HIMSS15 The Year of DigitalHealth, Interoperability and Security

HIMSS is finally upon us and like the 20,000+ people heading Chicago there is a lot to take in, many options and far too much for any one person to see or catch up with. So what do you do?

First off - download the HIMSS Mobile APP that now comes with GPS intelligence which hopefully will start to provide keen insights into activities and opportunities that are nearby as you move around Chicago, the convention center and beyond

Download and print (I know not very environmentally friendly but there is a lot to absorb) the HIMSS Conference Guide (72 Pages) - or if you are feeling really clever send it to you iDevice, Pocket, Kindle or some other reading device

Or use the online version of the HIMSS of the guide - here

For the physician centric guide - head on over to this living breathing dynamic Google Document - put together by Wen Dombrowski (@HealthcareWen)

For the HIT Centric Guide from John Lynn (@TechGuy)

For the latest and greatest news be sure to follow the #HIMSS15 hashtag, and others linked to the conference including #DrHIT

And your best option for keeping up with the latest and greatest from Symplur tracking system on #HIMSS15 and that page features additional topics and tags worth following and tracking

And of course follow your Social Media (#SoMe) Ambassadors can all be found in this list on twitter

Speech and the Digital healthcare Revolution at #SpeechTek

Come join me in the conversation with my colleagues at the SpeechTek 2014 conference in Marriott Hotel in Time Square, Manhattan New York.

The Panel: C103 – PANEL: The Digital Healthcare Revolution at 1:15 p.m - 2:00 p.m. The panel moderator Bruce Pollock, Vice-President, Strategic Growth and Planning at West Interactive and on Social Media @brucepollock

I will be joined by Daniel Padgett, Director, Voice User Experience at Walgreens and on Social Media at @d_padgett and David Claiborn, Director of Service Experience Innovation at United Health Group.

We will be discussing the opportunities and challenges associated with the current digital healthcare revolution and of course how speech plays an essential role in integrating this technology while maintaining the human component of medicine that we all want. Rather than Neglecting the patient in the era of health IT and EMR

We have progressed from the world of Sir Lancelot Spratt


And the Doctor need to look at the patient not the technology perhaps in a cooperative Digital Health world like this

Is this future of Virtual Assistant Interaction good, desirable

Demo Video 140422 from Geppetto Avatars on Vimeo.

We will be discussing

• What are the biggest obstacles to digital healthcare becoming a reality?
• Where do speech technologies bring the most value to healthcare?
• How will health providers, insurers, and payers provide patient support in the world of digital healthcare?

Perhaps the emerging Glass concepts improve this interaction as they are exploring in Seattle

Join us for analysis of the state of digital healthcare today and predictions for its future.

In the end

People forget what you said and what you did but they remember how you made them feel

Come join the discussion as we explore the digital technology and how it should be used in healthcare and how speech can help

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.

21 Bow Tie Salute to Farzad Mostashari

Like many in the healthcare IT industry, I was saddened by the announcement that Dr Farzad Mostashari (@Farzad_ONC) would be retiring. I would suggest as famed football legend Vince Lombardi said

"The strength of the group is the strength of the leaders"

And, for healthcare technology, Dr. Mostashari has been a great leader. I’ve outlined below some of the many contributions he has made to healthcare.

Dr. Mostashari joined the Office of the National Coordinator (ONC) in 2009, and has had a huge and positive impact on the implementation, development and overall perception of healthcare IT.  Personally impacted by the state of healthcare when his mother was admitted for arrhythmias, after having asked for the paper chart, he admitted;

I couldn’t even read the cardiology consult’s name

Perhaps this is one of the reasons he like me is a proud member of Regina Holliday (@ReginaHolliday) "Walking Gallery". This difficult, and highly personal, situation likely galvanized his vision as he took on the daunting tasks demanded by the role of the ONC. He inherited a department that had, in effect, been pushed over the edge of the luge and, whilst speeding wildly along this track, was expected steer a course that would deliver on a range of programs in record time:

• Meaningful Use of Electronic Health Records (EHR)
• Certification program for EHRs
• National Standards
• Grant programs
• Regional Extension Centers

And that was just what he knew about coming in. The team endured the challenges, weathered the storm in the "Office of No Christmas"

He rapidly earned a reputation as a leader who listened and was engaged.  He made many appearances and, although he may not have been the first, he was certainly an early adopter of social media and online engagement – clear indicators of his heartfelt passion to be part of the solution. As a customer service representative I recently encountered very astutely pointed out:

I can't do anything about the past, but I can help improve the future

Successes

It is hard to pick individual highlights from such an impressive record, but here's my list of Dr. Mostashari’s top 13 achievements and quotable/notable moments from his time in office:

