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John Irvine

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A reminder from the helpful people at THCB’s Tech Support Desk. You can now sign up to join THCB as a full member. (Use the login above.) Membership is free and signing up only takes a few minutes. Registration is required to comment and will qualify you for free stuff, invites to THCB Meet Ups and networking events in your area and more. If you have trouble signing up, use the contact form above at the right or email us at editor@thehealthcareblog.com and somebody will walk you through the signup process.  If nothing shows up, before contacting us, it’s a good idea to check your spam filter.

Transparency: Houdini’s last trick

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I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience – MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched for salt. I found neither.

I wondered what a speaker’s disclosure is supposed to trigger. Should we say “Stop, don’t advance your power point, until we regroup?” Demand that the statistics be re-run in front of us. Challenge, “You say p is 0.04. No, you lying Gordon Gekko, it’s actually 0.06.” Or ask “did you submit ANOVA to Tukey?” If we must ask these questions, must we not ask routinely? Skepticism is a habit, not an episodic righteous angst.

No really, I’m not being facetious, what should transparency make us do differently? His disclosure, paradoxically, made him a saint for his honesty, and gave the audience an excuse to switch off their skeptical neurons, which I suspect had been switched off all along.

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Giving Software Engineers a Seat at the Table


coding is the new literacy

Increasingly, research is becoming available that reveals the weaknesses and strengths of health information technologies.   Everything from infusion pumps to EHR systems have been subjected to analysis.  The new flow of information is wonderful to behold because it wasn’t too long ago that little in the way of actionable HIT research was available.

Research on usability, interoperability, and patient safety can lead to better clinical care software. From these studies, we are learning important information about workflow disruptions, clinician information needs, user interface issues, errors, etc. Now that we have more research, how do we use it to produce better products, to address the needs of HIT users?

Who actually builds HIT products?  Software engineers. They turn feature requests and requirements lists into working software making software engineers a rate-limiting component of any process leading to new products. Therefore, at some point, research must make it into the hands of software engineers who then covert it into objects, methods, APIs, and data store specifications. Continue reading…

Health System Conflict 101

Ok. You know the story. The work we do here at THCB would not be possible without the generous support of our corporate underwriters.  Like Castlight Health and Evolent, Health Catalyst are widely rumored to be bound for an IPO in the near future. They’re a really interesting company, with roots that go back to the fabled IT department at InterMountain Healthcare.  They’ve also been wonderful enough to sign on to support the community here at THCB as Flagship level sponsors. If you love what we do at THCB,  take a few minutes to show you support by taking a look at what they’re up to. Today’s free online session on adaptive leadership in a change of healthcare system conflict is a great introduction.

As you possibly may have noticed, there is a lot of conflict in healthcare. Doctors vs. Nurses. Patients vs. Doctors. Doctors vs. Computers. This online bootcamp will help you deal with it – or at least understand it – and should be required viewing for healthcare leaders, doctors, nurses and other healthcare providers. You will learn effective strategies for leading healthcare system change that will help address resistance to quality improvement, the drivers of negative attitudes, and the way to manage our own personal barriers to change. Well worth your time IMHO. Bring a friend. ; )

The Dark Age of Meaningful Use

A lesson from the future:

We look back at the years between 2010 and 2016  (The lifespan of Meaningful Use) as a dark age in healthcare software.

It was an era where software companies bound by government mandate to churn out horrible software tried to pretend their products increased productivity. “Eligible” providers were brow-beaten to click buttons and fill forms, print things and perform medical decision making without being paid.

Some software companies were successful, in a financial sense, as their armies of sales experts and market segmenters conquered their unassuming customers, brandishing the sabre of “ONC-ACB certified”. Those companies unwittingly managed to stamp out the potential of small physician offices, increasing consolidation to hospitals – and healthcare costs. Eventually, the ONC crest once emblazoned proudly on their chests, became a warning: “This software was designed for Meaningful Use, not Actual Use”.

Linguistically, the term “Meaningful Use” became entwined with “Electronic Health Record”. People forgot that medical software could improve patient care and not tout it’s Meaningful Use certification. An effort was made to ridicule those who believed that government regulations were legitimately harmful to the healthcare industry. The sky was lassoed and we were pulling it down.

