Readers Write: Health Data Analytics Provides Greater Value Over Big Data

Health Data Analytics Provides Greater Value Over Big Data
By Joe Crandall

Like you, I’m tired. I am tired of the latest buzzword in healthcare circles: “Big Data.”

The problem I see as a healthcare professional is that most experts are not offering solid, realistic ideas about how to leverage data at the decision-maker level. Most articles and experts are talking about using data to fundamentally change healthcare (genomics, population health, etc.) How many times have you heard that a new something was going to change healthcare forever? These experts are doing a disservice to the large majority of hospitals and health systems out there. I suggest you forget the term “Big Data” and begin to think about Health Data Analytics (HDA).

The truth is that most hospitals have been using health data analytics to some degree for a long time. Because of external and internal drivers, healthcare organizations are now being pushed to do more with less. That means leveraging their data and tools more efficiently. This isn’t about predictive analytics . It is about giving the clinical decision maker the information they need when they need it so they can make better decisions to drive better outcomes.

Six things to think about in regards to HDA:

1. Ignore the hype. Don’t fall for the sales pitches and doom and gloom if you haven’t bought a business intelligence (BI) tool yet. About 90 percent of the hospitals out there are in the same boat as you. The hospitals giving the “Big Data” talks have been on that path for decades and have spent millions of dollars. Not surprisingly, they are only starting to leverage the data for research. You don’t need “Big Data” — you need analytics.
2. Be realistic. Let me say that again: be realistic. You are not going to go from a data-averse culture to a data-driven culture overnight. You aren’t going to be able to convince everyone this is the right project to invest in. Buying the best in KLAS BI vendor is not going to magically transform your organization. If you do decide to buy a BI tool, be realistic when setting expectations with a BI vendor. The implementation won’t be as easy as they say and the people won’t flock to the platform as quickly as they say. In fact, it is like every other platform IT has installed. Focus on the people rather than the technology for lasting success.
3. Conduct an in-depth assessment. Before you start a HDA program, take an honest assessment of your current state of health data readiness. A readiness assessment saves money in the long run by clearly identifying any gaps in skills, tools, or process. Answer some basic questions first. Does our organization have a culture of sharing data? Do we have a good data governance program in place? Do we have data integrity issues? Do our people know how to use the information we can provide? Knowing where you are starting and your end goal is an important part of any project. A great assessment will help you plan to reach your goals with clearly laid out courses of action.
4. Start small. HDA projects need to start small with scalable and sustainable processes that will allow the program to expand intelligently. While in the military, we used the “crawl, walk, run” methodology and it applies to implementing a HDA program at your facility. Do not start running with “Let’s change the discharge process” as your first HDA project. A better and more focused choice could be to crawl with “On the labor and delivery floor, how do we discharge patients before 11 am?” Start small with big results. Then grow.
5. Grow intelligently. Once that first project is a success, look into expanding under the guidance of a strong executive sponsor and a competent governance structure. Keep in mind that you don’t need to duplicate the first project throughout your facility – you need the ability to replicate it. Duplication implies a direct copy, while replication allows variances for each situation that might be encountered while implementing the new way of doing business. Once people start to see the benefit of a data-driven culture, requests for projects will pour in and the organization will need a plan to intelligently address all requests and aggressively pursue the best ones.
6. Focus on your people. Most importantly is the focus on the people. Each person within your organization has a decision-making maturity that may or may not be able to leverage the HDA program effectively. This is why certain programs are successful under the leadership of one person but flounder once that leader moves on. It is why someone can look at raw data and see patterns in the business and make decisions that drive action. It is why a project can be successfully run by staff while being led by an inept leader. It is the maturity of each individual that will determine the success of the HDA program, not the tools or platform.

The requirement of leveraging data to gain a competitive edge is upon us. Healthcare organizations are being asked to improve outcomes as the main driver for improving the bottom line. A data-driven culture will transform an organization from volume based to value based, but it will take time and the right people. Focus on one project initially, guided by a strong executive sponsor utilizing a process that is scalable and sustainable.

If you do this, before you know it, your organization will be utilizing health data analytics to make more intelligent decisions that will ultimately improve outcomes. You will have created a data-driven culture.

Joe Crandall is director of client engagement solutions for Greencastle Associates Consulting.

Readers Write: The Case for One Source of Truth

The Case for One Source of Truth
By Deborah Kohn

The notion of managing and being accountable for the health status of defined populations requires much more sophisticated clinical data collection methods and skills than most healthcare organizations have today. However, for decades, numerous coded systems have been used to successfully capture clinical data for reporting purposes, such as quality initiatives and outcome measurements, as well as for reimbursement and other myriad purposes.

Such coded systems, which health information professionals categorize as either clinical classification systems[1] or clinical terminology systems[2], can continue to be used to assist in determining prospective, pre-emptive care management on covered populations. However, no single classification system meets all use cases. ICD-9 CM does not contain medications. ICD-10 CM does not address functional status. In addition, no single terminology system meets all use cases. LOINC is used to encode laboratory data. SNOMED CT is used to encode clinical care data. RxNorm is used to encode medications.

Consequently, using the existing or newer coded systems to meet any of the fast-growing clinical data collection and analysis initiatives presents a significant challenge: too many systems from which to choose, hindering any efforts to change the collection of the data into actionable information for interoperability and health information exchange. To resolve this challenge, one “one source of truth" or one central authority platform (CAP) for all clinical data capture systems, existing and new, allows all coded systems to be used to capture and exchange information.

© Deborah Kohn 2013

With one CAP, healthcare organizations need not be concerned about when to use which data collection system for which purpose. Organizations are able to capture required clinical, financial, and administrative data once and use it many times, such as for adjudication and information governance purposes. In addition, organizations are able to compare the data for data integrity purposes. More importantly, organizations are assured that electronic healthcare data input by different users is semantically interoperable, i.e. the data are understood and used while the original meaning of the data is maintained.

For example, for typical diabetic patients, Reference Lab #1 might denote glycohemoglobin within the chemistry panel, Physician Office Lab #2 might denote glycohemoglobin as an independent test: HgbA1c, and Hospital Lab #3 might use the embedded LOINC code: 4548-4. The central authority platform recognizes each of the three laboratory information system inputs representing the same value — glucose level. Subsequently, the healthcare organization’s electronic health record (EHR) or business intelligence system makes use of the common meaning, and for example, generates a trend analysis of the patient’s glucose readings over time.

Developing a CAP requires considerable effort. The platform must be able to store all coded values, metadata, and all the content / terms. It must be able to normalize and catalog all the content / terms. It must be able track all changes in content identifiers, watches for differences in terms, cross-maps the content, route the content while preserving the data and context, and regenerate the data and content as it was stored. Finally, it must be able to manage all the content updates / releases. Today both the public and private domains have been moderately successful in developing the platform.

The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) collaborated with the National Library of Medicine (NLM) to provide the Value Set Authority Center (VSAC). VSAC is to become the public domain, central authority platform for the official versions of the value sets that support Meaningful Use’s 2014 Clinical Quality Measures (CQMs). However, currently VSAC does not go far enough to cover all use cases.

