Month: April 2015

HIMSS 2015: Medicomp’s Dave Lareau

Apr 15, 2015

By MICHELLE RONAN NOTEBOOM

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…

An EHR Attestation Report Card and Data Set

Apr 14, 2015

by FRED TROTTER and ASHISH PATEL

DocGraph will release an initial dataset will become available on the last full day at HIMSS, and the crowdfund will continue until Datapalooza. This post discusses our underlying motivation for creating a new dataset, as well as some of our goals with its release.

I enjoy and appreciate many aspects of the annual HIMSS conference: the people who run it, the attendees, educational sessions, and keynotes. Further, I find that regional and local HIMSS events are well worth attending. However, I am not a fan of the “big” HIMSS tradeshow floor. The parallels between walking down the “main aisle” at HIMSS and walking down the strip at Vegas creates are striking. The opulence of the Vegas strip and the excess in the HIMSS tradeshow floor both stir a sense of unease and bring up the same questions: “Who is paying for all of this? Is someone getting fleeced? Is it me? If it is not me, would that make the fleecing OK?”

The HIMSS tradeshow floor is a necessary evil because we have, in Health IT, no better way to make decisions about what products we buy. As it stands, figuring out which vendors have the biggest booths at HIMSS is probably not the worst way to make decisions about EHR systems.

The alternative is to hire someone to tell us which EHR vendor fits us best. Probably the most famous provider in this space is the “Best in Klas” service. However, Klas is famous for being payed by both sides of the industry. Klas is paid both by potential EHR purchasers and by those who sell EHR system. Like HIMSS, Klas creates a space for buyers and sellers to meet. I think Klas and HIMSS both do an admirable job trying to maintain fairness and objectivity, given the massive financial biases under which both organizations operate.

HIMSS15: Health IT Leaders 3.0 & The Venture + Forum

Apr 14, 2015

By MICHELLE NOTEBOOM

I made it to Chicago Sunday morning and hit the ground running. After arriving at the mammoth McCormick Center I headed to the CHIME meeting just as several hundred CIOs were returning from lunch. Three of the industry’s most prominent CIOs were the keynote speakers for a session entitled, “Health IT Leader 3.0 Great Ideas In Action.” Ed Marx of Texas Health Resources shared his insights on employee engagement, while Patricia Skarulis of Memorial Sloan Kettering Cancer Center discussed security. Finally Timothy Stettheimer of Ascension Information Services offered some great wisdom on life and work balance.

I then trekked to The Venture+ Forum, which focuses on new and emerging healthcare solutions. The format is very face-paced with entrepreneurs pitching their companies in five minutes or less, and then answering a few questions from a panel of four industry veterans. I sat through about 10 of the pitches and was struck by the variety of technologies that were being promoted, as well as the quality (or lack there of) of the presentations. It’s a tough format if you are not a polished speaker as you have just a brief amount of time to present your story. A couple of the pitches were so confusing that I never quite figured out what their product was or the solution it solved. One thing I did learn was that if you are answering questions, it’s best not to begin every single response with, “that’s a great question.”

Pharma and Volume-to-Value: The Big Throwdown

Apr 14, 2015

By JOE FLOWER

The collision between the “volume-to-value” movement and the pharmaceutical and biotech industries over the next few years will have a powerful impact on them and on the healthcare industry and on us as customers, patients, and payers.

On the one hand, pharma is perhaps the part of the healthcare industry least exposed to direct price regulation under the Obama reforms. The actual costs of pharmaceuticals have been rising as a percentage of what people spend on healthcare, and are seen as the part they have the least influence on. At the same time, many new drugs for cancer and other life-threatening diseases have come with astonishingly high price tags, often not fully covered by insurance (due to the high deductibles and co-pays of the new plans), and with few ways for regulators or the market to push back on them. The public perceives these huge price tags as threatening people with a Hobson’s choice of bankruptcy or death. In the volatile political atmosphere of the 2016 elections, this leaves the pharmaceutical industry highly exposed to political attack and actual new price regulation.

