Author Archives

John Irvine

The Year of the Hacker

Dec 29, 2015• 3

By JK Wall

2015 was the year health care got serious about cyber security.

Hackers gave the industry no other choice.

The year started with a massive data breach at Indianapolis-based Anthem Inc., which the health insurer revealed on Feb. 4. Hackers roamed around in Anthem’s computers for six weeks and stole personal and financial information of 78.8 million customers, as well as the information of 8.8 million customers at Blue Cross and Blue Shield plans not owned by Anthem.

There have been 269 data breaches at health care organizations this year, according to statistics collected through Dec. 22 by the Identity Theft Resource Center. That’s actually down from 2014, when health care organizations suffered 333 breaches.

But the number of records stolen has soared to 121.6 million records stolen, up from less than 8.4 million records in 2014. Even without the Anthem breach, there were still 34 million records stolen this year from health organizations.
The health care industry accounted for one out of every three breaches recorded by the Identity Theft Resource Center.

“They can and are trying to break into everything,” Doug Leonard, president of the Indiana Hospital Association, said of hackers. He added, “It’s really on everybody’s radar screen in the health care industry.”

In a survey released in August by consulting firm KPMG, 81 percent of health care executives said their organization had suffered a cyber attack in the previous two years and 13 percent said they were being attacked daily.

Why Meaningful Use Has to Go

Dec 28, 2015• 39

By MARGALIT GUR ARIE

We don’t win anymore in health care. After repeatedly drilling in our heads that America’s sick care system is a disaster, that those who care for the sick are incompetent and stupid, and that the sick themselves are losers, Meaningful Use was advertised as the means by which technology will make health care great again. The program has been in place for 5 years and the great promise of Meaningful Use is just around the same corner it was back in 2011. The only measurable changes from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from our time with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives.

Meaningful Use, a metastasizing web of mandates, regulations, exclusions, incentives and penalties, is conveniently defined in the abstract as a set of indisputably wholesome aspirational goals for EHR software and its users, which stands in stark contrast to the barrage of bad news flooding every health related publication, every single day. Health care in America used to be the best in the world, but now our health care is crippled. Meaningful Use of EHR technology will improve quality, safety, efficiency, care coordination, and public and population health. It will engage patients and families, and it will ensure privacy and security for personal health information. With Meaningful Use leading the way, health care will be winning so much that your head will be spinning. You won’t believe how much we’ll be winning.

Be afraid, be very afraid

Bombastic? Laughable? Easily dismissible by educated people? Not so fast. According to Dr. David Blumenthal, president of the Commonwealth Fund, and former National Coordinator for Health IT, “we probably have the worst primary care system in the world”. Yes, worst system in the whole wide world, worse than Niger, Malawi and Somalia. Probably. According to a hobbyist “study” that extrapolates its “results” from a handful of other studies based on an admittedly inaccurate tool intended for different purposes, 440,000 people are killed in hospitals due to preventable errors each year – “that’s the equivalent of nearly 10 jumbo jets crashing every wee k”. Or, with a little more math, half of all hospital deaths, and one in six US deaths, are due to negligent homicide perpetrated by psychopathic doctors and nurses.

The Quest For Zero Infections: A Fool’s Mission?

Dec 27, 2015• 5

By ANISH KOKA, MD

Joyce is sick. I am in the intensive care unit, peering at vital parameters that glow on the screen above her bed. My eyes linger on those numbers because it is easier than looking at her. A fever rages, her core temperature reads 103.4 degrees. Her white hair is plastered on her forehead with sweat, and a tube to help her breathe emerges from her mouth and heads to a ventilator that angrily tweets a musical alarm every few minutes. Her breathing is painfully obvious. Her stomach moves paradoxically inward on every breath, and I can see the muscles in her neck tense with the effort of every breath. Mercifully, her eyes are closed. A nurse walks in and starts to change a bag of fluids that is hanging by her bed. I follow the flexible plastic tubing that arises from the bag to an infusion pump, and then to a catheter that snakes under a see-through dressing underneath Joyce’s left collarbone. I ask the nurse about how long the catheter has been in place…’3 days’…I’m told. I mutter about the possibility of a central line infection – the dreaded central line-associated blood stream infection (CLABSI). The nurse shakes her head, and tells me – “we don’t get those anymore”.

CLABSIs are ground zero in the war on preventing patient harm. The story entered the mainstream consciousness in the lyrical words of Atul Gawande in the New Yorker in 2007. There he told a story of an unlikely Superman in the form of a critical care intensivist named Peter Pronovost. Dr. Pronovost was waging war against infections from these nefarious central lines that were saving and killing patients at the same time. He published a landmark study in the New England Journal of Medicine that used an evidence-based intervention to dramatically reduce infection rates in the intensive care unit. Some form of the implementation bundle that worked for Dr. Pronovost soon found itself in ICUs everywhere. Dramatic reductions in CLABSI rates followed.

Thirty Events That Really Did Very Little to Change Health Care’s World

Dec 27, 2015

By PAUL LEVY

It was with some dismay that I read Modern Healthcare’s article called, “The 30 events that rocked healthcare’s world in 2015.” I jumped into the piece, confident that I would, indeed, find some developments that have made a difference in the quality and safety of patient care, that would introduce transparency, and that would encourage a greater partnership between clinicians and patients and families.

What I found instead was a version of The Nightly Business Report–a series of stories mainly about the corporate and financial interests of pharma, insurance companies, big hospitals, and big government. These stories have nothing to do with what actually happens on the floors and units of America’s hospitals or in the offices of local physician practices. There is nothing in the stories that is motivational to the doctors, nurses, and other health care professionals who have devoted their lives to taking care of us. There is nothing in the stories that presents an empathetic view of what happens to us when we interact with the health care system as patients or families.

