Month: February 2015

Health is Life

Feb 5, 2015• 7

By ALEXANDRA DRANE

We’ve all experienced the crushing agony of a heartbreak, or the deep foundational stress of worrying about how you’ll pay all your bills, or the isolating and bleak reality of a mum or dad or loved one whose health is failing in a way you can’t figure out how to stop – or fix. Life is hard. Now – how hard is all relative … but for most of us, our days are consumed on some level with a pretty significant level of worry. Did you overextend when you bought that house? Is so-and-so gunning for your job? Is it wrong that you secretly and deeply resent your partner because you’re sick of them “never doing anything”?

And how about the real worries – will you have food, electricity, heat, clothing, safety…the worries that consume more people than any of us would care to imagine (The Shriver Report has 1 out of 3 women living ‘on the brink’ – in other words, right smack dab in this reality). For fun – let’s try an exercise marriage counselors use for marriages that are in trouble…they have each of you sit down and write on a piece of paper what matters to you, and what you think matters to your partner. Then they compare the two. And what do you think stands out in stark testament to the current state of the relationship? Pretty much zero overlap. You don’t understand what matters to me, and I don’t understand what matters to you.

Let’s extend that analogy to the healthcare space…picture a typical day for many of us in the health communication space, for example. How are we spending our days? Dreaming up new and more imaginative ways to lecture about the importance of getting a colon cancer screening, or eating well, or taking your blood pressure medication, or getting in for your annual Medicare wellness visit, or or or…

And a question for those of us working on this stuff. If you turned all that passion and intensity you bring with you to work, and to the task of telling others how to live in a way that complies with HEDIS this or STAR that or [insert any other traditional health quality metric here]…if you turned that lens on yourself – how are you doing? Do you eat the way you should? How’s your weight? Do you sleep the recommended 7 to 8 hours of sleep a night? How are you on your preventive screenings – are you up to date? Did you exercise at all in the last week?

I’d bet the answer to all those questions is “no”. Continue reading…

How the Advent of Propofol Changed the Meaning of the term “Sedation”

Feb 4, 2015• 1

By KAREN SIBERT, MD

“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!”

We were in the preoperative area of my hospital, where my patient – brightly alert, with a colorful headband and bright red lipstick – was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, and she needed skin grafts to cover the open wounds. She had a long list of cardiac and other health problems.

This would be a painful procedure, and there would be no way to numb the areas well enough to do the surgery under local anesthesia alone. My job was to figure out the best combination of anesthesia medications to get her safely through her surgery. Her daughter was convinced that a little sedation would be enough. I wasn’t so sure.

“Were you asleep the last time your doctor worked on your legs?” I asked the patient. “Oh, yes,” she said. “Completely asleep.”

“But she didn’t have general,” the daughter interrupted. “She just had twilight.”

Health IT: Glass Half Empty? Half Full? Shattered?

Feb 4, 2015• 5

By JACK COCHRAN, MD and CHARLES KENNEY

Technology occupies an unusual place in health care. Some people say that electronic health records are clumsy barriers between patients and their doctors. Others suggest that technology is a kind of secret sauce.

In many places physicians and other clinicians are stymied by awkward technology. In other organizations — Kaiser Permanente included — electronic health records enable some of the finest individual and population health care ever.

This humorous equation speaks volumes about technology and health care:

NT + OO = COO

New technology + old organization = Costly old organization. In other words, technology doesn’t change an organization. Change is about leadership and culture. It is about thinking in new ways and asking new questions.

For example, rather than ask how many patients can you see, let’s ask how many patients’ problems can you solve?

Instead of asking how can we convince patients to get required prevention, let’s ask how can we create systems that significantly increase the likelihood that patients get required prevention?

Instead of asking how often should a physician see a patient to optimally monitor a condition, let’s ask what is the best way to optimally monitor a condition?

When we begin asking these kinds of questions, we see technology as a tool — not a solution by itself, but as a powerful tool we can use to deliver better individual and population care. Technology, like data, is only useful when it enables clinicians and teams to work effectively to provide the highest quality care for patients.

Hospitals and physician groups throughout the country are installing and working with electronic health records at a rapid pace. Some organizations integrate the systems beautifully, others do not.

Privacy and Security and the Internet of Things

Feb 3, 2015• 7

By DAVID HARLOW

In the future, everything will be connected.

That future is almost here.

Over a year ago, the Federal Trade Commission held an Internet of Thingsworkshop and it has finally issued a report summarizing comments and recommendations that came out of that conclave.

As in the case of the HITECH Act’s attempt to increase public confidence in electronic health records by ramping up privacy and security protections for health data, the IoT report — and an accompanying publication with recommendations to industry regarding taking a risk-based approach to development, adhering to industry best practices (encryption, authentication, etc.) — seeks to increase the public’s confidence, but is doing it the FTC way: no actual rules, just guidance that can be used later by the FTC in enforcement cases. The FTC can take action against an entity that engages in unfair or deceptive business practices, but such practices are defined by case law (administrative and judicial), not regulations, thus creating the U.S. Supreme Court and pornography conundrum — I can’t define it, but I know it when I see it (see Justice Stewart’s timeless concurring opinion in Jacobellis v. Ohio).