A healthcare IT Renaissance:

The tides did turn, however. Visionaries and industry leaders came to realize how harmful Meaningful Use was to innovation.  Lawmakers were educated on how destructive constantly changing software and workflow requirements are to software development and medical workflow management.Continue reading…

From the People Who Brought You ACOs: A New Model For Healthcare Transformation

farzad_mostashariWhen my co-founder Mat Kendall and I launched Aledade last June, I wrote that our mission was simple: empowering doctors on the front lines of medicine to put them back in control of health care—and rewarding them for the unique value they create. Today, a few days shy of our first birthday, we are announcing that we have raised $30 million in a funding round led by ARCH Venture Partners, and including our Series A funding partners at Venrock. This investment is a testament to the growing demand for our technology-enabled services, and to the rapid progress we have made in creating a platform for doctors to manage the new value-based healthcare economy. But most importantly, it’s a commitment to long-term thinking.

First, we have tapped into a huge unmet need and a growing demand for our healthcare technology services. We hand-picked and signed up 26 practices within weeks of starting the company, and have now established unique partnerships with over 100 primary care practices in 9 states.

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Obamacare Set To Spike? Um…

Joe-FlowerSo it’s all over the news space and the shrieking blogosphere, with headlines like, “Obamacare Rates To Spike Up To 51%,” “Obamacare Hell…” and “Obamacare Inflationary Deluge…”

And online friends are commenting about “Obamacare premiums set to rise next year as much as 51% in some states…”

Hey, hey, hey. No need to panic. “Set to rise.” Stated as an actual set-in-stone future. See, kids, this is why I tell you not to try this at home. Being a real futurist takes a professional.

You might remember in spring of 2014 we saw headlines about how 2015 rates would “skyrocket.” And I said, “Nope.”

So what’s really happening this year? Do we each have to imagine our present rates suddenly rising by 40 or 50 percent? Here’s my reasoning.

First, these are rate hike requests, not actual rate hikes. They are not “set” at all. Think of them as opening bids by individual companies in the current round of rate adjustments, which have to pass muster in their particular states. Like any group of numbers, they fall on a bell curve. The headlines are about the extreme outliers in a few markets.

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What Went Wrong?

It’s been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we’ve been quiet in nearly every way – few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question.  This is exactly what should be happening when things are going right.  My patients are happy.  My patients don’t need me now.  My patients are satisfied with my care.  This would be a problem in most offices, as revenue depends on people having problems, having questions about their care, or anything else that would fill the schedule.  In practices like mine, however, this is what we want; after all, I am paid just as much for an empty office as a full one.

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Is CRM the Answer?

Screen Shot 2015-06-11 at 6.23.51 PMThe Internet has taught us valuable lessons about what works and what doesn’t in regards to identifying, engaging, and retaining customers.

Retailers are increasingly using sophisticated data aggregation and customer stratification methods to build business and grow revenues. Other industries are also leveraging technological advances to directly improve and enhance customer relationship management (CRM).

The health care industry? Not so much.

For a variety of reasons related to regulatory requirements, competitive pressures, cost considerations and privacy concerns, health care has lagged behind other industries in the development of effective CRM strategies. The industry has been slow to adopt data collection and communication models that promote value-based care and the inclusion of care team members (both clinical and non-clinical).

Since I first entered the health care industry many years ago, I’ve been surprised by the absence of innovative CRM capabilities that are typically commonplace in other industries.

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Can Open Health Data Promote Entrepreneurship and Innovation in India?

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There are a growing number of exciting opportunities to think about leveraging health data globally.  Just imagine the possibilities when you bring open health data initiatives together with creative tech entrepreneurs across countries to address key health and health care issues.  More solutions, greater global impact?  This was a key area of exploration at the 2015 Health Datapalooza, and a special session featuring government representatives from India.   

Health Datapalooza welcomed a delegation from the Government of India (GOI), including two representatives from the Office of the Registrar General (ORG), Ministry of Home Affairs: Rohit Bhardwaj, Deputy Registrar General, and Rajeev Kumar, Deputy Director. Both participated in a panel titled, Using Open Data to Promote Entrepreneurship and Innovation in India, chaired by Indu Subaiya, Co-Chairman and CEO, Health 2.0.

“India is poised for major growth in health IT innovation. We are excited to both share our experiences with open health data and learn from them as they leverage more than 900 million mobile phone users and a growing community of technology entrepreneurs,” said Susannah Fox, Chief Technology Officer of the Department of Health and Human Services (HHS).

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