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The hype around wearables is deafening.  I say this from the perspective of someone who saw their application in chronic illness management 15 years ago. Of course, at that time, it was less about wearables and more about sensors in the home, but the concept was the same.

Over the years, we’ve seen growing signs that wearables were going to be all the rage. In 2005, we adopted the moniker ‘Connected Health’ and the slogan, “Bring health care into the day-to-day lives of our patients,” shortly thereafter.  About 18 months ago, we launched Wellocracy, in an effort to educate consumers about the power of self-tracking as a tool for health improvement.  All of this attention to wearables warms my heart.  In fact, Fitbit (the Kleenex of the industry) is rumored to be going public in the near future.

So when the headline, “Here’s Proof that Pricey Fitness Wearables Really Aren’t Worth It,” came through on the Huffington Post this week, I had to click through and see what was going on.  Low and behold this catchy headline was referring to a study by some friends (and very esteemed colleagues) from the University of Pennsylvania, Mitesh Patel and Kevin Volpp.

Continue reading “The Tao of Wearables”

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Don’t get lost amongst the 1,200+ exhibitors that will be fighting for the attention of 38,000 or so health IT professionals at next spring’s HIMSS conference. Make sure your brand is top-of-mind before the attendees descend on Chicago April 12-16.

THCB  understands that exhibiting at HIMSS requires a significant financial and time commitment for participating vendors. Our goal is to help organizations maximize their marketing success by sharing their message with the 6,000 THCB readers who visit our site each day.

HIMSS exhibitors wishing to connect with our highly healthcare-centric audience are encouraged to take advantage of one of our HIMSS Specials.

Our sweet marketing packages include:

  • Unbeatable social media exposure on THCB and Twitter
  • Awesome THCB front page placement (logo, ad unit, guest blog post)
  • Networking access to THCB’s healthcare obsessed audience of 650,000 plus healthcare pros
  • Other slick advantages that will help you stand out during and after the event

A limited number of promotional opportunities remain. Contact Michelle Noteboom for details on  options and to reserve your spot.

Screen Shot 2015-02-22 at 7.23.57 AMBeing provocative isn’t always helpful. Such is the case with Fred Trotter’s recent headline ‒ Why Anthem Was Right Not To Encrypt.

His argument that encryption wasn’t to blame for the largest healthcare data breach in U.S. history is technically correct, but lost in that technical argument is the fact that healthcare organizations are notably lax in their overall security profile. I found this out firsthand last year when I logged onto the network of a 300+ bed hospital about 2,000 miles away from my home office in Phoenix. I used a chrome browser and a single malicious IP address that was provided by Norse. I wrote about the details of that here ‒ Just How Secure Are IT Network In Healthcare? Spoiler‒alert, the answer to that question is not very.

I encourage everyone to read Fred’s article, of course, but the gist of his argument is that technically ‒ data encryption isn’t a simple choice and it has the potential to cause data processing delays. That can be a critical decision when the accessibility of patient records are urgently needed. It’s also a valid point to argue that the Anthem breach should not be blamed on data that was unencrypted, but the healine itself is misleading ‒ at best.

Continue reading “Why Anthem Was Wrong Not to Encrypt”

Mark Smith

Mark Smith, MD, MBA, was the founding CEO of the California HealthCare Foundation; he served in that role for 17 years before stepping down last year. I’ve known Mark since we were residents together at UCSF in the mid-1980s, and both of us were influenced by training at the epicenter of the AIDS epidemic. Mark continues to see AIDS patients at San Francisco General Hospital one day each week. He was the lead author of Best Care at Lower Cost, a major Institute of Medicine report, published in 2012. Mark is one of those rare people who can take complex and politically charged concepts and distill them into sensible nuggets – while managing to be hilarious and profound at the same time.

In the continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Agehere are excerpts of my interview with Mark Smith, conducted on July 24, 2014.

Bob Wachter: Put yourself back about 10 or 15 years ago when you were thinking about the promise of healthcare IT. As you’ve watched the last 15 years play out, what’s been surprising to you?

Mark Smith: As with most of life, it’s a lot harder in fact than in theory. My first hint of this came with the implementation of computerized order entry at Cedars-Sinai in 2002. [In a story I tell in the book, Cedars’ physicians all but threatened to go on strike after they turned on the clunky system. Within a month, they pulled the plug on the system, a hiccup that cost the organization $34 million in 2002 dollars.] That was my first window into the gap between what sounds lovely in a policy paper, and what it means in practice to implement this stuff. Continue reading “Reality-Based Policy and the Digital Doctor: An Interview with Mark Smith”

flying cadeuciiThat’s right…it really happened.

At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”

In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.

My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins.  A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents.  The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.

Continue reading “My Doctor Just Gave Me His Cell Phone Number …”

flying cadeuciiWhile your humble correspondent continues to delight in the emerging science of “mHealth” as a newly minted start-up Chief Medical Officer, he ran across this interesting article on risk and patient safety.

Authors Thomas Lewis and Jeremy Wyatt worry that “apps” can lead to patient harm.