In the private domain, several health information technology vendors provide most of the required capabilities of the CAP. Interestingly, these vendors collaborated with clinical professionals to create different categories of coded systems to describe their products than those categories created decades ago by health information professionals. For example, the vendors refer to any coded system used for capturing and exchanging data as a “terminology” system, even though some of these systems are categorized by health information professionals as classification systems. In addition, the vendors categorize all “terminologies” as either standard[3] or local terminologies[4]. Some of these vendors go even farther in categorizing all “terminologies” as either retrospective or point-of-care terminologies[5]. Consequently, today not only are there too many coded systems for data capture and exchange from which to choose, but too many categories of coded systems to make sense of it all.

Assuming that both public and private domain CAP options will prevail, healthcare organizations can expect widespread use of the platforms, allowing EHRs and other electronic records, such as financial records, to incorporate multiple coded systems for specified needs. In addition, workforce demands for the clinical informatics skills needed to manage all the coded data will continue to remain strong.

[1] Clinical classification systems, such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS derive from epidemiology and health information management. These systems group similar diseases and procedures based on predetermined categories for body systems, etiology or life phases. As such, they organize related entities for easy retrieval. They are considered “output” rather than “input” systems and were never intended or designed for the primary documentation (or input) of clinical care.

[2] Clinical terminology systems (a.k.a., nomenclature or vocabulary systems), such as SNOMED CT and RxNorm derive from health informatics. These systems are expressed in “natural” language, and, typically, codify the clinical information captured in an electronic health record (EHR) during the course of patient care (because the number of items and level of detail cannot be effectively managed without automation). As such, they are considered “input” systems.

[3] Standard terminologies consist of “administrative” terminologies, such as ICD and CPT, and “reference” terminologies, such as SNOMED, LOINC, RxNorm, and UMLS.

[4] Local terminologies are those that healthcare providers, such as laboratories or physicians, use on a daily basis in their records, on the telephone, etc., to describe specific diagnoses and procedures.

[5] Retrospective terminologies consist of all standard terminologies (administrative and reference) and local terminologies, while point-of-care terminologies are those that are healthcare provider-friendly and used for specific documents.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with Dak Systems Consulting.

Morning Headlines 6/26/13

For McKesson’s CEO, A Pension of $159 Million

The record-breaking pension owed to John Hammergren, chief executive of McKesson, is discussed in a Wall Street Journal article. Had he left on March 31 this year, Hammergren would have walked away with $159 million, the largest pension in corporate American history.

Hawaii Health Systems revises upward its estimate of electronic conversion of medical records

Hawaii Health Systems Corp revises the estimate for its EHR conversion. The health system originally budgeted $58 million to implement Siemens across 14 hospitals, but is now saying that the cost will likely fall north of $100 million.

1,900 new jobs, $9.5m tax break for Athenahealth

Athenahealth has pledged to hire an additional 1,900 employees to its Watertown campus by 2022 in exchange for $9.5 million in state tax credits under a tentative deal worked out with Massachusetts economic development officials.

Quality and Safety Implications of Emergency Department Information Systems

Contributors from the American College of Emergency Physicians published an article in the Annals of Emergency Medicine that discusses the patient safety related benefits and dangers associated with the use of emergency department information systems. The article concludes with seven recommendations for patient safety.

News 6/26/13

Top News

McKesson Chairman and CEO John Hammergren is due a $159 million lump sum pension payout when he retires, the company discloses in its annual proxy filing. Experts believe it’s the largest pension in corporate history, also noting that the amount doubled in the past six years. I mentioned the hoops the company’s board went through to boost his pay without being obvious to shareholders back in January 2009, when he would have received only $85 million. Above is the six-year share price (blue) vs. the standard market indices. You can decide whether he’s worth it and if healthcare can afford it.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Seamless Medical Systems, which offers the SNAP Practice cloud-based patient engagement platform. It includes an iPad-based patient registration app and health education and literacy tools. SNAP Express includes primary care forms, digital signature capture, and forms tools, while the enterprise version also includes a bidirectional interface to the PM/EMR along with marketing tools. The iPad-based system engages patients in the waiting room as they complete forms electronically, read health and wellness information, and take notes about their visit and e-mail them afterward. Download it to your iPad for a free trial. Thanks to Seamless Medical Systems for supporting HIStalk.

I found this SNAP Practice overview on YouTube.

Acquisitions, Funding, Business, and Stock

Next Wave Health makes a minority investment in HealthPost, which offers a provider search and booking platform.

Tenet Healthcare will acquire Vanguard Health System for $4.3 billion, which includes the assumption of Vanguard’s $2.5 billion in debt. The transaction will make the combined company the second-largest for-profit US hospital chain with $15 billion in revenue, 79 hospitals, and 157 outpatient centers. Obviously they aren’t worried that healthcare costs are going down any time soon.

Sales

Baptist Memorial Health Care will integrate Micromedex clinical referential and patient education resources into Epic.

Kerckhoff Klinik in Germany choses iMDsoft’s MetaVision for its 267-bed facility.

The North Dakota HIN selects Orion Health HIE for its statewide exchange.

Washington Regional Medical Center (AR) selects patient portal and HIE solutions from InteliChart.

ProMedica (OH) will add dbMotion’s interoperability platform.

Bon Secours Health System (MD) will implement HIE technology from Aetna’s Healthagen subsidiary.

Athens Bone and Joint Orthopedic Clinic (GA) selects simplifyMD.

Novant Health chooses CSI Healthcare IT to fill training positions for its October Epic go-live.

People

Care Team Connect names Richard Popiel, MD (Cambia) to its board.

Shaun Shakib (Caradigm) joins Clinical Architecture as chief informatics architect.

Brett Davis (Oracle) is named general manager of Deloitte Health Informatics, a newly launched informatics business.  

The Premier healthcare alliance names Leigh Anderson (Global Healthcare Exchange) COO of informatics and technology services.

Announcements and Implementations

The Yale Center for Clinical Investigation deploys an interface between Yale’s Epic EMR and the OnCore Clinical Research solution.

Fulton County Hospital (MO) goes live on Healthland’s financials and clinicals.

Deloitte and Intermountain Healthcare launch OutcomesMiner, an analytics tool that leverages EMR data for comparative research.

RFID Journal profiles Texas Health Harris Methodist Hospital Alliance and its use of RTLS, including software from Intelligent InSites. They interviewed Winjie Tang Miao, the hospital’s president.  I did too, in December 2012.

SCI Solutions releases v36 of its Schedule Maximizer patient and resource scheduling system.

Government and Politics

The VA reports that it has processed 97 percent of its two-year-old veterans’ disability benefits claims and is now working on one-year-old claims.

Other

Hawaii Health System revises its estimate for converting its 14 public hospitals to Siemens, which now stands at $100 million compare to $58 million five years ago and $75 million at the end of last year. The health system say consultants underestimated the time required to maintain the system and the infrastructure in its facilities is in bad shape.

The Massachusetts eHealth Institute will award grants of up to $75,000 each to 32 collaborative projects to help 80 healthcare organizations connect to the Massachusetts statewide HIE.

Massachusetts economic development officials tentatively agree to extend $9.5 million in state tax credits to athenahealth in exchange for athena’s pledge to add 1,900 workers by 2022. Athenahealth also announces it will bring 500 new jobs to Atlanta and invest $10.8 million in a new office complex.

Weird News Andy isn’t sure what the business model of Figure 1 (the narrator of the video above pronounces it “figger one”) since it offers free photo sharing for clinicians, but WNA hopes they have plenty of photo screeners. The company says it has figured (figgered?) out a way to limit use to licensed physicians. A terse comment about the video says it all: “Looks like a quick way to get fired. Or sued.”