1. Successfully delivering on the Stage 1 Meaningful Use, despite frustrations and the challenges of a fickle and change-resistant healthcare profession.  He gracefully offered a personal hand to help steer his colleagues:
   "Meaningful use is the best-we-could-make-it roadmap to prepare for delivery of higher quality care and mitigating some of the costs toward getting there, if it's a distraction we need to change it, and I want to hear from you personally."
2. Creating a viable technical assistance program that has touched many providers and hospitals through regional extension centers (REC).
3. Driving the successful adoption of electronic health records (EHRs) and electronic medical records (EMRs).
4. Interoperability (see note below on focus for the future)
5. Pushing for patient empowerment (He, like me, is a proud owner and runway model for the Regina Holliday Healthcare Collection).
6. As he said: "We’re on the right track to make meaningful use of meaningful use" 
7. ePrescribing
8. And as if to prove the point about his use of social media, this from his twitter feed: “We've made more progress with EHRs in the past 2 years then we have in 20"   
9. Championing the patient engagement he stated: "We cannot have it be profitable to hoard patient information"
10. Nailing the coffin shut on paper he said: "Once you close a paper file it's dead. You’re not able to move it or learn from it"
11. While this may not be his own personal quote but he applied cyberpunk science fiction, William F. Gibson famous quote to healthcare: “The future is already here – it’s just not evenly distributed.” by pointing out that we do have the technology - its just not being applied
12. Piloting Meaningful Use stage 2 criteria, which built on the success of stage 1, and pushed towards interoperability including standards for data sharing data, quality improvement, and quality measures that foster  patent engagement. As he put it: "We are using every lever at our disposal to increase the sharing of information" and "Patients need to care for themselves and become partners in their care"
13. Successfully weathering the storm of the controversial (or as he put it "headline grabbing") Health Affairs article based on data from 2008 that suggested that EHR technology was increasing the costs of healthcare.

The Future:

To the lucky individual taking the reins, I offer five suggested  areas of focus:

2. A friend once said to me: "You've put us on the horse, you might as well give us the ride." The same can be said of payment reform, which must shift from quantity-based to quality-based payment. And taking a sheet from Dr Mostashari's play book, every journey starts with a single, small action, so even a small dent would be a welcome shift.

1. Continue the engaged and inclusive discussion with all the constituents and make social media a central part of that strategy both for ONC but also for the healthcare industry.
2. A friend once said to me: "You've put us on the horse, you might as well give us the ride" The same can be said of payment reform, which must shift from quantity-based to quality-based payment. And taking a sheet from Dr Mostashari's play book, every journey starts with a single, small action, so even a small dent would be a welcome shift.
3. I must include a shout out for patient engagement. Nowhere else in the industry will you find such a large and untapped resource that is ready, willing – but perhaps not yet able to participate in the change. As I have stated many times:  when a doctor and patient are in a room, there is nobody, I repeat nobody, more interested in successful outcomes than the patient. Give them the tools and make them part of the solution.
4. Occasionally, the issue of Tort and Medical Negligence is raised, but it appears to have the "third rail" syndrome. Unless this is addressed, we will continue to see "defensive medicine" practiced. As I recently blogged in Science, Evidence and Clinical Practice, despite clear data that shows intensive monitoring causes more harm in normal care deliveries, we continue to see almost universal rates of this high-level monitoring.  While some may be attributable to the payment system, I believe a large part of this volume stems from the general inertia of and fear of litigation.
5. Above all - have fun. I made this point at every soccer practice when I was a coach. If you aren't having fun, there is little incentive to do well or, for that matter, to do at all. I know I am constantly amazed at the great fortune that finds me at this intersection of medicine and technology. I constantly have that feeling as if I paddled for the wave just at the right time:

"Surf's Up dude - ten foot waves of the Pier"

The Making of the 21 Bow Tie Salute

Dr Farzad Mostashari has been an incredible role model, a source of inspiration and a true visionary who has helped others see what the future of healthcare can look like. And so, in extreme appreciation of all that he has accomplished, I offer this 21 Bow Tie Salute.  

I was fortunate enough to have another wonderful role model, my father, take the time to teach me how to tie a bow tie, but for those of you wanting to learn the fine craft of tying a bow tie, instructions are included below (The 21 Bow Tie Salute was made with Real Bow Ties). 

Thanks Dad!

Here are some basic instructions:

News and sources include:

Healthcare IT News

ONC

News Round Up - July 20

Some interesting news pieces to review this week including

The Value of the EHR

"The Relationship Between Electronic Health Records and Malpractice Claims,” from the Archives of Internal Medicine on Jun 25 and featured in the AMED News: "EHR use linked to fewer medical liability claims" on July 16

A research letter published online June 25 in Archives of Internal Medicine found that the rate of liability claims when EHRs were used was one-sixth the rate when EHRs were not used. Researchers say their findings suggest there was a reduction in errors associated with EHR use.

