Screen Shot 2015-04-17 at 7.59.18 PMAlthough this March marked the fifth anniversary of passage of the Affordable Care Act many of its promises to place patients at the center of care remain elusive. No where is this more evident than in the law’s provision to improve shared decision making.

Oftentimes there is more than one reasonable medical treatment to choose from. Shared decision making helps patients partner with health care providers to make more informed decisions about treatments based on patients’ personal beliefs and values and their informed understanding of their medical choices. Frequently, patients are simply told what course of treatment they are to undergo without considering alternatives.

A well-accepted path towards aligning patients’ preferences with medical care is to use decision aids. These tools include written educational materials, informed face-to face encounters, or videos with instructional images that explore different options for care by providing the risks and benefits of interventions and their alternatives, exploring individual values and preferences, and offering testimonials from other patients who have experienced the various choices.

It is an astounding fact that after five years the Centers for Medicare and Medicaid Services (CMS) has certified only a single decision aid. Even in a city infamous for bureaucracy, this is inefficient at best – especially given that the overwhelming number of studies demonstrate that decision aids align medical care with what patients want, while also saving the health care system billions of dollars.

Continue reading “Five Years of Failing Patients”

Dale Sanders

In 2005, Northwestern Memorial Healthcare embarked upon a strategic Enterprise Data Warehousing (EDW) initiative with the Microsoft technology platform as the foundation. Dale Sanders was CIO at Northwestern and led the development of Northwestern’s Microsoft-based EDW. At that time, Microsoft as an EDW platform was not en vogue and there were many who doubted the success of the Northwestern project. While other organizations were spending millions of dollars and years developing EDW’s and analytics on other platforms, Northwestern achieved great and rapid value at a fraction of the cost of the more typical technology platforms. Now, there are more healthcare data warehouses built around Microsoft products than any other vendor. The risky bet on Microsoft in 2005 paid off.

Date: Wednesday, April 22, 2015 | DETAILS and SIGN UP

Time: 1:00–2:00 PM ET

Ten years ago, critics didn’t believe that Microsoft could scale in the second generation of relational data warehouses, but they did. More recently, many of these same pundits have criticized Microsoft for missing the technology wave du jour in cloud offerings, mobile technology, and big data. But, once again, Microsoft has been quietly reengineering its culture and products, and as a result, they now offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare.

Continue reading “Microsoft: The Waking Giant In Healthcare Analytics and Big Data”

new adrian gropperI mean: Last chance for patients as first-class citizens in Meaningful Use.

The ghetto is abuzz. As I write this #nomuwithoutme  is just hitting Twitter. The reason the natives are restless in the patient ghetto is a recent proposal  by our Federal regulators to downgrade a Meaningful Use (MU) requirement for Stage 3, in the final stage of a $30B + initiative to advance interoperable digital health records. The focus is on something called View / Download / Transmit (V/D/T) but the real issue and the Last Chance is broader and more important. The bad news is that MU may leave patients as beggars for own data. The good news is that the Office of the National Coordinator (ONC)  and Congress are paying attention and patients still have a chance to shift the terms of the debate to what HIPAA calls “the patient’s right of access” and demand that it apply strictly to MU Stage 3 Appication Programming Interfaces (API).

To find the core of the downgrade, search the Notice of Proposed Rulemaking NPRM  for the word “download”. To experience the ghetto first-hand, search the NPRM for “4 business days”. The issue is plain: patients are to get degraded, delayed information through a “portal” that forces us to take whatever the “providers” are willing to grant us.

Continue reading “Last Chance for Meaningful Use”

Screen Shot 2015-04-14 at 3.50.49 PM

The Designer’s Oath brings together designers from disparate disciplines and backgrounds to create collaborative Oaths that speak across design practices and organizations. The traditional boundaries of design are quickly expanding, and our code of ethics needs to be as flexible and easy to redefine as the process of design itself. The Designer’s Oath must become a tool that is applied to the process of design to ensure that the end result does good.

Continue reading “Designing For Good: A Designer’s Hippocratic Oath”

Screen Shot 2015-03-23 at 8.02.41 AMIt’s done.  Congress on April 14 passed and the president signed into law a bill that terminates one of the most egregious and silliest examples of dysfunctional government in recent years—the so-called “sustainable growth rate” (SGR) formula for doctors’ fees under Medicare.

A previous blog explained the background and protracted lead-up to this moment.

Now what?

First, a round of applause for bipartisan agreement—however obvious it was that had to happen in this case.   The vote in the house was 392-37.  In the Senate, it was 92-8.

Praise is also in order for enacting two more years of funding for the Children’s Health Insurance Program and $7.2 billion in new funding over two years for community health centers, a program that was expanded under the Affordable Care Act and serves low-income families.  There’s also welcome help for low-income Medicare beneficiaries and rural hospitals.

But the main thrust of the law is to kill one (failed) program that adjusted doctors’ fees under Medicare and create a new and hopefully better one.

Continue reading “The Big Fix. Medicare Doc Pay Enters a New Era”

Susannah Fox Cite Me!

Two years ago, I interrupted a speaker at a big health/tech conference, right in the middle of his presentation. I still blush at the memory. But the speaker was citing data — my data—incorrectly and I couldn’t let it pass.