WNA also likes this story, which he titles “Busted!” A Chinese woman lying on her stomach playing a smartphone game for several hours experiences chest pain, which the hospital diagnoses as a ruptured breast implant.

Sponsor Updates

• First Databank launches a five-part blog series on prescription drug abuse.
• Merge announces the eClinical OS Marketplace, which allows users to electronically request and receive services from within clinical study workflows.
• CCHIT certifies that Health Care Software’s INTERACTANT v6.9 software is compliant with the ONC 2011 Edition criteria as an EHR module.
• Levi, Ray & Shoup earns HP’s Silver Partner in Excellence Award.
• Allscripts outlines its population health management strategy during a gathering of industry and financial analysts at the Center for Connected Medicine.
• Novant Health chooses CSI Healthcare IT to fill training positions for its October go-live with Epic.
• Beacon Partners publishes an article that highlights four healthcare system executives and their perspectives on integrating strategic initiatives.
• Elsevier launches EduCode Doc Briefs, an ICD-10 education series for physicians and other practitioners.
• Kareo reports that one-third of the 4,000 providers signed up for its EHR have moved from another EHR system.
• Clinovations staff volunteered at the Spring Kick event with DC United, which brought soccer to 400 underprivileged youth from 12 DC neighborhoods.
• CareTech Solutions will offer its help desk clients Courion’s PasswordCourier password management and AccountCourier user provisioning solutions.
• Verisk Health will give away three $30 Starbucks gift cards to random participants of its online survey on the shared-risk care delivery model.
• EClinicalWorks has signed up 1,000 providers for its RCM during the first six months of 2013 and is projected to reach $100 million in revenues by 2015.
• SQL Server Pro highlights the new version of Predixion Software’s collaborative predictive analytics platform.
• Conway Medical Center (SC) shares how its implementation of Rev-Cycle+ from T-System helped the organization increase collections 41 percent over five and a half years.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/25/13

The Impact of Electronic Health Records on Ambulatory Costs Among Medicaid Beneficiaries

A study published in the Medicare and Medicaid Research Review followed the implementation of ambulatory EHRs in three communities, concluding that the adoption of EHRs in community practices does not consistently impact Medicaid costs either positively or negatively.

Vanguard deal would bolster Tenet in key markets

Dallas-based Tenet Healthcare Corp. will acquire Vanguard Health Systems in an all-cash $1.8 billion deal. The acquisition also requires that Tenet assume $2.5 billion of Vanguard’s debt, bringing the true price to $4.3 billion. The new health network will include 79 hospitals across 30 markets. The deal also brings ACO expertise to Tenet as the organization prepares to move toward a value-base purchasing reimbursement model.

Disruptions: Medicine That Monitors You

The New York Times covers the rise of ingestible "smart pills" after a recent FDA decision to ease their regulatory requirements. The pills contain sensors that monitor a variety of conditions, powered by electrical current within the human body. They can send an alert to the patient and their physician should they detect an abnormality.

Today at DIA: Deloitte, Intermountain Launch OutcomesMiner Solution

Just four months after embarking on a collaborative big data partnership, Deloitte and Intermountain unveil the first tangible result of their efforts. This week at Drug Information Association’s 2013 Annual Meeting, the organizations unveiled OutcomesMiner, an analytics tool that help researchers evaluate treatment options and predict likely outcomes specific to unique sub-populations.

Curbside Consult with Dr. Jayne 6/24/13

There are some days where I just have to shake my head. Today is one of them. I received some news from one of the hospitals where I moonlight. It was the kind of news that defies all logic, and especially in the era of healthcare cost cutting, makes you wonder what in the world people are thinking. In trying to process through it, I’ve decided that there must be some kind of extraterrestrial accounting system (not to mention logic) that only applies to hospital administration.

It reminded me a little of the starship Bistromath in Life, the Universe, and Everything by Douglas Adams. For those of you who aren’t sci-fi aficionados, the Bistromathic Drive is a propulsion system that “works by exploiting the irrational mathematics that apply to number on a waiter’s bill pad and groups of people in restaurants.” Read the full description — it’s good for a laugh. I always think of it when I’m with a group trying to figure out who owes what part of a check.

I’m not against hospital administrators. This is not an “us vs. them” rant. I understand they have to make the same types of difficult choices that all of us do in trying to deliver high-quality, cost-effective care to the right people at the right time. Some of my best friends are administrators. They seem to be between the proverbial rock and the hard place a good percentage of the time, especially those at non-profit and safety net facilities. How they juggle the competing requests for resources and determine how one priority takes precedence over another is often beyond me.

What did they do this week however that was so logically convoluted I had to take my jaw off the floor? The administration of a semi-urban safety net hospital decided to close the “quick care” part of the emergency department. I’ve written about my work here before, joking that we could provide more cost-effective care by stationing a well-trained Boy Scout with a first aid kit at the front door.

People come to this hospital for everything under the sun. I’ve worked on the express care unit for half a decade because the “real” emergency physicians don’t want to go there. Those of us that are board certified in other specialties enjoy the work because it looks a lot like a primary care practice although without a stable patient population.

Quick care has been doing its part to keep the overall ED wait times low. We handle all patients door-to-door in close to 60 minutes or less, which is amazing when you consider the population, their lack of follow-up, and the volume. The hospital is one of the busiest facilities in the region, which is why I was completely floored when I received notice today that the quick care unit was closing. Since this isn’t my full-time hospital, I had no idea it was coming. Worse yet, neither did the staff with whom I just worked last week.

The hospital has decided to take the unit and roll it into the rest of the ED. As another part of the cost-saving measure, they’ve decided to terminate the services of all the part-time physicians. Quick care patients will be handed by nurse practitioners and physician assistants embedded in the “regular” emergency department.

Why doesn’t this make sense? Several things jump out at me.

The physical quick care unit will be repurposed and the patients will be physically seen in the existing ED. This is a net loss of nine beds. The existing ED physicians will be expected to supervise the midlevel providers in addition to their normal shift duties. Nursing staff ratios will be kept the same and the quick care nurses were laid off as well. I almost cried when I realized that. These men and women are the rock stars of the ED, handling nine patients at a time and keeping the flow moving while doing the same level of documentation as the rest of the ED, often having to clean rooms themselves because of the lack of other support staff and sometimes taking care of really sick overflow patients still at a 9:1 ratio. They are hard workers who know just how to juggle patients to keep the visits under 60 minutes. Most of them have been in quick care for more than a decade.

It was this realization that led me to believe they must be using some kind of Bistromathic accounting. In this healthcare climate, who lays off nurses? Especially nurses who can juggle patients and flip rooms as fast as this crew? Who thinks they can just take an additional 50 to 60 patients per shift and funnel them into the ED workflow without drastically sabotaging the ED wait time statistics? And with nine fewer beds? I also wonder who thought the ED physicians would be game to supervise additional midlevels without compensation, which is part of the package.

I think there may have been a bit of sorcery involved as well because none of the line staff seemed to know this was coming. I’m sure the department chair and the nursing directors were in cahoots with the administrators and accountants, but the rest of the team sure wasn’t. Keeping a secret like that is pretty impressive. They managed to keep it quiet a good long time too, only showing their hand the week before the closing. I guess I won’t be bringing my famous chili dip to the July 4 shift party after all.

