interdisciplinary studies and eventually earned his BA in communication from San Francisco StateUniversity.  He sees creativity as the synthesis of art and science.

This led to a fascinating career path that began with the explosion of Silicon Valley technology drawing the film business toNorthern California. There, Francis Ford Coppola, George Lucas and others set up shop. Clayton worked with all of them but most notably Lucas and his Skywalker Ranch studios inMarin County,California, where he engineered sound recordings, which included the first recordings at Skywalker Sound with the San Francisco Ballet Orchestra.  He founded and ran his own multi-media production company from 1985 to 2000 and worked on many Academy Award winning films, Grammy winning albums and Emmy winning TV shows. There he worked on projects with Michael Jackson, Dave Brubeck, The Cure, Brian Eno, David Bowie, Mel Torme, Sam Shepard, David Byrne, Norman Mailer, Apple Computer (Knowledge Navigator,Newton) and many others. After a succession of consulting projects at Pacific Bell and a start-up gig at TellMe, (acquired by Microsoft for a reported $800 million in 2007) he spent time at Yahoo where he headed up their speech strategy.  From there he landed at Nuance in 2008.  Clayton is the owner of eight patents and is considered one of the leaders in the digital speech recognition movement.

As one of the key developers of the Dragon Go! and Nina product lines, he is helping to push Nuance into the forefront of turning mobile device personal assistants into personal advisers.  His vision of the synthesis of art and science may be a never-ending process, but his work on Nina just may be the full fruition of a lifetime of trying.

 

via forbes.com

Imagine that - a User friendly EMR interface that uses the power of your voice and a natural exchange to navigate and interact with. The long term memory (or retaining of context) offers a more natural and engaging exchange

The major innovation behind Nina is its capability to retain context over time. People can interact with Nina, the virtual assistant for customer service apps, and carry on a complex set of instructions within the same conversation flow.

The example cited is for your banking exchange but imagine this in healthcare
"Nina show me my patients for today"
"What are the latest laboratory results for Mr Jones"
"Are there any new results on my patients marked abnormal"

You get the picture

Changing the interaction with technology, especially in the mobile world but also in every human/computer interface shielding the user from the complexity of the technology by providing an easy conversational speech front end.

I can hear Scotty now..."a keyboard...how quaint"

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Doctors Using Electronic Health Records Provide Higher Quality Healthcare | Government Health IT

The use of electronic health records is linked to significantly higher quality care, according to a new study by Lisa Kern and her team, from the Health Information Technology Evaluation Collaborative in the US. Their work appears online in the Journal of General Internal Medicine, published by Springer.

Electronic health records (EHRs) have become a priority in the US, with federal incentives for 'meaningful' use of EHRs. Meaningful use entails tracking and improving specific patient outcomes, as well as gathering and storing information.

Kern and colleagues examined the effect of EHRs on ambulatory care quality in a community-based setting, by comparing the performance of physicians using either EHRs or paper records. They assessed performance on nine specific quality measures for a total of 466 primary care physicians with 74,618 patients, from private practices in the Hudson Valley region of New York.

The quality measures included: eye exams, hemoglobin testing, cholesterol testing, renal function testing for patients with diabetes, colorectal cancer screening, chlamydia screening, breast cancer screening, testing for children with sore throat, and treatment for children with upper respiratory infections.

Approximately half of the physicians studied used EHRs, while the others used paper records. Overall, physicians using EHRs provided higher rates of needed care than physicians using paper, and for four measures in particular: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.

The specific quality measures included in this study are highly relevant to national discussions. Of the seven quality measures expected to be affected by EHRs, all seven are included as clinical quality measures in the federal meaningful use program. There has been little evidence previously that using EHRs actually improves quality for these measures.

This study took place in a community with multiple payers. This is in contrast to integrated delivery systems, such as Kaiser Permanente, Geisinger, and the Veterans Administration, all of which have seen quality improvements with the implementation of health information technology. Most health care is delivered in “open” rather than integrated systems, thus increasing the potential generalizability of this study.

The authors conclude: "We found that EHR use is associated with higher quality ambulatory care in a multi-payer community with concerted efforts to support EHR implementation. In contrast to several recent national and statewide studies, which found no effect of EHR use, this study's finding is consistent with national efforts to promote meaningful use of EHRs."

Study: Kern LM et al (2012). Electronic health records and ambulatory quality of care. Journal of General Internal Medicine; DOI 10.1007/s11606-012-2237-8

 

Brian Ahier works as Health IT Evangelist for Information Systems at Mid-Columbia Medical Center. He is a City Councilor in The Dalles, Oregon and also serves on the Board of Mid-Columbia Council of Government, and Q-Life, an intergovernmental agency providing broadband capacity to the area. He blogs regularly at Healthcare Technology & Government 2.0.

via govhealthit.com

There's been a lot of coverage recently suggesting the Meaningful Use incentive program has failed to deliver value, EHR's have actually induced more cost in healthcare and EHRs have decreased quality of healthcare....
But as Brian Ahier rightly points out there is evidence that supports the value proposition
This study demonstrated value in a typical community setting with multiple players and found real positive impact delivering higher quality care measured by specific measures such as screening and testing for chronic diseases

We found that EHR use is associated with higher quality ambulatory care in a multi-payer community with concerted efforts to support EHR implementation. In contrast to several recent national and statewide studies, which found no effect of EHR use, this study's finding is consistent with national efforts to promote meaningful use of EHRs

Expect more studies that will demonstrate the value

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The Terrifying State of "Unaccountable" Healthcare

via online.wsj.com

The latest book exposing the healthcare system and how broken it is from Dr Makary a surgeon from Johns Hopkins. As he says

Meet 'Shrek,' a doctor who insists on surgery in every case—and has a surgical-incision infection rate of 20%.

and more troubling

He quotes a recent Hopkins survey of employees of 60 high-quality hospitals, where more than half of the respondents said they would not feel comfortable receiving care in the unit in which they work

He makes the case for flat rate payment that removes the incentive for steering care to individual specialties devoid of any decision making that is for the benefit of the patient.

Take pancreatic cancer, half of Dr. Makary's practice at Hopkins. With only a 15% cure rate, surgery is the only hope. But if the cancer is inoperable, patients may be offered chemo and radiation, which confer minimal benefit and yet make money for doctors and hospitals

There are detractors to this and without incentive there is a corresponding decline in efficiency so finding a balance between these two competing ideals seems necessary

Looks like another book to add to the reading list

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