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An Interview with BID-Plymouth CIO Ron Rutherford and Clinical Informatics Nurse Jean Marie Grupillion

By MICHELLE RONAN NOTEBOOM

An Interview with BID-Plymouth CIO Ron Rutherford and Clinical Informatics Nurse Jean Marie Grupillion

Michelle Noteboom: Give me a bit of background on your hospital.

Ron Rutherford: Jordan Hospital is a 100-plus-year-old, 155-bed community hospital that was acquired and became a part of the Beth Israel Deaconess Health System in January of 2014. We’re a full-service community hospital serving approximately 200,000 residents in eleven communities. There are few healthcare services we don’t provide.

MN: You recently implemented the Voalte smartphone solution. What led you to seek a new communication platform?

RR: We recognized the need for our clinical users to communicate in the most efficient way possible, and we were aware of some technology tools that could make that happen. We also needed to make sure the solution was secure and HIPAA-compliant.Continue reading…

Forks In the Road

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By NORTIN HADLER, MD


On Saturday, Dr. Hadler delivered the commencement address at the University of Michigan Medical School.  THCB is pleased to feature his remarks. 

Nortin HadlerThank you, Class of 2015, for the privilege of sharing this special occasion with you, your families and the community that has come together to celebrate with you. This is a rare day of pure self-indulgence. Our professional life allows little room for self-indulgence and seldom applauds when one of us makes the room. For those of you who are drawn to a career anchored at the bedside, the trade-off is the quiet, internalized quest to become the best physician you can be. I have pursued this goal nearly all my life – literally, I have been working in hospitals since I was 12. If I had it to do over, I would pursue the same goal.

This goal demands expertise. Expertise requires intellect and discipline. I have a superabundance of both and so do you. Expertise is necessary but not sufficient.  More than expertise, one must understand myriad contexts in which illness plays out.

Medicine is not a science. Medicine is a philosophy informed by science.

I was a medical student when this dawned on me. Like you, I entered clinical rotations brimming with the pathophysiology of all those diseases that are poised to smite a mighty blow. Was I missing the forest for the biochemistry? Many of our patients are elderly patient and plagued by more than one serious disease. As we set to the task of confronting each in turn, it occurred to me that I might not care as much about what kills me as I care about when, and what the journey was like? Today, we have a good handle on that “when”. I can make a strong argument that if you manage to stay well to 85, you’re off warranty.

Notions of “fatal diseases” and of “saving a life” demand a temporal component.  Realize that in America, you can’t die without a diagnosis. In the mid-1980s, I started to sign the death certificates of frail elderly patients with “It was her time.” I would get a call from Raleigh; Doctor Hadler you can’t do that. I’d respond, “Which of the several diseases vying for the honor do you want me to list?” Whenever you hear of the epidemic of cancer or heart disease or stroke, ask the “When” question.

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Value-based Interoperability: Less is more

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By MARGALIT GUR-ARIE

flying cadeuciiInteroperability in health care is all the rage now. After publishing a ten year interoperability plan, which according to the Federal Trade Commission (FTC) is well positioned to protect us from wanton market competition and heretic innovations, the Office of the National Coordinator for Health Information Technology (ONC) published the obligatory J’accuse report on information blocking, chockfull of vague anecdotal innuendos and not much else. Nowadays, every health care conversation with every expert, every representative, every lobbyist and every stakeholder, is bound to turn to the lamentable lack of interoperability, which is single handedly responsible for killing people, escalating costs of care, physician burnout, poverty, inequality, disparities, and whatever else seems inadequate in our Babylonian health care system.

When you ask the people genuinely upset at this utter lack of interoperability, what exactly they feel is lacking, the answer is invariably that EHRs should be able to talk to each other, and there is no excuse in this 21st iCentury for such massive failure in communications. The whole thing needs to be rebooted, it seems. After pouring tens of billions of dollars into building the infrastructure for interoperability, we are discovering to our dismay that those pesky EHRs are basically antisocial and are totally incapable or unwilling to engage in interoperability. The suggested solutions range from beating the EHRs into submission to just throwing the whole lackluster lot out and starting fresh to the tune of hundreds of billions of dollars more. When it comes to sacred interoperability, money is not an object. It’s about saving lives.

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Keep Calm and Interoperate On

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By SAURABH JHA, MD

Following the recession, the Obama administration sought shovel-ready projects.

One unlikely shovel wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 % of the stimulus towards digitizing medical records.

Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between electronic health records with the implication that such an exchange is a public good and so government intervention is justified.

Robert Wachter, voted the most influential physician by Modern Healthcare, sums the optimism and frustration with the electronic health record (EHR) in Digital Doctor – which stands to be a classic.

It was Bush Jr., not Obama, who started the digitization. Seeking bipartisanship after the war in Iraq, Bush was inspired by his closest ally, Tony Blair, who was wiring the National Health Service (NHS) – a $16 billion initiative which has since failed, spectacularly.

Bush founded the Office of National Coordinator of Health Information Technology (ONC) and appointed David Brailer – a physician, quant and entrepreneur – as head. Brailer wanted interoperability so that hospitals shared information. It is because of interoperability that we can use our debit cards in New York and Singapore. The market must agree on a common language, such as the TCP/ IP for the internet, to achieve interoperability.