For those of us that don’t have regular shifts, it was like a death in the family – realizing that you may never again see people you’ve (literally) shared blood, sweat, and tears with. For the handful of staff that are losing their full-time jobs, it’s stunning. Maybe it will go better than I expect, although I can’t wait to see the next quarter’s numbers for wait time, patient satisfaction, and provider productivity.

I’m mourning for my colleagues and missing them already. I suppose it’s a good thing since I’ll have unexpected free time. But if you happen to need a skilled adrenaline junkie to pick up some shifts, give me a call.

E-mail Dr. Jayne.

Readers Write: My Notes On Last Week’s Senate Finance Committee Hearing

My Notes On Last Week’s Senate Finance Committee Hearing
By Data Nerd

In a rare twist of fate, I had some down time last week in between deadlines and got to choose between a variety of Congressional hearings to ridicule observe. While I’d really have loved to see Gen. Alexander prove that the NSA has foiled a legitimate terrorist threat, I decided to go with the Senate Finance Committee’s hearing on the dually-pressing grievances of high prices and low transparency in the health care industry as enumerated in Steve Brill’s Time piece, “Bitter Pill: Why Medical Bills are Killing Us.” The hearing lasted about as long as it took me to read the original article and unfortunately I couldn’t “observe” all of it, but here are the questions and responses I found most relevant on the topic.

Sen. Baucus kicked off the questioning by stating that disclosure alone may not be sufficient to bring down healthcare prices and asked each of the panelists to supply a solution to the problem. Mr. Brill pointed out that injecting competition into the insurance market alone doesn’t guarantee price reduction. He brought up the large amounts of campaign contributions made by the healthcare industry to each of the members on the committee, the least of whom accepted half a million dollars in the past five years. Suzanne Delbanco, executive director of Catalyst for Payment Reform, states that consumers tend to assume that higher price means higher quality, while Paul Ginsburg, president of Center for Studying Health System Change, suggests changing benefit design so that consumers care which provider they see.

Sen. Hatch questions what type of data is being released and how reliable and useful it is to consumers. Dr. Ginsburg hones in on insurers and employers as the best source for consumer health care pricing data, stating that data has to be customized and reflect details of particular health plan, and these organizations are in best position to provide that.

Sen. Hatch shifts focus to hospital chargemasters: “If they are only marginally relevant, what steps should we take to move away from these systems and replace them?” Dr. Delbanco responds by agreeing that CMS pricing data released was great education for all concerning price disparities, but that providers and consumers need to understand costs of delivering care and the costs of delivering high-quality care.

Sen. Thune next takes the floor and cites some state measures to publish price lists. He asks Dr. Delbanco if published price lists for elective procedures are effective in putting market pressure on hospitals. Dr. Delbanco states that very little research has been done on whether consumers use this data, but is a beginning. She stresses the need of customization to make usable, vis a vis connecting price data to health care plan specifications.

Sen. Thune astutely acknowledges the role of recent regulations in pushing the industry towards more consolidation and asks what role this plays in pricing and whether antitrust laws need to be reevaluated in light of this shift. Dr. Ginsburg says that the best approach is to take steps to make the market more competitive despite its consolidated state. He mentions a need to revisit FTC Safe Harbor policy to require demonstrations of benefits for patients, and asserts that government can take a legislative approach to outlaw non-competitive contracting practices between health plans and providers.

Sen. Burr asserts that “seniors don’t like choice” and that “faced with healthcare decisions, their [adult] children are increasingly being turned to rather than healthcare providers”. He also offered that it “would be a cheap shot” to say that donations that health care organizations have made to him as informing the healthcare legislation he has written. Mr. Brill pointed out that he didn’t accuse him of such.

Sen. Rockefeller brought up the “public option” and the fact that everyone loved it but no one voted for it, so it was replaced with a “medical loss ratio” that resulted in private insurers being forced to issue rebates to consumers. He brings it all home by praising Congress on the establishment of IPAB to take the power of the purse away from lobbyists and Congress and give it to physicians that can make “wiser” decisions to save Medicare dollars. To this, Dr. Ginsburg responds that IPAB is “constrained,” with only the authority to squeeze money from reimbursement. Reimbursement, he says, is on autopilot and Congress can still lower reimbursement amounts at will. Instead, he expects more savings to come from Innovate Reimbursement models.

Sen. Baucus highlights the price variations and states that “he saw a chart somewhere” that showed that Medicare reimbursement amounts do not vary as much as private insurance reimbursement. He asks why this is so and if CMS has access to private insurance reimbursement data. Dr. Ginsburg agrees with Sen. Baucus’s assessment and asserts that new reimbursement models should address price variances. He mentions regulating private prices like Maryland has done since the late 70s. Brill asserts that a five-column list should be made public: what Medicare pays, what the Chargemaster charges, and what the three largest insurers pay for the same service. Dr. Delbanco asserts the need for quality input. She states that it matters little what you pay for a service unless the quality is satisfactory.

Sen. Menendez quickly launched into an attack, stating that Mr. Brill’s article did little to acknowledge how healthcare reform is addressing price disparities. Brill interjects and refers the senator to a specific paragraph of the article, to which the senator tells him to wait until he is done stating his question. He then attempts to corner Mr. Brill into agreeing that Obamacare addresses price volatility by eradicating low-quality health insurance plans and expanding coverage for citizens. Mr. Brill maintains that, while beneficial in other areas, the ACA does not directly address price variation in the market. Menendez asks him if he believes prices should be controlled by the government. Mr. Brill states that he believes “patented, life-saving drugs” should be controlled, but not procedures, and that “some interference is needed to preserve a free market.”

Sen. Baucus asks why hospitals are so fancy and compares healthcare to education and insurance to student loans. Dr. Delbanco points out that patients do not have data on which to base their provider choice, so they generally go on perception of facilities. Dr. Ginsburg states that consumers are removed from cost.

Sen. Schumer points out that higher costs at teaching hospitals are justified because they typically treat more rare, last-resort patients.

Sen. Baucus proposes an entrepreneurial approach to itemizing costs at a hospital on any given procedure and making that data available to consumers. Ultimately, he asked “What data, if any, should be proprietary?”

Overall, the Senators prepared meaningful questions to ask the panelists and were provided well-thought-out responses that intimate the complex nature of this issue. Consumers do not want raw massive files of data to pore over – they want someone to provide it in a way that is personalized, comprehendible, trustworthy, and ultimately actionable. Doing this will require a complex system of cost to quality analysis coupled with personal health and insurance policy parameters.

In my opinion, any true consumer solution will offer an element of predictive capability on which to base insurance and provider choices. To the entity (or entities) that can provide this in the least-intimidating way go the spoils. Who knows whether it will be insurance companies themselves, a joint venture between them and employers, or an entrepreneurial one-size-fits-all solution? 

I’m giddy to see the day when I can not only predict my tax burden six months in advance and strategize how to minimize it for free online, but also chart out a course for my family’s healthcare and make informed decisions about how much coverage we need and where we should go to get care.

Morning Headlines 6/24/13

Experts tout Blue Button as enabling information exchange between medical provider and patient

The Pittsburgh Post Gazette covers the federal government’s Blue Button initiative, calling for its expansion into the private sector and citing it as a key concept to moving forward in an EHR-enabled healthcare system.

