Dale SandersMatthew Holt: I’m talking with one of the most interesting people in healthcare, Dale Sanders who these days is the Senior Vice President for Strategy for Health Catalyst, a really fast growing data warehousing analytics company. Dale, before that, did a bunch of stuff in the Air Force, at Intermountain, was involved with starting the Health Data Warehouse Association, and even for a while running the National Health IT System in Cayman Islands

Anyway we’re here to chat about some work that Health Catalyst is doing, that you guys have been doing these webinars, very successful ones, a few months and years. You actually had a big conference last year, which you’re repeating again this year, I know, but specifically coming up on April 22nd 1 – 2 PM PST is a webinar about Microsoft.

So let me tell you my Microsoft story from HIMSS last week I was in one of the last sessions in Thursday, actually, and it was a guy named Dave Francis talking about the future of consumer health. Someone said, “I am a Microsoft guy. I work for Microsoft. They send me out to health systems and I help in dealing with technical issues. You’re talking about the future of online consumer health. The Google Health guys, they had that thing, it failed. We have Healthvault, we failed and close it down. Oh no, we didn’t officially close it, so I’m not supposed to say that, but anyway”. So that’s the kind of way people think about Microsoft and healthcare. But you’re saying not so fast. So what’s the story here?

Dale Sanders: Yeah, it’s very interesting. In this webinar, I spend the first few minutes talking about my life on Microsoft. So I’ve been an IT now for 32 years, starting out in the Air Force and now in Health Catalyst. So I put this timeline together and I put all these significant events in my life that had some relationship to some event in Microsoft. Most of the time, it’s like horrible, right? I want to poke my eyes out. My Microsoft experience as a healthcare IT guy or just an IT guy in general has been terrible, right? Security problems, backwards compatibility problems, scalability problems. But now I’m very bullish in Microsoft, so it’s kind of unusual that I’ve completely turned my opinion

Matthew Holt: Perhaps because they’re no more the evil monopoly, they’re David vs Goliath?

Dale Sanders: Yeah. Really, it’s fascinating. This webinar is about their cultural transformation as much as it is their technical transformation. It’s fascinating, and I was never a big fan of Bill Gates, never a big fan of Steve Ballmer. They’re just contrary personalities to me.

Matthew Holt: They may care less about what you think.

Continue reading “Why Microsoft May Be the One to Watch”

flying cadeuciiI had a HIMSS 2015 hallucination.

Walking through the crowded exhibit halls of the premier health information technology trade show, the Prophet Isaiah’s vision of beating swords into plowshares and the lion lying down with the lamb suddenly unfolded before my eyes. Even if we were in McCormick Place in Chicago, not the Temple Mount in Jerusalem. (Although we were on an upper level.)

There ahead of me, the maker of the A-10 Thunderbolt “tank buster” dwelled in a booth a few steps from a maker of fasteners for tractor engines: sword and plowshare. Elsewhere, the PAC-3 missile manufacturer contentedly cohabitated with a company that sells baby strollers: lion and lamb.

However, what prompted this copacetic condition was not a prophet, but profits. As tens of billions of dollars pour into digital technology to improve the efficiency and effectiveness of U.S. health care, companies large and small all want a cut.

“Swords into plowshares” at HIMSS 2015?

Total U.S. spending on health care is closing in on a staggering $3 trillion.Entrepreneurs from everywhere in the economy are making a pilgrimage to this sector. Venture capital funding in health IT roared to $4.7 billion in 2014, according to the Mercom Capital Group, more than double the $2.2 billion in 2013. Small wonder that more than 42,000 attendees flocked to HIMSS this year, a jump of some 10,000 from as recently as 2011.

Here’s where we come to the part about world peace. The U.S. health care system is by no means the only one needing modernization and rationalization. Several years ago, HIMSS issued awhite paper examining electronic health records from a global perspective. The group now boasts regional offices and puts on events in Europe and Asia. As global capital markets recognize the potential of health IT, it’s not too much to hope that individuals of all religions, races and nationalities can come together in search of the “new, new thing,” the next big deal and the large pot of cash that comes with both.

Ideology is one thing, but, as the saying goes, business is business. Co-existence fostered by capitalism.

Admittedly, this isn’t quite what Isaiah had in mind. Still, if a prominent Middle Eastern country decides to switch from centrifuges to Software As a Service, I’ll be looking for the Iranian booth at HIMSS next year.


flying cadeuciiIt’s taken me two days to recover from 3-1/2 days of HIMSS15 and I wonder how the other 43,138 attendees are faring. Actually I am pretty confident that few people escaped Chicago without swollen feet and exhausted minds and bodies.

The convention is a mammoth event that offers a little something for everyone, whether you are interested in policy, technology, education, networking, buying, or selling. Some folks, including Greg Rakas of epatientfinder, believes the event is almost too big and overwhelming. In Greg’s words, “We have the most professional people and vendors in all of medicine there resorting to magicians and games of chance to lure people in. I found that to be a little disappointing and pandering.”

Others, like Houston Johnson, CEO of Practice Insight, were quite satisfied with the overall experience.  “We met with many of our partners and that’s really why we come here,” Johnson shared. “It gives us a chance to talk to our existing resellers and meet new resellers.”

The exhibit hall – which supposedly measures 22 football fields – creates a bit of a sensory overload. While walking the floor with a friend of mine, he remarked that it’s a bit like New York City with all the big crowds and flashing lights. Over 1,000 exhibitors pay thousands of dollars for the opportunity to draw the attention to their offerings, hence the magicians, late afternoon cocktail receptions, and iPad, Apple Watch, and GoPro giveaways.

Continue reading “HIMSS15 Wrap up”

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”

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”


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