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Medical informatics needs a rock star

Medical informatics needs a rock star. Not a David Brailer-esque figure
who could excite people in the technology sphere, but perhaps a Don
Berwick type who can reach every level and constituency of health care,
and even capture the imagination of the general public.

I had this thought yesterday during a highly engaging session at the American Medical Informatics Association‘s
annual symposium in Washington, a session with the mouthful of a title,
“Harnessing Mass Collaboration to Synthesize and Disseminate Successful
CDS Implementation Practices.” In English, that means panelists were
discussing the forthcoming “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide” and related feedback mechanisms, including a wiki.

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The Mormon Church has forfeited its right to not pay taxes

I don’t often use THCB for direct political protests. I don’t care what the obscure cult known as The Church of Jesus and the Latter Day Saints does in the privacy of its own congregation, even though it (like many other churches) discriminates against all types of people and actively excommunicates homosexuals.

I don’t even care that a group that left the east coast because of the discrimination it faced from people and groups there (including the killing of its founder by an angry mob) has somehow become a bastion of its own bigotry. I don’t even care that many in the Mormon church hypocritically wink at the concept of "non-traditional marriages" so long as they contain one man and many women. And I guess that I don’t care that a group of any kind decides to spend $20 million and organize to influence election results, even if their stance is riddled with bigotry and hatred coded with terms about "defending marriage."

But I do care that as a taxpayer I’m forced to subsidize that activity. The Mormon Church pays no taxes, which means that the rest of us pay more and part of the deal they’ve agreed to is that they are a church and not a political organization.

Well, there’s an easy way to try to do something about it. This is an IRS form pre-completed that you can download, complete and email to the IRS asking that they review and change the Mormon church’s tax-exempt status after its appalling behavior over Proposition 8.

Transparency Works!!! (And better than you can imagine)

Timeout_poster_3I just saw clear evidence of the importance of transparency with regard
to the reporting of important adverse events and medical errors. Bear with me through the details, but I will not keep you in suspense regarding the conclusion: The wide disclosure of a “never” event in a blame-free manner resulted in an intensity of focus and communal effort to solve an important systemic problem, resulting in redesign of clinical procedures, buy-in from hundreds of relevant staff people, and an audit system that will monitor the effectiveness of the new approach and leave open the possibility for ongoing improvement.

If you ever needed a clear example of the power of transparency, here it is.

Back in early July, a patient experienced a wrong-side surgery in our hospital because the staff failed to carry out the required time-out. We disseminated the story of this event to all staff in the hospital.  There was a full investigation of the matter, both internally and by the state DPH, and some immediate improvements were made in our procedures. But the more important work was being done by a Safety Culture Operational Task Force co-chaired by a nurse, a surgeon, and an anesthesiologist, and engaging almost two dozen other people from a variety of disciplines and positions in the hospital.

Its charge and mission: To implement and embed the Culture of Safety at the point of care in Perioperative Services, with an emphasis on teamwork and enhanced communications.

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A patient’s perspective: Do doctors read?

After monitoring e-patients.net and The Health Care Blog, I have to ask: Do doctors read? And if so, what?

I know four things from my own experience (and watching “Grey’s Anatomy”).

First, physicians are busy often exhausted individuals who deal with life-and-death matters.  For some, a robust sense of importance, if not their institutional setting, makes them deaf to patient input. The work-to-the-max ethic and lifestyle is inculcated since before medical school.

Second, physicians in my daughter’s chain of medical events were highly resistant if not resentful of patient input regarding new sources of information, from medical to newspaper to Internet articles. Regardless of how tactfully the material was presented.

Third, as is clear from my own posts, the ones I encountered don’t read The New York Times.

Fourth, the doctors I know, when they do have leisure time, spend it at the health club, on the ski slopes, at the theater or flying jets. They don’t read for leisure and thus are unlikely to familiarize themselves with the irony, say, of Robert B. Parker’s Spenser novels. Irony is useful here in that it, and the humor in Spenser, arises from the skepticism of a Single Joe dealing with large, but not efficient, corporate and government entities.

So I raise the question: Do doctors read? And if so, what?

Whatever they are reading, or not reading, seems to contribute to the ossification of attitude implicit in David Kibbe’s recent post on The Health Care Blog about his quest to urge physicians to adopt up-to-date Information Technology.  Of all the entities involved in transformation of the health care system, the physician community seems least able to adapt to changing times.