Creative Skills For Life – Creative England Competition Fund

In England, the NHS and Creative Skills for Life announce a $154,000 contest that challenges developers to create apps that will help young people with life-threatening or debilitating medical conditions explore their creative potential.

Optometry EHR Breached in Florida, 9,000 Notified

An optometrist’s office in Gulf Breeze, FL is notifying 9,000 patients that their personal health information has been compromised after hackers break into the practice’s EHR and copy the medical records data.

Monday Morning Update 6/24/13

From Over Overlake: “Re: Overlake Hospital & Medical Center, Bellevue WA. Recently went live on Epic and is conducting a RIF by reposting its jobs and requiring current employees, including those supporting and installing Epic, to reapply for their jobs. Estimates are they will eliminate 10-15 percent of the IT workforce. The CIO is on a month-long leave while the RIF takes place.” Unverified.

From Robot Ghost: “Re: Duke University Hospital. Live on Epic as of Saturday morning.” Verified, according to the forwarded e-mail.

Respondents aren’t impressed with the EHR Developer Code of Conduct, with the vast majority saying it won’t have any effect on anything. New poll to your right, inspired by Ed’s “Bank Life, Not Vacation Days” post: do you take all the paid time off provided by your employer in a given year? I admit that I don’t, meaning my PTO days roll to the long-term bank and I’ll never get them back.

I have HIStalk Webinars scheduled through the end of the year and need more CIO reviewers to spend about 45 minutes reviewing a recorded Webinar rehearsal and providing feedback to the presenter. I’ll send you a $50 Amazon gift certificate and my thanks. Let me know if you are interested.

With Friday’s official start of summer, the industry takes a collective break and legitimate news tapers off until September. HIStalk articles will sometimes be shorter (like this one), but you aren’t missing anything. I just refuse to waste your time padding out the posts with junk news cleverly written to sound important.

Welcome to new HIStalk Platinum sponsor Clinical Architecture. The Carmel, IN-based company provides solutions that overcome healthcare’s terminology-related barriers. Those challenges include translating the terms within Continuity of Care Documents for Meaningful Use using structured and coded information (lab to LOINC, meds to RxNorm); mapping local terminologies specific to users or departments; handling translation ICD-10; and meeting PQRS/NQF quality reporting by identifying patients using normalized information and a standard coded vocabulary. The company’s approach with its high-performance, self-monitoring Symedical Server is to normalize (with its Cognition Engine), standardize (Coordination Engine), correlate (RelationSense Engine), and interpret (Sift Engine). Behind the scenes, Symedical Server handles high performance run-time APIs, a messaging and communications framework (including an iPad app), content distribution, a domain designer for custom content domains, and tools for searching and collective reasoning. Customers include providers and HIEs (semantic interoperability, quality reporting, and aggregating clinical and administrative data), HIT vendors (meeting Meaningful Use requirements and managing terminology content), and payors (analytics and improving efficiency). Everything in healthcare revolves around terminology and Clinical Architecture’s solutions enable the efficient and semantically accurate exchange of actionable healthcare data. The company is running a Share Your Healthcare Terminology Dream or Nightmare contest just for HIStalk readers, with winners receiving a Windows Surface Pro. Thanks to Clinical Architecture for supporting HIStalk.

Here’s a new YouTube video from Clinical Architecture that describes healthcare terminology challenges.
 
 

Miami Valley Hospital (OH) CIO Mikki Clancy is promoted to COO.

Former AirStrip VP Connie McGee launches Evolve Women, a career development website for women.

The “Race for Heroes” 5K race in Alpharetta, GA raises $100,000 for job training for veterans and their spouses. MedAssets and Hire Heroes USA were the sponsors.

Catholic Health Initiatives chooses QuadraMed, now owned by Canada-based Constellation Software, to provide data consolidation services. 

Creative Skills for Life, along with NHS England, is running a contest that offers $154,000 in prizes to developers of 10 prototype apps that support young people in the UK who have life-threatening and limiting medical conditions.

I’m really enjoying Vince’s HIS-tory of Epic, including his Part 3 installment.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Through a Different Lens

Through a Different Lens
By Kathy Krypel

In the end, it was hepatitis. Not some organized alphabetized version, but a quick, no-holds-barred attack from inside that would give me 10 days in the hospital and a look at healthcare from a very different perspective.

I am a clinician. I am also a healthcare IT expert. And now, I am a patient.

My induction into patient life was abrupt and unexpected. I, who had not been hospitalized in 30 years, was afflicted with sepsis in very short order. The trip to the emergency department, the 103 degree fever, and the 10 days spent in the hospital are all a bit of a blur.

Looking at it weeks later, from the slow recovery side of things, I offer these observations.

The Clinicians

I don’t know if they still teach something called ‘bedside manner’, but my experience with clinicians varied significantly. On the high end of the scale were the infectious disease doctor and hospitalist who coordinated care, modeled teamwork, and went out of their way to explain tests and procedures to me and my family. On the low end was the consulting physician, who referred to me as the ‘bile duct in 52’ in a hallway conversation that I happened to overhear.

The nursing, lab, radiology, and transport staff will forever have my gratitude for the way they fiercely protected my modesty (even when I was too sick to care), kept me informed about test results, and treated me and my family with utmost kindness.

The Electronic Medical Record

Ironically, I actually helped build the EMR and train users at the hospital where I was admitted. It was astonishing and very impressive to see it in action. I was able to see how quickly blood test results came back, watch the multiple ultrasounds and CT scans, and even observe my own liver biopsy.

It was fascinating, but reminded me that the EMR is only a tool that offers safeguards and suggestions. The physicians on my case were dogged in their pursuit of this infection, but even with the best of electronic records, they could not grow a blood culture faster or obtain instantaneous results on lab draws. These just take time. As good as an EMR is, it can help with the diagnostic process, but cannot magically make it faster.

The Patient

At the end of the day, it’s the human things that I will remember most – the infectious disease doctor who held my hand in the ED, the hospitalist who sat on the end of my bed for 30 minutes and explained what was happening and said that she would “tell us when to worry,” and the number of nurses who looked me in the eye and said, ‘I am so sorry this is happening.”

Despite advances in healthcare information technology, there’s still an inherent need for the personal connection – the relationship. That is the vehicle for healing. As the industry tackles the patient engagement challenge, the relationship – the patient experience – truly is at the center.

Kathy Krypel, LICSW, PMP is a master advisor for Aspen Advisors.

Readers Write: What’s in YOUR Medical Record?

What’s in YOUR Medical Record?
By Ken Schafer

If my wife were admitted to the hospital with diabetic ketoacidosis (DKA), I’m pretty sure I wouldn’t want her electronic record to erroneously record a leg amputation (BKA). I’m equally confident that if this documentation mistake were made, I wouldn’t care too much how it happened. I would just want it fixed.

And if incorrect documentation on my diabetic wife resulted in an incorrect treatment course, which resulted in her death? You might end up with a $140 million verdict like this one.

Inga’s post on The Atlantic’s “The Drawbacks of Data-Driven Medicine” (from Big Datty,on 6/12/13) illustrates something that we all know to be true. Our medical records often contain mistakes, and electronic errors perpetuate themselves embarrassingly quickly. But her comments – and the source article – miss two very important points.

Doctors are responsible for the content of the records they create. This is true regardless of the method used to document patient encounters. Blaming the speech recognition system for hearing “DKA” instead of “BKA” makes no more sense than blaming a keyboard for a typographical error. If the physician picked the wrong checkbox on an EHR interface, would that be the fault of the EHR? Of course not.

