Tag: Meaningful Use

Heady Times for Health Care in the Cloud

Apr 30, 2012• 1

By Jonathan Bush

In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.

Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.

Why? I’ll give you one good reason and one bad one.

Connecting the Dots

Apr 27, 2012• 1

By Will Saunders

Data is only data until it is structured. Then it becomes powerful, relevant and insightful.

That was a key message from Ursula Burns, Xerox chairman and chief executive officer, on the first day of the World Health Care Congress in Washington, D.C. In opening the event with a fireside chat with Dr. Nancy Snyderman, chief medical editor for NBC News, Ursula talked about Xerox’s vision to improve health care including empowerment– ensuring that patients have a stake in their health, and realizing the true value of data. As Ursula said, “It’s not the data itself, but it’s recognizing actionable data.”

Here’s another way to think of it: Xerox provides the “smarts” around each aspect of health care such as:

·Easier access to data through solutions, such as advanced document recognition, intelligent data entry and fraud detection;

·Turning information into insights through real-time clinical decision, patient behavior modeling, population management, and Meaningful Use reporting; and

·Putting insights into action, for example, through a health information exchange – connecting electronic medical records (EMRs) to give caregivers information, analytics and decision support tools that help improve patient care.

101 Ways to Engage Patients to Easily Exceed Stage 2 Meaningful Use Requirements

Apr 24, 2012• 1

By Dave Chase

I believe the Health 2.0 community can put to rest any concerns that patient engagement will be difficult by commenting below on how apps they’ve built or seen can help blow away the requirements proposed in Stage 2 Meaningful Use.

In an earlier piece, I asked the question “Will the ONC provide a huge stimulus to Health 2.0 startups?” I touched on how this could be the biggest boost the health 2.0 startup community has ever received. Elsewhere, there has been pushback such as an article in Healthcare Informatics that describes patient engagement as The Least Popular Thing About Stage 2 MU So Far. In particular, providers question the requirement that 10 percent of patients access their data.

I don’t doubt that the proposed requirements will be difficult for some but I hope we aren’t, once again, beset by the tyranny of low expectations. 10% is a strikingly low # when you consider that health items are the 3rd most searched items across the entire population (not just sick people who should be much more motivated on a relative basis). While we know that some people are difficult to engage, it’s a llllonggggg way from 90%.

It’s only difficult (today) because the incentive systems have created a dynamic where providers have become highly skilled at getting as big a bill out as fast as possible. Why wouldn’t they have developed that skill? That is exactly what the flawed “do more, bill more” model of reimbursement has rewarded. The byproduct is they haven’t honed their skills at engaging patients. Having worked with hundreds of providers and dozens of vendors, these are smart and motivated people. I have ZERO doubt that they will rise to the expectations if they are given the chance.

Will the ONC provide a huge stimulus to Health 2.0 startups?

Apr 16, 2012• 5

By Dave Chase

The federal government is on the cusp of leveling the playing field for healthtech startups. Health 2.0 events have shown an unprecedented wave of innovative healthtech startups have developed over the last few years. You can also see them at demo day events that Blueprint Health, Healthbox, Rock Health and StartUp Health host. However, the health sector may be the single most challenging arena for startups.

I would argue nothing would result in population health improvement (while decreasing healthcare costs) more than having greater engagement by patients in the healthcare process. The Office of the National Coordinator (ONC) could catalyze an unprecedented wave of innovation with a stroke of a pen by strong inclusion of patient engagement requirements in the Meaningful Use requirements.

Having high expectations for Patient Engagement will cause healthcare providers to rise to the occasion to solve this critical issue. It’s well documented that three-quarters of healthcare spend is on chronic disease and decisions that drive outcomes are made by individuals (aka “patients”). It’s long been said the most important member of the care team is the patient. Now is the time to transform that from a catchphrase to reality. The ONC can do that.

The biggest potential stimulus ever for healthtech startups

We have seen how Stage 1 Meaningful Use requirements (PDF) have spurred providers into action. By and large, that has meant an infusion of customers to EHR vendors. Legacy healthIT has had very, very little focus on the patient because financial incentives motivated the development of systems designed to get as big a bill out as fast as possible — i.e., there has been no incentive to involve the patient.

What Keeps Me Up at Night 2012

Apr 11, 2012• 1

By John Halamka, MD

I’ve written several posts about the issues that keep me up at night. Here’s what I wrote in 2011.

Today, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here’s my list of top risks for 2012:

1. Old Internet browsers – many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws. We’ve worked diligently to eliminate, upgrade or replace applications with browser specificity. At this point we are 96% Internet Explorer 8/Firefox 7/Safari 5 minimizing our risks to the extent possible.