That showed the following results before and after an EHR implementation:



A word about correlation and the fact this does not imply causality: …correlation between two variables does not automatically imply that one causes the other

But as the authors put it:

It’s entirely possible that there’s something still distinct and unusual about practices that adopted electronic health records earlier, and they just happen to practice in a way that reduces their risk of malpractice claims….But I think it’s equally plausible that there’s something about electronic health records that does reduce their risk.

Uncertain but an interesting positive development

High Price Variability in US Hospital Surgical Procedures

Calprig published a report "Your Price May Vary" that offered a view into the wide differences in pricing for the same procedure in California. For example for a knee replacement from $59,800 (Alameda County Medical Center) to $164,400 (Washington Hospital). But the variation doe snot necessarily track quality adn they pointed to an earlier study in the Archives of Internal Medicine that showed county hospitals usually charge the least and for-profit hospitals charge the most and did an an interesting analysis of the hierarchical model for percentage increase in median charge for various patient and hospital factors:


And the charges for Appendicitis:

The median hospital charge among all patients was $33,611, with a lowest observed charge of $1529 and highest of $182,955

Personal Health Records

This review of Kaiser's myHealthManager: Lab tests and knowing our numbers can inspire patient engagement:

Engaging patents and sharing laboratory data helping them understand their results can inspire patent engagement. As they put it it is not enough to share the data you have to engage with the patient:

That means patients need to knowing their numbers: what they mean, and how changing them can impact their future quality and length of life… where personal behavior change has the potential to do this

This is the start of patient engagement and one that I think we will see increase in the coming months and years

This and more on #VoiceoftheDr



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

Voice of the Doctor - July Part 2

July Voice of the Doctor Guests

Jul 13
Talking to Don Rosenthal (You can follow him on twitter @DonRosenthal) part of the original team that developed the scheduling system for the Hubble Space Telescope and ran the artificial intelligence group at NASA. HE is also the founder and CTO of Allocade and publishes a blog THITSE A Mashup of Tech, Healthcare IT, and Space Exploration
He published a two part blog on HiTech answer on Medical Records Interoperability: My medical data should move with me as easily as my music or photo library and Part 2 where he threw down the "latex" gauntlet to the #HealthIT industry in creating interoperability that was as easy as sharing my music and photos libraries <--I could not agree more with his points and these articles are worth digesting to get a good understating of the barriers we all face to sharing medical data effectively and creating truly interoperable healthcare.

We will be talking about Artificial Intelligence in Healthcare and how we can bring this technology to the complex world of medicine.

Will AI really make a difference to healthcare or is it still a mirage on the horizon of innovation
Can AI replace the clinicians consultation and review and should it
What can we learn from AI implantation from NASA and space exploration where time and distance have significant impact on the need for autonomous intelligence.

Jul 20
Monthly news round up - more opportunity to dive into the latest news and activities. THere has been lots of follow up commentary and discussion on the ruling and we will cover this as well as the most recent #HealthIT #HITsm #hcsm #HIT #EMR #CMIO #doctors #mHealth news


Jul 27
I am looking forward to talking with Gregg Masters (You can follow him on twitter @2healthguru). He is the CEO of Xantamedia and a well recognized voice and Top Players in the Social Media world. I had the privilege of meeting Gregg a while back in person and have enjoyed reading his posts and thoughts.

He and I exchanged tweets shortly after the #SCOTUS #ACA ruling was announced after I posted a link to this: Health-care leaders: Ruling no cure for spiraling costs which for me was an interesting take on the challenges that talked about the fragmented nature of the healthcare system and a general agreement that it's broken:

"We all agree, I think, that the current fee-for-service model has all the wrong incentives in it," said Swedish Medical Center CEO Kevin Brown. "The health-care system has been really fragmented, with independent entities all working for their own best interests."

I liked the concept they talked about where:

Insurers and providers have worked together, rejiggering the typical payment model to shift incentives toward keeping people healthy instead of just running up bills when they're sick.

Which reminded me of the ancient practice of paying the doctor in your village while you were healthy, only stopping paying him when you fell ill (I know simplistic but quite compelling). They did say that

The Affordable Care Act, which relies on private insurance, for the most part doesn't directly address costs.

And while it represents a start (every journey begins with a step) there are still holes (tort and medical liability to mention a couple). Gregg responded and suggested that:

innovation will come via margins aka CMMI. Private market ACOs & direct practice models galloping ahead

We had a series of exchanges and I suggested that instead of the 140 character exchange he come on my radio show to discuss and he graciously agreed. Much as I did pre the release of the ruling, when I had the pleasure of talking with Sam Bierstock on March 30, we started with tentatively opposing views but in reality our opinions were not widely different. You can hear download that show here

I'm looking forward to a lively and informative discussion and by then will have had an extra 2 weeks to diets more of the details of the ruling and its potential effects.

Hope you can join me on #Voice of the Doctor


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