Christine Gray is a patient who blogs at e-patients.net, where this post first appeared.

Telehealth right here right now

A very smart doctor told me, "there’s been a realization that the exam room is wherever the patient is."

That simple, elegant and insightful remark was offered by Dr. Jay Sanders, one of the godfathers of telehealth. I quote him here from my report published this week by the California Health Care Foundation. It’s called Right Here Right Now: Ten Telehealth Pioneers Make It Work.

This report is coupled with another by Forrester, Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem. My colleagues at Forrester, Carlton Doty and Katie Thompson, have assembled a very current look into the state of telehealth and drivers for the future.

Forrester defines "telehealth" as, "The use of telecommunications and information technologies in any area of health care, including medical intervention, prevention, care management, education, administrative tasks, and even health advocacy….It is a broader term than ‘telemedicine.’"

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Happenings in HIT

Cleveland Clinic launched its pilot partnership with Microsoft HealthVault to provide personal health records for 150,000 patients.

CMS selected four companies to pilot its personal health record program: Google, HealthTrio, NoMoreClipboard, and Passport MD. Beginning in January, Medicare beneficiaries will have their claims data automatically added to their PHRs.

Google launched Flu Tracker, a program to help CDC track disease outbreaks in real time by looking for regional trends in search terms.

MedSphere announced a $9.7 million contract with the federal Indian Health Service (IHS) to develop the agency’s EHR system.

Intel unveiled its new telehealth home monitoring technology. According to Health Data Management, "The home computers can be linked to medical devices, including blood pressure
monitors, glucose meters and pulse oximeters, to transmit encrypted data to a
secure server via the Internet. They also can display patient reminders, offer
access to educational content, and accommodate e-mail between caregivers and
patients."

Analysts say deCODE Genetics is headed for bankruptcy.

Winners & Losers in HIT

I was recently asked to predict IT Winners and Losers in 2009. Rather than name individual companies, I’d like to highlight categories.

Winners1.  Electronic Health Record vendors, especially web-based applications – The Obama administration has promised  $50 billion for interoperable EHRs.

2.
Software as a Service providers – SaaS providers offer lower cost of
ownership and faster implementation than traditional software
installation approaches.

3. Open Source – I’m embracing Open
source operating systems, databases, and applications as long as they
can provide the reliability and supportability that I need.

4.
Green IT – Winners will be innovative techniques to adjust power draw,
such as idle drive management, cpu voltage adjustments, and high
efficiency power supplies.

5. Cloud Computing offerings – These
are remote infrastructure utilities such as storage and high
performance computing. Friday’s Cool Technology of the Week will
describe a new technology called Cloud Optimized Storage.

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Shreeve brothers named winners of Linux Freedom Award

I am deeply honored and profoundly grateful to be recognized, along with my brother Steve Shreeve, as the 2008 winner of the Linux Medical News Freedom Award. While this is a niche award in a niche space, it is highly symbolic in recognizing individuals who are “crying in the wilderness” regarding the promise and potential of open source within health care.

The award comes with the bitter irony of course, in the history and
historicity of the events which have led to it being awarded. On the
positive side, Medsphere was
born as a revolutionary force within the Health Care information
technology world. The company was founded on the premise that open
source could have a similar impact within health care as it has had in
other major industries of lower costs, improving quality, and
delivering more value. The open source approach has a particular
kinship with health care, as the notions of price sensitivity, peer
review, open collaboration, and transparency are desirable attributes.
I have discussed this at length before in many forums, and I see that Medsphere is still using our same slides to describe this connection.

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Maxing out on health reform

Senate Finance Committee Chairman Max Baucus’ unveiling of a health reform proposal yesterday fed speculation about the possibility of Democrats tackling health reform from the get-go of the new Administration.

The Montana Democrat’s proposal is detailed in an 97-page "call to action" document. In his letter of introduction, Baucus says the plan is not a legislative proposal but his vision for policy reforms and the political process.

Baucus says the plan will require an initial investment, but doesn’t name how much. There are no cost figures in the plan, but the Senator writes, "It is my intention that
after ten years the U.S. will spend no more on health care than is
currently projected, but we will spend those resources more
efficiently, and will provide better-quality coverage to all Americans."

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