Speech recognition, keyboarding, and dropdown menus are all methods for data capture. For that matter, so is a more traditional transcription process. But all of these methods have one element in common: the final content should be reviewed and validated by the documenting clinician. Physicians who fail to do this put their patients at risk.

Doctors make mistakes. I know a radiologist who dictated “liver” when he meant “heart.” The transcriptionist dutifully returned the report with the word “liver,” and it was signed by the physician. When the mistake was discovered, the audio was retrieved. The doctor listened to himself dictate the wrong organ, and blamed the transcriptionist. The point? Doctors are people, and people make mistakes, whether they own up to them or not.

That same physician was convinced speech recognition would eliminate transcription errors, and he was right – sort of. What speech recognition systems really do is eliminate transcriptionists, not errors. If radiologists are involved, there will still be errors. There’s no speech recognition system that will hear the word “liver” and change it to “heart.”

In fact, in our DKA:BKA example, the doctor may have had a bad day and actually said BKA to the speech recognition system. No matter what, though, the doctor made a mistake – either in what he said, or in what he saw on the screen and failed to correct.

Those with experience greater than mine often post to HIStalk about the shortcomings of EHRs in terms of the data they contain, with usability and completeness being favorite topics. My concern for our records is more specific. Especially when speech recognition is involved, what metrics do we have in place to make sure that narrative data is recorded accurately? If doctors are responsible for the content of their documents, and we know they make mistakes, how do we monitor and improve the quality of the narrative components of our EHRs?

As the government, physicians, patients, and the free market determine what systems we are to use and how they should work, we should never lose sight of this one truth: no matter what’s in the record, it should be right.

Ken Schafer is executive vice president, industry relations for SpeechCheck.

Time Capsule: The Obama-HIStalk Digital Stimulus Grants: Why Letting Me Hand Out the Freshly Printed HIT Cash Makes Sense

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2009.

The Obama-HIStalk Digital Stimulus Grants: Why Letting Me Hand Out the Freshly Printed HIT Cash Makes Sense
By Mr. HIStalk

This government stimulus thing is new to everyone. It’s no wonder all of us (Uncle Sam included) are bumbling around cluelessly, flitting from one hare-brained idea to another on how we’ll improve healthcare by throwing new money at old products used by uncommitted providers who have had minimal impact so far.

Hospitals and vendors are used to being poor, so the pressure is excruciating. Without the excuse of perpetual poverty, people are going to want results. Duh!

(It’s ironic. We got into this mess by living beyond our means. Now Uncle Sam is going to do the same to buy our way out of the recession. If it fails, we’ll be like Zimbabwe printing $100 trillion notes that won’t buy a loaf of bread.)

Nobody can quite figure out what to stimulate with the hundreds of billions. What people are missing is this: it doesn’t matter. The goal is to just blast a lot of freshly printed cash out there. It only has to exchange hands enough times to create the illusion of restored prosperity. Nothing really has to be fixed in return. You might as well kick $100,000 cash bundles out of airplanes. Just get the money into circulation and hope for the best.

(See: Wall Street bailouts. And note: while I enjoyed MBA macroeconomics, I really never understood the whole money supply thing, so I could be slightly off base).

That’s why I humbly nominate myself to personally manage the process for healthcare IT’s $20 billion lottery winnings.

Everybody agrees that the deficit-enhancing stimulus needs to be a shock-and-awe carpet bomb of currency to put out the recessionary fires, kind of like John Wayne in “The Hellfighters” bombing burning oil wells to snuff out the flames. Here’s how I’ll get all that money into circulation and working by April.

I’m going to take all $20 billion to the HIMSS conference (note to self: I’ll need a suite rather than a room, hopefully one with a large in-room safe). When the show opens in the inevitable Chicago snowstorm, I’m going to quietly observe the action and decide in a unilateral but entirely trustworthy manner who I’m going to hand it out to, kind of like Oprah giving away cars or that ‘50s TV show “The Millionaire.” There’s no committee and no paperwork – you just have to impress me while I’m undercover, and I tend to like non-conformists.

Unlike Uncle Sam, I don’t care about your previous track record. Given the state of healthcare IT, the folks with a long industry history aren’t the ones you would want leading a revolution. It’s time to identify some new blood.

I’ll start with the Venture Fair, giving some CEO-wannabe armed with his idea for an EMR written in Excel $50 million. Then on to the opening reception, where anyone willing to publicly say that interoperability is a cruel hoax will find wads of cash in their pockets afterward. CIOs of hospitals under 200 beds doing CPOE get $10 million, no questions asked.

Got a cool booth design that catches my eye? Here’s $25 million – thanks for the chuckle. A session presenter who actually has something interesting to say without any obvious bias? Take this $50 million, my friend, and do good deeds. A bored hooker forced by economically challenged Johns to moonlight as a booth babe? This million will get you through an informatics training program. A replacement for the cheesy HIMSS opening theme, “Now Is Our Time?” AC/DC live right there in the hall, doing “ Information Highway to Hell.”

I’m going to seek out the industry’s downtrodden, the non-suit wearing, non-badge ribboned rank and file who have been rowing hard in the galleys while the millionaire captains were steering the ship aground. As long as you’re passionate, poor, and fun, you get one of the thousands of Obama-HIStalk Digital Stimulus grants (extra points if you’ve been laid off or forced to move to Kansas City).

You might scoff at the frivolous nature of my self-nomination, but I will get the job done better than any HIMSS committee or federal agency. The money will trickle down like nobody’s business. I will make sure only interesting people and not soul-sucking corporations get it and I won’t siphon off 20 percent as my administrative costs. It might work and it might not, but that’s no different than any of the fancy-pants suggestions that are on the table. Everybody’s making it up as they go.

All I ask in return is adoration and maybe an Obama fist-bump. And, the thanks of a grateful nation.

Morning Headlines 6/21/13

Cone Health to lay off 150 workers

Greensboro, NC-based Cone Health will lay off 150 workers, or about three percent of its workforce, to help cut $30 million from its annual budget. Terry Akin, Cone Health president and COO, said that its Epic implementation has been a big short-term expense.

Cerner Launches Pilot Program To Offer Personalized, Quality Care Aligned For Better Health 

Cerner launches a Kansas City area pilot program to test new health delivery model in which retail locations serve as patient access points. Nurses will perform wellness screenings and provide tailored patient education and recommendations.

New Technology in Place for Electronic Submission of Veterans’ Disability Claims

The VA has launched a new Web portal that will allow veterans to submit disability claims electronically. The system is integrated with the VA’s paperless claims processing system VBMS, creating a nearly paperless end-to-end process. Medical records are one of the few claims elements that will still need to be scanned or mailed on paper.

The Regional Extension Center Program in Texas Met the Scope of Services in Their Cooperative Agreements With the Office of the National Coordinator for Health Information Technology

The Office of the Inspector General audits four Texas Regional Extension Centers that were cumulatively awarded more than $30 million in federal funds. The goal of the inspections was to verify that the RECs had meet the requirements outlined in their cooperative agreements with ONC. OIG auditors concluded that the REC programs had meet all requirements and were successful in supporting health IT adoption across their territories.

News 6/21/13

Top News

Healtheway announces its nine founding organizations. The public-private partnership will provide operational support for the eHealth Exchange, formerly known as the Nationwide Health Information Network Exchange.