They posit that the likelihood of harm is mainly a function of 1) the nature of the mistake itself (miscalculating a body mass index is far less problematic than miscalculating a drug dose) and 2) its severity (overdosing on a cupcake versus a narcotic).  When you include other “inherent and external variables,” including the display, the user interface, network issues, information storage, informational complexity and the number of patients using it, the risks can grow from a simple case of developer embarrassment to catastrophic patient loss of life.

In response, they propose that app developers think about  this “two dimensional app space” that relies on a risk assessment coupled to a staggered regulation model.  That regulation can range from simple clinical self assessment to a more complex and formal approval process.

Continue reading “Could mHealth Apps Be a Reprise of the EHR? The Need For Clinician Input”

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As if healthcare executives needed more to worry about, the recent hacker attack on Sony Pictures should send yet another reminder that data security can’t be ignored. On an international stage, Sony management learned the hard way that their e-mails, text messages, and private conversations were vulnerable to attack. Hackers accessed everything from the company’s sensitive financial information to its confidential employee communications. In the immediate aftermath of the attack, Sony is facing government inquiries, class action lawsuits from employees and business partners, and a significantly tarnished reputation.

Many executives in our industry might think that healthcare facilities are better prepared to withstand hacker attacks, with numerous government agencies regulating how we store and transmit protected health information (PHI) and personal identifiable information (PII). In reality, a significant number of healthcare facilities have already suffered damaging hacker attacks over the last few years and expectations are that hacker attacks will be a continued threat for the foreseeable future. The question healthcare executives must ask is: “What are we going to do about it?”

Continue reading “Three Lessons Healthcare Executives Can Learn From the Sony Hack”

Optimized-FredTrotterThe Internet is abuzz criticizing Anthem for not encrypting its patient records. Anthem has been hacked, for those not paying attention.

Anthem was right, and the Internet is wrong. Or at least, Anthem should be “presumed innocent” on the issue. More importantly, by creating buzz around this issue, reporters are missing the real story: that multinational hacking forces are targeting large healthcare institutions.

Most lay people, clinicians and apparently, reporters, simply do not understand when encryption is helpful. They presume that encrypted records are always more secure than unencrypted records, which is simplistic and untrue.

Encryption is a mechanism that ensures that data is useless without a key, much in the same way that your car is made useless without a car key. Given this analogy, what has apparently happened to Anthem is the security equivalent to a car-jacking.

When someone uses a gun to threaten a person into handing over both the car and the car keys needed to make that care useless, no one says “well that car manufacturer needs to invest in more secure keys”.

In general, systems that rely on keys to protect assets are useless once the bad guy gets ahold of the keys. Apparently, whoever hacked Anthem was able to crack the system open enough to gain “programmer access”. Without knowing precisely what that means, it is fair to assume that even in a given system implementing “encryption-at-rest”, the programmers have the keys. Typically it is the programmer that hands out the keys.

Most of the time, hackers seek to “go around” encryption. Suggesting that we use more encryption or suggesting that we should use it differently is only useful when “going around it” is not simple. In this case, that is what happened.

Continue reading “Anthem Was Right Not to Encrypt”

flying cadeuciiI’ve been thinking a lot about “big data” and how it is going to affect the practice of medicine.  It’s not really my area of expertise– but here are  a few thoughts on the tricky intersection of data mining and medicine.

First, some background: these days it’s rare to find companies that don’t use data-mining and predictive models to make business decisions. For example, financial firms regularly use analytic models to figure out if an applicant for credit will default; health insurance firms can predict downstream medical utilization based on historic healthcare visits; and the IRS can spot tax fraud by looking for fraudulent patterns in tax returns. The predictive analytic vendors are seeing an explosion of growth: Forbes recently noted that big data hardware/software and services will grow at a compound annual growth rate of 30% through 2018.

Big data isn’t rocket surgery. The key to each of these models is pattern recognition: correlating a particular variable with another and linking variables to a future result. More and better data typically leads to better predictions.

It seems that the unstated, and implicit belief in the world of big data is that when you add more variables and get deeper into the weeds, interpretation improves and the prediction become more accurate. Continue reading “Will Getting More Granular Help Doctors Make Better Decisions?”

flying cadeuciiAt a recent clinical staff meeting, a physician complained that the new requirement that clinicians enter all orders manually into the electronic record (CPOE) is slowing us down and causing errors. The IT and administrative staff were not the least sympathetic. Their message: it’s really not a big deal, it only takes an extra minute or two, and smart people like you should be able to master a simple skill like this. On the way home, I came up with a way to help them better understand: CPOE for management.

I would like to see them forced to use their own version of CPOE: Computer Process for Organizing Errands. Here’s how it would work.Every errand they do requires a computerized planning and documentation process. Whether they were going grocery shopping, out to fill up the tank on their car, buying shoes for their child, or a present for their spouse, here is what they would have to do:

  • Go to their computer and start the Errand Management Resource (EMR).
  • Go to the Schedule Errands tab and open it.
  • Enter each errand (picked from a list of 20,000 possible errands) and link it to a household or family category. Examples might include:
    Continue reading “CPOE For Management”
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