On the other hand, the pharmaceutical and biotech industries also potentially offer some of the best answers to bringing the cost of healthcare down through the use of personalized medicines, smart medicines, new methods of administration such as implants, as well as the possibilities glimmering at us from recent research of real breakthroughs in such important chronic disease areas as Alzheimers, diabetes, addiction, behavioral medicine, and functional medicine. For the most part, though, these answers remain potential. We will not see them adding to the “value” side of the equation until they become fully integrated into a system that is at risk for the health of its customers and using every trick in the handbook to bring those costs in line.

In Search of Intra-Aero-Bili-ty

Apr 12, 2015• 4

By MATTHEW HOLT

Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up. (I’ll also be in the Surescripts booth talking about it at 3.45 Monday)

I want to put this essay in the context of my day job as co-chairman of Health 2.0, where I look at and showcase new technologies in health. We have a three part definition for what we call Health 2.0. First, they must be adaptable technologies in health care, where one technology plugs into another easily using accessible APIs without a lot of rework and data moves between them. Second, we think a lot about the user experience, and over eight years we’ve been seeing tools with better and better user experiences–especially on the phone, iPad, and other screens. Finally, we think about using data to drive decisions and using data from all those devices to change and help us make decisions.

This is the Cal Pacific Medical Center up in San Francisco. The purple arrow on the left points to the door of the emergency entrance.

Cal Pacific is at the end of that big red arrow on the next photo. On that map there’s also a blue line which is my effort to add some social commentary. To the top left of that blue line in San Francisco is where the rich people live, and on the bottom right is where the poor people live. Cal Pacific is right in the middle of the rich side of town, and it’s where San Francisco’s yuppies go to have their babies.

Last year, on August 26, 2014 at about 1 am to be precise, I drove into this entrance rather fast. My wife was next to me and within an hour, we were upstairs and out came Aero. He’s named Aero because his big sister was reading a book about Frankie the Frog who wanted to fly and he was very aerodynamic. So when said, “What should we call your little brother?” She said, “I want to call him Aerodynamic.” We said, “OK, if he comes out fast we’ll call him the aerodynamic flying baby.” So he’s called Aero for short.

Thus began the Quest for Intra-Aero-Bili-ty –a title I hope will grow on you. The Bili part will become obvious in a paragraph or two.

Something had changed since we had been at Cal Pacific three years earlier for the birth of Coco, our first child.

If you look carefully at the top of Amanda’s head, there’s now a computer system. Like most big provider systems, Sutter–Cal Pacific’s parent company–has installed Epic and it’s in every room or on a COW (cart on wheels). Essentially we have spent the last few years putting EMRs in all hospitals. This is the result of the $24+ billion the US taxpayer (well, the Chinese taxpayer to be more accurate) has spent since the 2010 rollout of the HITECH act.Continue reading…

ONC Report on Health Information Blocking: A Solid Double, But NOT a Home Run

Apr 12, 2015• 3

By VINCE KURAITIS and DAVID C. KIBBE, MD

Last Friday ONC (the Office of the National Coordinator for Health IT) released a long-awaited Report On Health Information Blocking. The ONC blog capsulizes the report:

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

We were struck with two major reactions to the ONC Info Blocking Report:

It’s a solid double: it does a credible job of recognizing that the major problems of interoperability and blocking are not technical or due to a lack of standards, but rather due to business practices and business models. The report also proposes a baseline of potential solutions.
It’s not a home run: the report misses the opportunity to describe a comprehensive approach to combat information blocking.Continue reading…

The Blocking of Health Information Undermines Interoperability and Delivery Reform

Apr 10, 2015• 20

By KAREN DeSALVO, MD and JODI DANIEL

The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Today we delivered a new Report to Congress on Health Information Blocking that examines allegations that some health care providers and health IT developers are engaging in “information blocking”—a practice that frustrates this national information sharing goal.