Reader Comments

From Site Watcher: “Re: HIStalk. Happy 10th anniversary!” Thanks! It has gone by quickly.

From Doug: “Re: Meaningful Use security risk analysis. I would be interested in which of your sponsors offers consulting engagements, especially those appropriate for a 100-bed community hospital.” Thanks for showing preference to HIStalk’s sponsors, any of which that can help Doug can contact me and I’ll forward your information.

From Vascular Surgeon: “Re: health data. A Wired graphic from April finds that Kaiser Permanente’s data set is 31 petabytes, six times the size of the digital collection of the Library of Congress.”

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: the top ambulatory EHR, PM, and clearinghouse products according to the KLAS Mid-Term Report (and don’t miss the readers’ comments about the rankings.) A computer outage in the Canadian province of Alberta causes 202 practices to lose access to patients’ charts for over five hours. Almost half of practicing physicians are dissatisfied with their jobs. CMS publishes updated 2014 clinical quality measures for EPs. Technology could improve treatment outcomes for children with chronic illnesses. I whine and wonder about waiting at my doctor’s office. I love new readers almost as much as I love ambulatory HIT news, so sign up for the e-mail updates when you are perusing the news. Thanks for reading.

Some of the interesting recent posts on HIStalk Connect are (International) White Collar Healthcare, Mobile Health App Platform Choices, Apple Markets Its Role in Global mHealth, and Start Me Up HIT Event. Get e-mail notification of new HIStalk Connect posts by signing up.

I’ll be surveying the HIStalk Advisory Panel of primarily CIOs again this week. Let me know if you have a question you’d like me to ask them.

Welcome to new HIStalk Platinum Sponsor Logicare. The Eau Claire, WI company offers patient instructions for hospitals, clinics, and EDs that integrate with all major EHRs including the VA’s VistA. Clinicians enjoy the ability to create a patient-specific teaching document in just a few clicks, while patients can actually understand that document since the content is written at a sixth-grade reading level. Patient instructions are offered for 6,300 topics and the system has earned numerous ONC certifications, making it easy to meet the Meaningful Use requirement to provide electronic discharge instructions (flash drive, secure e-mail) at the time of discharge for patients who request them. Thanks to Logicare for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Clinical Outcomes Management Systems, a provider of disease management technology for the long-term care industry, secures a minority investment of $21 million from Summit Partners.

Agilum Healthcare Intelligence raises $1.82 million of a $2.32 million equity offering.

Sales

Polyclinic Surgery Group (WA) selects ProVation medical software from Wolters Kluwer Health.

The Georgia Department of Community Health selects Truven Health Analytics to build and implement the Georgia Health Information Network.

Chinese Hospital (CA) will deploy NextGen Inpatient Clinicals.

KishHealth System (IL) selects PerfectServe clinician-to-clinician communications platform for two of its hospitals.

WellStar Health System (GA) will deploy Capsule’s DataCaptor software across its five hospitals.

People

Eastern Maine Healthcare Systems announces that VP/CIO Catherine J. Bruno will retire in December.

Ernst & Young names Encore Health Resources CEO Dana Sellers its 2013 Entrepreneur of the Year for Healthcare in the Gulf Coast Area.

Jerry Dennany (Allscripts) joins RazorInsights as CTO.

UltraLinq Healthcare Solutions appoints Ross Hoffman, MD (MedSolutions) CMO.

Announcements and Implementations

Caradigm announces the availability of Provisioning v4.0, which manages clinician access to applications while supporting data privacy regulations.

EHealth Technologies breaks ground on its new company headquarters in Rochester, NY.

Cerner launches a pilot of the Primary Health Network, a health model that uses retail locations as access points for wellness screenings.

Government and Politics

The HHS Office of Inspector General audits four Texas RECs and concludes that each has met the scope of services in their cooperative agreements with the ONC. The audits are the first of their kind by the OIG and focused on outreach activities, vendor selection and implementation assistance, and workflow analysis.

The VA announces the availability of eBenefits, an online portal that will allow veterans to file disability compensation claims electronically.

Hello, Cleveland! MT @ChitraMohla 400 attendees present to listen in on what @JudyMurphyONC has to say. Great venue!

— ONC (@ONC_HealthIT) June 20, 2013

Today’s best use of a “This Is Spinal Tap” reference in a tweet comes from, interestingly enough, the federal government.

Other

Unionized nurses with Affinity Medical Center (OH) call on hospital officials to delay this weekend’s implementation of Cerner EMR, saying patients will be at risk because the nurses have not received sufficient training and will be short staffed during the first days of the live. The nurses detailed their concerns in a letter to hospital officials, but claim that hospitals officials refused to meet with them and would not accept the letter.

Here’s athenahealth’s Jonathan Bush speaking at TEDMED 2013 on healthcare profits, pointing out that non-profit hospitals often make bigger margins than Exxon. “In the mid-1990s, healthcare was annoyingly affordable – annoying if you’re one of the hospitals.” He names names.

Cone Health (NC), facing a $30 million annual budget shortfall, will lay off 150 employees. Both Cone and nearby Wake Forest University Baptist Medical Center say their Epic implementation costs hurt their bottom line at least temporarily.

Sponsor Updates

• HealthEdge, a provider of IT solutions for healthcare payors, partners with NTT DATA to transition Independent Health and Riverside Health to the HealthRules product suite.
• Divurgent posts a video of its DIVOLYMPICS employee spring games event.
• Two members of Wellcentive’s implementation team earn NCQA certification as content experts for patient-centered medical homes.
• Access partners with The Last Well to bring clean water to all of Liberia.
• A Deloitte Center for Health Solutions report explores how CIOs are navigating  day-to-day management challenges.
• Visage Imaging publishes “Three topics you may have missed from #SIIM13” as a follow-up to the recent Society for Imaging Informatics in Medicine 2013 meeting.
• ISirona President Peter Witonsky lists key criteria for evaluating a medical device data system.
• GetWellNetwork announces the Transformative Health Series, a series of short films that recount the personal journeys of patients, families, caregivers, and healthcare professionals who are shaping the patient engagement movement.
• API Healthcare opens its annual conference with a keynote address featuring Paul Spiegelman, author of Patients Come Second: Leading Change by Changing the Way you Lead.
• Verisk Health announces the agenda and speakers for its 2013 national conference September 18-20 in Orlando.
• The Association for Healthcare Documentation selects Emdat as a nominee for the Innovation Through Technology Award.
• A local publication features Canton-Potsdam Hospital (NY) and its online bill-pay service operated by Instamed.
• Strata Rx announces the schedule for its O’Reilly Strata Rx Conference September 25-27 in Boston.
• Aspen Advisor consultant Claudia Blackburn will discuss how to empower population health during a June 25 Webinar.
• Wellsoft’s EDIS earns the top rating for EDIS and Imprivata takes the top spot for Single Sign-On in the KLAS 2013 Mid-Year Performance Software & Services report.
• Former CMS Administrator Donald Berwick, MD discussed the future of healthcare at this month’s 22nd Annual Midas User Symposium.

EPtalk by Dr. Jayne

The American Medical Association’s House of Delegates met in Chicago this week. One of their resolutions addresses sitting in the workplace. Employers are encouraged to make alternatives available including standing desks, treadmill desks, and isometric balls. I’d love to have a treadmill desk, although I spend half my day on conference calls which would render it almost useless. Several schools in my area are experimenting with standing desks in the classroom, citing famous users Thomas Jefferson, Winston Churchill, Charles Dickens, and Ernest Hemingway.