Patients suffer when systems can’t talk. Were patients, not a third party, bearing the full costs of care – a free market – they might have forced hospital information systems to talk. Rightly or not, healthcare is not a free market and hospitals have little motivation in making cross-talking simpler.

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The “21st Century Cures” Draft Bill: A Step Away From Transparency

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By NIAM YARAGHI

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There is optimism that Congress will soon pass the 21st Century Cures bill. The draft bill proposed by the House Energy and Commerce Committee aims to foster medical innovation by streamlining the FDA regulatory process and increasing NIH research funding by $10 billion. The draft bill has overwhelming bipartisan support and will benefit patients, medical researchers and pharmaceutical companies. However, it also includes a passage, which aims to amend the Sunshine Act and exempt pharmaceutical companies from reporting the payments they make to physicians for continued medical education (CME) programs. The supporters of this change argue that physicians learn about the latest developments in medical science through CME programs and that requiring the disclosure of these payments would discourage pharmaceutical companies from financially supporting educational programs. Ultimately they believe it could inhibit the diffusion of medical innovation among doctors.

I took a look at the data released by CMS on the financial transactions between the pharmaceutical companies and individual physicians. In the last five months of 2013, more than $120 million were paid to physicians who participated (as faculty or speakers) in CME programs. The payments constitute 26 percent of the total financial transactions between pharma and individual physicians. The proposed change essentially allows pharmaceutical companies to hide more than a quarter of their payments to physicians. Exempting the pharmaceutical companies from reporting the largest part of their financial relationship with doctors will not help to foster medical education, rather it will add to current suspicions about the unjustified impact of such payments on the drugs that physicians prescribe to their patients.

If CME programs legitimately increase the awareness of physicians about the latest medical innovations and provide them with unbiased information about new drugs, then both pharmaceutical companies and those physicians who serve as speakers and faculties of such programs should be extremely proud of their role as champions of innovation and envoys of the latest knowledge in the medical community. If that is the case, one would wonder why they wouldn’t embrace and support the efforts that shed light on their noble role.

Patients heavily rely on the recommendations of their doctors to make any kind of decision regarding their health and thus have the right to be informed about the possibility that their doctors have a conflict of interest. Congress should refrain from amending the Sunshine Act and avoid jeopardizing the patients’ right to have access to information.

Niam Yaraghi is a fellow at the Brookings Institute Center For Technology Innovation. His posts appear regularly on THCB and on the Brookings Institute Tech Talk blog, where this post first appeared. This post also appeared as an opinion column on the US News and World Report site.

Sumit Nagpal, Lumira, talks rebranding & more

Now that the technical reboot of THCB is well underway, I’m going to be running more interviews recorded at HIMSS (April 2015) on THCB. Next up is Sumit Nagpal, CEO of Lumira, which used to be Alere ACS and before that, for those of you with long memories, Wellogic. Beyond telling you what is up with the new name and rebranded company, Sumit has some interesting thoughts about the inter-operability trend. Incidentally, Sumit’s colleague Helen Figge will be at Health 2.0 Europe this week if you happen to be in the vicinity of (newly crowned La Liga Champions) Barcelona–Matthew Holt

Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse

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By JOE SELBY, MD

Joe SelbyFor more than a decade, the United States has faced an escalating opioid abuse crisis. The number of deaths associated with abuse of these prescription painkillers more than tripled between 1999 and 2012 and now outstrips the number associated with any other drug, according to the US Centers for Disease Control and Prevention. The problem is estimated to approach $56 billion in costs to society.

Often, opioid abuse or overuse is associated with patients seeking effective relief from the common and often devastating problem of chronic pain, which has been reported as affecting up to one in three US adults. People in pain often request opioid medications, not understanding that these drugs don’t effectively treat certain types of pain, don’t work well for many people, and can lead to a range of additional health problems.

Researchers, policy makers, clinicians, and their professional organizations are working hard to stem the opioid abuse epidemic, seeking ways to reduce overprescribing of these drugs by expanding the use of alternative and supporting therapies, as well as identifying more effective treatments for addiction.Continue reading…

Physician Data on Impact of Health Reform In 2014

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By JOSHUA GRAY

Screen Shot 2015-05-13 at 3.05.39 PMOver the past year, our athenaResearch team has been working with the Robert Wood Johnson Foundation (RWJF) on ACAView, an initiative that provides researchers, policymakers and the public with regular updates on how the Affordable Care Act (ACA) is affecting physician provider practices. To accomplish this, we curate and analyze data from a nationally distributed sample of 16,000 providers on the athenahealth cloud-based network. This gives us a timely view into national physician practice patterns and an ideal platform for measuring the impact of health care reform on the day-to-day practice of medicine.

After reporting some initial findings a handful of times, we’ve recently published our comprehensive report from the first year of the ACA rollout: “ACAView: Observations on the Affordable Care Act: 2014” (PDF). Here are some of the more interesting findings from the data:

Many feared a surge of new patient volume. That hasn’t occurred.

In 2014, the coverage provisions of the ACA went into effect, with the intention of bringing millions of patients into stable physician relationships that would improve their health status. Just before the coverage expansion, some commentators expressed concern that physicians might lack the practice capacity to treat these new patients, many of them with unmet medical needs. That has not happened.Continue reading…

Why Are Medicaid Visits Falling In Non-Expansion States?

By THCB Bot

Josh Gray’s post above triggered a nice Twitter exchange between @ddiamond and @Neoavatara.

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