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

This report is important and comes at a crucial time in the evolution of our nation’s health IT infrastructure. We recently released the Federal Health IT Strategic Plan 2015 – 2020 and the Draft Shared Nationwide Interoperability Roadmap. These documents describe challenges to achieving an interoperable learning health system and chart a course towards unlocking electronic health information so that it flows where and when it matters most for individual consumers, health care providers, and the public health community.

The HIMSS Version of Voter ID Laws

Apr 10, 2015• 4

By ADRIAN GROPPER, MD

At a time when patients, physicians, and even congress are all clamoring for the interoperability we were promised with the HITECH incentives, the principal EHR vendor organization has figured out yet another way to add to their barricades. HIMSS has just released their “Recommended Identity Assurance for Patient Portals” provide cover for more impediments to the patient’s right to access our own health information.

The parallels to voter ID initiatives is striking. A self-assembled “HIMSS Identity Management Task Force” decides to invent a security threat that is undocumented and then propose a self-serving solution. I had the privilege of witnessing this process first hand.

The use of HIPAA as a barrier to patient access is well known. Almost all of us, as patients, have experienced denial of access to our own health information “because of HIPAA”. This misinterpretation of the law is so pervasive that the Office for Civil Rights, in September 2013, issued a right to access memo that articulates the patient’s right to an electronic copy of her record and to have that record sent to someone else. Later, in comments designed to encourage adoption of the Blue Button initiative, the Office for Civil Rights made clear that the patient’s right of access included the right to insist on transmission of the record by insecure means if that was what they wanted. (By the way, how many of you have actually received a useful Blue Button file from private-sector hospital?)

18 months and maybe $15 Billion of HITECH incentive payments after the OCR memo, the EHR vendors have come up with their interpretation of the HIPAA patient right of access. I urge all of you to read the 3-page HIMSS recommendation and try to understand what this means to you as a patient.

Secure and privacy-preserving patient identity is currently under consideration by the IDESG Healthcare Committee https://www.idecosystem.org/group/healthcare-committee. On this page you will find the contact info for the leadership and I hope you will send your comments and even consider participating. Or, just comment below.

Adrian Gropper, MD is the CTO of Patient Privacy Rights.

Why the Market Can’t Solve the EHR Interoperability Problem

Apr 9, 2015• 2

By ROSS KOPPEL and STEVE SOUMERAI

Niam Yarhagi’s THCB piece, Congress Can’t Solve the EHR Interoperability Problem (March 21, 2015) raises excellent points with which I mainly agree. So why write a responding blog? Because I don’t agree with his solution.

To review: Dr. Yarhagi discusses a draft congressional bill that calls for the creation of a “Charter Organization” that “shall consist of one member from each of the standard development organizations accredited by the American National Standards Institute and representatives that include healthcare providers, EHR vendors, and health insurers.”

Four agreements: I agree with Dr. Yarhagi’s conclusion that the proposed charter organization will not succeed; I agree with his prediction that it won’t be able to develop useful interoperability measures (hint: these are the same vendors that have refused to cooperate for the past 30 years); I agree that the ONC or CMS will not decertify an EHR vendor that has over 50% of all American patients and providers; and I agree that there are some medical providers who intentionally refuse to share patient information (because they think it gives them a competitive advantage over their local rivals).

One disagreement: But I disagree strongly with Dr. Yarhagi’s faith in the market to ensure that healthcare information technology (HIT) vendors will be obliged to “develop sustainable revenue stream through reasonable exchange fees negotiated with the medical providers.” That is, he asserts that if there were a real market without federal subsidies and requirements that all healthcare providers buy the HIT, then providers and the HIT vendors would agree on reasonable fees for exchanging patient records.Continue reading…

How Technology is Driving the Next Wave of Telemedicine

Apr 9, 2015• 2

By RYAN BECKLAND

The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.