2. Local Administrative rights – Of our 18,000 devices on the network, a few thousand are devices that require the user to have local administrative rights to run their niche applications (often the research community doing cutting edge research with open source or self developed software). We have done everything possible to eliminate Local Administrative rights on our managed devices.

3. Outbound transmissions – Security has historically focused on blocking evil actors from the internet. Given the current challenges of malware and infections brought in from the outside, it’s equally critical to block unexpected outbound activity.

4. Public facing websites – any machine that touches the internet has the potential to be targeted for attack. We’ve implemented proxy servers/web application firewalls on most public websites.

5. Identity and Access management – Managing the ever changing roles and rights of individuals in a large complex organization with many partners/affiliates is challenging. If an affiliate asks for access to an application, how do you automatically deactivate accounts when users leave an affiliate, given the lack of direct employment relationships?

Infographic: The Future of Healthcare

Apr 10, 2012• 3

Click to open infographic

Todd Park Was Right…Now What?

Mar 15, 2012• 9

By John Hallock

In March of 2005, I staffed an interview between Todd Park and Steve Lohr of The New York Times in the cafeteria of the old New York offices of the “Grey Lady.” At the time, Park was heading a very small web-based start-up company that was trying to convince medical groups – and on that day, a leading national technology business reporter – that web-based “cloud” technologies would become mainstream in the healthcare IT industry and were the only logical means to get the hundreds of thousands of independent U.S. doctors and their small offices to go digital.

At the time, Lohr, one of the foremost technology reporters in the country covering IT giants like Microsoft, IBM and Intel, had just started covering Health IT upon the appointment of Dr. David Brailer as the nation’s first National Health Information Coordinator (or, as many called him back then, the “Health Information Czar”). In fact, Lohr had just gotten back from attending the annual HIMSS Conference in Dallas where he met with CEOs of “legacy” healthcare IT behemoths like IDX (now GE), Siemens, Cerner, Allscripts, McKesson and Epic.

In his first article addressing Health IT adoption in the U.S., Lohr touched on what he felt was the core challenge to achieving widespread EHR adoption: getting small medical practices to adopt and actually use these systems – something that had eluded the industry and those legacy IT vendors for many years. On the topic of getting small practices to adopt EHRs and the potential harm to the industry and the Bush Administration’s efforts if they didn’t, Dr. Brailer told Lohr, “The elephant in the living room in what we’re trying to do is the small physician practices. That’s the hardest problem, and it will bring this effort to its knees if we fail.”

Last week President Obama appointed Todd Park as the new Assistant to the President and U.S. Chief Technology Officer, with the responsibility to ensure the adoption of innovative technologies to support the Administration’s priorities including affordable health care. This got me to thinking.

Since taking office, President Obama has made some strong moves to champion the adoption of EHRs through the passing of the HITECH Act. This act, combined with the existing relaxation to the existing Stark anti-kickback laws, has actually enabled a spike in adoption of EHRs due to medical groups’ efforts to qualify for Meaningful Use dollars. But it has also had some unintended consequences that Mr. Park may now find himself in a unique position to rectify if he stays true to his support of cloud computing.Continue reading…

The Perfect Storm For Innovation

Feb 6, 2012• 7

By JOHN HALAMKA

In my career, there have been a few perfect storms, defined as “a confluence, resulting in an event of unusual magnitude”.

When I was an undergraduate at Stanford University in 1980, two geeky guys named Jobs and Wozniak dropped by the Homebrew Computer Club to demonstrate a kit designed in their garage. IBM introduced the Personal Computer and MSDOS 1.0. I purchased an early copy of Microsoft Basic and began creating software in my dorm room including early versions of tax calculation software, an econometric modeling language, and electronic data interchange tools. Every day brought a new opportunity. The energies of hundreds of entrepreneurs created an industry in a few intensely creative months that laid the foundation for the architecture and tools still in use today. A guy named Gates offered me a job and I decided to stay in school instead.

In 2001 when I was first hired at Harvard, a visionary Dean for Medical Education, a supportive Dean of the Medical School, talented new development staff, and a sleepless MD/Phd student came together to create one of the first Learning Management Systems in the country, Mycourses. Robust web technologies, voice recognition, search engines, early mobile devices, and new multi-media streaming standards coincided with resources, strong governance, and a sense of urgency. Magic happened and in a matter of months, an entire platform was created that is still powering the medical school today.

A Look Back at 2011

Dec 31, 2011• 12

By John Halamka, MD

2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.

It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.

What about the world of healthcare IT?

Federal

In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way

Vendors were challenged to add the features necessary for certification resulting in some “haste makes waste” lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.