This Visit May Be Recorded

Dec 21, 2015• 5

By ALAN SCHWARTZ and SAUL WEINER

In their 1993 book, Reinventing Government, David Osborne and Ted Gaebler entitled a section “what gets measured gets done.” Unfortunately, when it comes to improving health care quality, safety, and costs, we often fail to observe the real work of care, and miss the chance to get it done better. To make a real difference, we need to begin measuring care when and where it happens – behind the curtain.

Why We Must Directly Observe Patient Care

For the last 10 years, our work in research and quality improvement has used concealed audiorecorders to capture what actually happens during patient-physician encounters, and to provide feedback to physicians about their performance. Much of our focus has been on demonstrating the importance of appreciating the patient’s life context and showing how encounters in which physicians elicit patient context and incorporate it into care planning have better health care outcomes and lower costs from inappropriate care. We’ve found such contextual factors are relevant to health care in two-thirds of encounters, that physicians ask about them less than a third of the time, and when they are discovered, they are incorporated into the plan less than 60% of the time. Contextual errors—inappropriate care due to failure to contextualize—are pervasive.

Records Don’t Record

Only direct observation of care reveals these errors. The medical record, currently the source of most data in performance improvement, does not and cannot identify mistakes that the physician doesn’t already recognize. The medical record, at best, shows that the physician rendered the care they believe the patient needed, which can be the “right” care for the wrong patient.

Genetic Testing: The New Frontier of Wellness Madness

Dec 16, 2015• 4

By AL LEWIS

The Wall Street Journal just reported that Genetic Testing May Be Coming to Your Office Soon. This is all well and good, assuming employees would want their health insurer’s buddies collecting their DNA for no good reason, handling it, selling it, and possibly losing it. This is not us talking. This is what the testing company itself says on their website. You can read all about it here.

Instead we will focus on the fact that this scheme simply doesn’t save money – according to the main proponents of this dystopian scheme, Aetna and its buddies at the ironically named Newtopia. Anticipating the day (yesterday) that this would become front-page news, we have already showed how Aetna’s study accidentally showed the opposite of what it intended to show. This is that proof.

HEART for the Stage 3 API

Dec 14, 2015• 3

By ADRIAN GROPPER, MD

It is imperative that we support the interoperability components of Meaningful Use Stage 3. The promise of reform to justify our massive investment in MU must be supported by broad, patient-centered interoperability mandates so that “data follows the patient”. The Stage 3 API requirement will be the centerpiece of interoperability because only patient-directed exchange can solve the challenges of patient matching and governance as described in the recent General Accounting Office report.

The Stage 3 API requirement will serve both patients and providers by enabling patients to delegate access to their records on the API to anyone, including apps, providers, and other EHRs. The vision for how this will happen is taking place in two workgroups: the OpenID Foundation Health Relationship Trust (HEART) and ONC’s API Task Force.

How this will work is the subject of a HEART use-case titled Elderly Mom with Family Caregiver. Based on the Kantara User Managed Access (UMA) and the HL7 FHIR standards, HEART profiles for healthcare are the foundation for broad interoperability and improved cybersecurity.Continue reading…

This Is America: You Don’t Have to Do Anything You Don’t Want To

Dec 13, 2015

By HANS DUVEFELT, MD

“I just want you to know, I won’t have a colonoscopy”, my new patient said with some amount of fervor in his voice. “And I don’t want to take a lot of medications.”

I looked him straight in the eyes and said “This is America, you don’t have to do anything, and I work for you. My job is to help you know your options.”

He seemed to relax. I reflected on the words I had just uttered, yet another time – it is the way I often try to set the tone as a non-authoritarian, patient focused physician.

“You don’t have to do anything”, of course, only applies to the patient.

The doctor has to do a lot of things, like document a treatment or follow-up plan for Medicare patients with a BMI over 30, or provide computer generated patient education to a minimum percentage of patients, and achieve a certain percentage of e-prescriptions. And right about now, we are starting to see financial consequences if too many of our patients, like the man I had just met, don’t want to take the medications that can bring their blood pressures or blood sugars below certain targets.

A Health IT Developer’s Confession: How Bad Software Is Made and What to Do About It

Dec 7, 2015• 30

By MARGALIT GUR-ARIE

It was a dark and stormy night. My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from dropdown lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software in general, and Microsoft Word in particular, magically removed the hassles of quills, ink, paper, blotters, sharpeners, ribbons, whiteout, carbon paper, dictionaries, and all the cumbersome ancillary paraphernalia needed to support authoring, but made no attempt to minimize the cognitive effort associated with writing well. Authoring great literature today requires as much talent and mastery as it did in the days of Edward Bulwer-Lytton.

For several decades, software builders have tried to help doctors practice medicine more efficiently and more effectively. As is often the case with good intentions, the results turned out to be a mixed bag of goods, with paternalistic overtones from the helpers and mostly resentment and frustration from those supposedly being helped.Continue reading…

What Killed Scott Weiland?

Dec 7, 2015• 2

By JOSEPH KRAININ, M.D.

His voice had the unusual ability to convey both aggressive muscularity and profound vulnerability. Scott Weiland and Stone Temple Pilots were icons of my adolescence. Personally, my memory of Mr. Weiland will always be inextricably linked with “Plush,” that initial hit single which, upon first listen, instantly captivated me and thousands of other kids like me. During my high school days, “Plush” was elevated to the highest sonic status possible, joining Metallica’s “Enter Sandman” and Pearl Jam’s” Black” as an essential component of our football team’s pre-game locker-room pump-up playlist.

So it was with shock and sadness that I read in the New York Times this morning that Weiland had “died in his sleep” on Thursday during a tour stop in Bloomington, MN. He was 48.