To anyone actively involved in data privacy and security, the recommendations seem frighteningly basic:

–build security into devices at the outset, rather than as an afterthought in the design process;

– train employees about the importance of security, and ensure that security is managed at an appropriate level in the organization;

– ensure that when outside service providers are hired, that those providers are capable of maintaining reasonable security, and provide reasonable oversight of the providers;

– when a security risk is identified, consider a “defense-in-depth” strategy whereby multiple layers of security may be used to defend against a particular risk;

–consider measures to keep unauthorized users from accessing a consumer’s device, data, or personal information stored on the network;

–monitor connected devices throughout their expected life cycle, and where feasible, provide security patches to cover known risks.

–consider data minimization – that is, limiting the collection of consumer data, and retaining that information only for a set period of time, and not indefinitely;

– notify consumers and give them choices about how their information will be used, particularly when the data collection is beyond consumers’ reasonable expectations.

HIT Newser: A Meaningful Sigh of Relief

Feb 3, 2015• 4

By MICHELLE RONAN NOTEBOOM

ONC Issues Draft HIT Interoperability Road Map

The ONC releases a draft of its 10-year nationwide interoperability road map, which includes a focus on helping the majority of providers across the care continuum and consumers achieve basic interoperability of health data over the next three years. The ONC also released a draft of its Interoperability Standards Advisory, which includes an assessment of the best available standards and implementation specifications for clinical health information interoperability.

Public comment for the draft Roadmap closes April 3, 2015; comment period for the Standards Advisory closes May 1, 2015.

Meaningful Use Reporting Relief

CMS proposes rule changes for the EHR incentive program, including a reduction in the 2015 reporting period from one year to 90 days. An additional change would re-align the reporting period to match the calendar year, giving hospitals more time to incorporate 2014 Edition software into their workflows and better align with other CMS quality objectives. CMS will consider additional program modifications to reduce complexity and lessen providers’ reporting burdens.

CMS noted that the proposed rule changes are separate from the upcoming Stage 3 proposed rule that should be be released in March that is expected to limit the scope of the Stage 3 requirements for MU in 2017 and beyond.

Providers, vendors, and professional organizations are breathing a collective sigh of relief over the CMS announcement. The proposed changes aren’t too surprising, given low Stage 2 attestation numbers and overwhelming provider dissatisfaction with the MU program.

New Valued-based Payment Goals to Drive HIT Adoption

HHS sets a goal for 30 percent of Medicare payments to be link to value-based performance through alternative payment models, such as ACOs, by 2016 and 50 percent by 2018. In addition, HS wants 85 percent of traditional Medicare payments tied to quality by 2016 and 90 percent 2018.

Achieving those objectives will require technology that supports quality-based payments versus the traditional fee-for-service model, so both vendors and providers will need to make aggressive moves to deploy the appropriate tracking and reporting tools. No doubt this will be one of the hotter topics at the HIMSS conference in April.

CPOE For Management

Feb 2, 2015• 9

By PETER ELIAS, MD

At 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…

KLAS Announces 2014 Best in KLAS Winners

Feb 2, 2015• 1

By MICHELLE RONAN NOTEBOOM

Epic regains its top spot in the 2014 Best in KLAS awards, winning in the Overall Physician Practice Vendor and Overall Software Suite categories. Impact Advisors was named the Overall IT Services Firm.

Last year athenahealth beat out Epic by a narrow margin. This year athena still had an excellent showing, taking the top spots for Practice Management in both the 1-10 physician and 11-75 physician categories, as well as second place (after Epic) in the over 75 physician category.

Epic won Best in KLAS or category leader honors for Acute Care EMR, Ambulatory EMR (11-75 physicians and over 75 physicians), HIE, Lab, Patient Account and Patient Management, Patient Portals, Pharmacy, Radiology, and Surgery Management.

The Therapeutic Paradox: What’s Right for the Population May Not Be Right for the Patient

Feb 2, 2015• 17

By SCOTT ABEREGG, MD

An article in this week’s New York Times called Will This Treatment Help Me? There’s a Statistic for that highlights the disconnect between the risks (and risk reductions) that epidemiologists, researchers, guideline writers, the pharmaceutical industry, and policy wonks think are significant and the risks (and risk reductions) patients intuitively think are significant enough to warrant treatment.

The authors, bloggers at The Incidental Economist, begin the article with a sobering look at the number needed to treat (NNT). For the primary prevention of myocardial infarction (MI), if 2000 people with a 10% or higher risk of MI in the next 10 years take aspirin for 2 years, one MI will be prevented. 1999 people will have gotten no benefit from aspirin, and four will have an MI in spite of taking aspirin. Aspirin, a very good drug on all accounts, is far from a panacea, and this from a man (me) who takes it in spite of falling far below the risk threshold at which it is recommended.

One problem with NNT is that for patients it is a gratuitous numerical transformation of a simple number that anybody could understand (the absolute risk reduction – “your risk of stroke is reduced 3% by taking coumadin“), into a more abstract one (the NNT – “if we treat 33 people with coumadin, we prevent one stroke among them”) that requires retransformation into examples that people can understand, as shown in pictograms in the NYT article. A person trying to understand stroke prevention with coumadin could care less about the other 32 people his doctor is treating with coumadin, he is interested in himself. And his risk is reduced 3%. So why do we even use the NNT, why not just use ARR?