Brian Dolan recently wrote about how he wished he’d spoken up when he heard someone spreading misinformation at a conference:

Unfortunately, about 80 people sitting in the room either accepted this as new information or failed to stand up to correct the speaker. I wish I had pulled a Susannah Fox and done the latter.

He linked to my 2012 post about what happened at Stanford Medicine X.

In that post I asked:

  • What style of conference is the right one for the health/tech field? The TED-style “sage on stage” who does not take questions? Or the scientific-meeting style of engaged debate? Or is there a place for both?
  • Do different rules apply to start-ups? Is it OK to fudge a little bit to make a good point, as one might do in a pitch? Personally, I do not think people are entitled to their own facts. There’s too much at stake.

We can’t let misinformation—or worse—go by without comment.

I think it’s time for more people to speak up in health care.

More pediatricians should express their measles outrage.

More people should chronicle the reality of living with chronic conditions.

More people wearing medical devices should demand access to the data being collected.

More people should speak up about medical errors before—and after—they happen.

Continue reading “Time For a Stand Against Misinformation”

flying cadeucii“Drinking single malt has stopped me from developing flu” – Anecdote (& Business Opportunity)

“Everyone should drink single malt based on my experience. It stops flu” – Advice

“You are talking baloney” – Paternalism

“Everyone is entitled to opine what saves them from flu” – Freedom and Choice

“We need science to determine efficacy of single malt “- Elitism

“Burden of proof is on he who asserts the benefit of single malt” – Epistemology

“We need evidence before third parties can pay for single malt” – Value-based healthcare

Continue reading “The Anecdote-Innovation Cycle”

Screen Shot 2015-04-16 at 10.00.20 AMWhat a difference a few years makes. It wasn’t long ago that healthcare CIOs declared they would never use smartphones for caregiver communication. Now, with smartphones proliferating throughout the nation’s hospitals as an effective clinical communication solution, many vendors are adding smartphone options to their product lines. If you’re attending HIMSS15 in Chicago this week, you will undoubtedly see traditional communication vendors touting the benefits of their brand-new smartphone offerings.

The good news: It’s fairly easy to build a smartphone app using current development technologies. The bad news: It’s not so easy to build a solid smartphone platform that’s reliable in the healthcare environment and scalable enterprise-wide.

While vendors may present their smartphone solutions as tried and true, many have only a portion of their advertised functionality deployed in a real healthcare environment. And many of those deployments are small, one-unit pilot projects that haven’t been tested site-wide. As you assess the mobile communication solutions presented at HIMSS, take the time to ask probing questions to determine which vendor, products and services are right for your facility.

Continue reading “The 3 S’s of Smartphone Shopping”

flying cadeuciiJust a few years ago, you would have had to scour the show floor to find a startup exhibiting at the HIMSS Annual Conference. But, for the first time this year, they will have a major presence at this show that gathers more than 37,000 health IT professionals and innovators who are developing next-generation technologies. In fact, more than 200 startups will be on the floor at the inaugural Hx360 event taking place at the conference in Chicago– demonstrating the perceived ripening of the industry for disruption and the rising expectations of entrepreneurs and the investors supporting their efforts.

Drawing these innovators like the Sirens from the Odyssey is the newly empowered and often under informed consumer with their high deductible and array of chronic diseases. Healthcare provider organizations, payers and pharmacies must adapt to them and view them as actual customers not untapped wells overflowing with potential CPT codes. Now, more than ever, the industry needs to focus on quality experiences and good clinical outcomes for patients – and many startups are developing new approaches and technologies to tackle these issues. In order to make these new approaches a reality sooner rather than later, larger industry players need to understand the dynamic landscape, and work with and invest in these emerging companies.  Incumbents with their large feet planted squarely on the traditional solid ground are sensing some seismic rumblings and how well they are leveraging and embracing these emerging companies to help maintain their balance may determine whether they can sustain themselves moving forward. Continue reading “Emerging Healthcare Innovation Space Needs Serious Investors, Herd Thinning”

Michelle Noteboom: Give me a bit of background on Medicomp and what Medicomp does.

Dave Lareau:Medicomp was founded by Peter Goltra in 1978 and the main mission since its founding was to present relevant clinical information to the physician at the point-of-care so they can document and treat the patient. That’s really the core of what we do. We work with 15 to 20 physicians, most of them board certified in internal medicine, as well their specialty. We have a fairly expansive knowledge editing system, where the physicians work with our knowledge engineers.

So, if you’re thinking about asthma, what are the relevant symptoms, history, physical exam, test, diagnosis, and therapies? If somebody presents with left upper quadrant abdominal pain and nausea and vomiting, what would you be thinking of, and what would you want to document, what kind of test do you want order, what’s your presumptive diagnosis? At the point-of-care we can present the relevant information for documentation given the clinician’s thought process so that we don’t slow them down, we don’t get in their way, let them see more patients. They get all their documentation done and it’s all coded to all the standards. The ICD-9 or 10, as well as LOINC, RxNorm, etc. is in the background, but they’re dealing with something that is fast and familiar. That’s what we do. Continue reading “HIMSS 2015: Medicomp’s Dave Lareau”


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