I loved this piece on batch workflow for the medical office that turned up on KevinMD this week. It should be required reading for EHR users. Author Dike Drummond, MD compares physicians that respond to popups and messages in the EHR to a dog with a tennis ball that can’t choose to not chase it once thrown. Watching my colleagues become totally distracted with Instant Messenger, Twitter, Facebook, and e-mail all day long, I can’t help but agree.

Dr. Gregg tweeted earlier in the week about the fundraising effort for Scanadu Scout, being billed as the first real medical tricorder. I e-mailed myself to look at it later and am happy to see that they have raised over a million dollars. I also learned that the Scout is built on the same platform as the Curiosity Rover, which is pretty cool if you’re a science geek like me. Scanadu hopes to use backers to gather data to help refine its algorithms as well as to prepare for FDA approval as a medical device.

Speaking of Twitter, Bill Gates @BillGates noted this week that he is “Excited to join the 200M+ strong @LinkedIn community.” I wonder if his connections will start endorsing him for skill sets that he doesn’t actually have, which is what my connections recently started doing? It’s definitely been amusing.

I’m excited about the new HIStalk webinar series, but unfortunately my day job keeps interfering with my potential attendance. Next week’s webinar addresses “Using Clinical Language Understanding & Infrastructure Planning as Key Strategies to Ensure Clinical Revenue Integrity with ICD-10” and you can register here. I’ll likely register anyway with the hopes that my conflicting meeting will cancel – hope to see you there!

We’ve all heard horror stories about organizations dumping medical records rather than shredding them or unintentionally misplacing paper charts. Now that patients are receiving copies of their visit summaries and other documents at every visit, there’s an increased chance that we’re going to see more than grocery receipts and shopping lists blowing in the wind. Kudos to my friends at DISC Corporation who made sure the full-color copies of a patient’s colonoscopy report made it to the shredder. Not every patient-facing document has a patient or practice address, so that was probably the most ethical course of action.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/20/13

Atul Gawande, Renowned Surgeon And Writer, Launches Innovation Lab

Surgeon Atul Gawande, MD, once named by Time magazine as one of the world’s most influential thinkers and author of The Checklist Manifesto, launches the Adriane Labs health innovation center. It will conduct research focusing on childbirth and death.

Health Law Won’t Bring Prices Down For Patients

At a Capitol Hill hearing Tuesday, Time magazine journalist Steven Brill told Senate Finance Committee members that President Obama’s healthcare law will do little to lower prices for consumers. Brill covered health care costs in a heavily circulated recent Time article titled, "Bitter Pill: Why Medical Bills Are Killing Us."

Healtheway Announces Founding Members for Groundbreaking Public/Private Health IT Exchange

Healtheway, the nonprofit organization that supports the eHealth Exchange, today announced its nine founding organizations, of which Epic is the only EHR vendor and Kaiser Permanente is the only health system.

Affinity nurses seek delay on electronic records 

Unionized nurses at Massillon, OH-based Affinity Medical Center call for a delay in its Cerner implementation scheduled for this weekend, citing insufficient training and patient safety concerns. The nurse’s union is using the issue to demand contract negotiations.

Readers Write: Help on the Way for Clinician Work Fatigue with Drug Interactions?

Help on the Way for Clinician Work Fatigue with Drug Interactions?
By Helen Figge, RPh, PharmD

Clinicians are increasingly using an electronic health record (EHR) to enter prescriptions via a computer. Increased utilization of computerized medication order entry is being driven in part by the Meaningful Use program, which includes incentives for the adoption and meaningful use of certified electronic health records for eligible clinicians in both the Medicare and Medicaid programs.

Electronic prescribing is an integral component of the Meaningful Use program. Regardless of whether the prescriber elects to print or electronically transmit the prescription, the prescriber’s EHR can apply a series of edits to check for potential errors that could be harmful to the patient.

Some EHRs display all edits with equal significance. Hence, clinicians are presented with a stream of low-priority or irrelevant edits mixed in with occasional high-value edits. The consequences of this type of presentation are very serious because clinicians become overwhelmed and frustrated with the continuous presentation of low-priority nuisance alerts – hence clinician “alert fatigue.”

Because alert fatigue threatens to potentially jeopardize the entire concept of improving patient safety, the Office of the National Coordinator for Health Information Technology (ONCHIT) awarded a grant to the RAND Corporation and Harvard/Partners HealthCare in collaboration with UCLA to study the problem and develop a solution. The approach taken by the study group was to identify a critical set of interactions that should be implemented universally.

Thirty-one high risk drug-drug interactions were reviewed and a final list of 15 interactions was adopted. The study group considered the final set of 15 interaction pairs to be a starter set that should be identified in all commercial products as high severity because they have high potential for patient harm and are contraindicated for co-administration. The list might not represent all high-severity interactions, so additional research will be needed in this area, but it’s a proactive start.

Deployment of these 15 interaction sets in EHRs as high risk, along with the elimination of clinically irrelevant edits, could greatly reduce the burden of alert fatigue that clinicians overwhelmingly feel in their day-to-day encounters with the technologies. However, the actual commercial implementation of this approach has not been successfully accomplished due to legal issues, particularly due to concerns among database and EHR vendors about liability.

The overarching question to be answered is funding and exact methodology for moving this effort forward at the national level, which has not been identified. Furthermore, it has not been determined whether the database should be maintained by a private entity or by a public agency such as FDA.

But it is progress in the war against what really true drug integration is and what is just a cautionary listing for liability’s sake.

Helen Figge is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: Have a Seat

Have a Seat
By Ryan Secan, MD, MPH

Customer service is important. This is not a revelation. We’ve all had our terrible customer service experiences (airlines, banks, utilities, cable companies, and social media, I’m looking at you), but today I’d like to focus on good customer service. There are lots of examples of excellent customer service which don’t cost that much money (like this, or this), mostly just time, effort, and actually caring about providing a high level of service. 

While everyone pays lip service to the notion that customer service is important, somehow there never seems to be money in the budget for it. While some customer service efforts require investment, many can be done at low or no cost. This is a win-win we all hope for – a better experience for our customer that is cost neutral.

I used to own a high-mileage luxury brand car. When it needed service, my wife liked to take it to the dealer for repairs. It cost more money for the service, but to her it was worth it. The drop-off area was clean. There was a place to sit down and talk to a professionally dressed person regarding what was wrong with the car. While the car was being fixed, she always got a nice, new car as a loaner free of charge. The dealer was flexible about when she could pick up the car and bring back the loaner, and her car was always washed and vacuumed when it was done. 

This was high level customer service that was worth paying for. It likely didn’t cost the car dealer much, as any costs were likely covered by the higher prices for service. It may have actually been a source of profit if the cost of providing this level of service was less than the extra money made from the service. 

One of the best examples I’ve read is described in this post by Joe Posnanski about an experience he had at Harry Potter World at Universal Studios. He’s a sportswriter, but writes on a range of topics, and if you aren’t reading him, you’re really missing out even if you aren’t into sports. 

The column is a bit of a long read, but definitely worth it, and if you’re a parent like me, it might make you a little misty at the end. Go ahead and click through and read it right now – you’ll be happy you did.  It wasn’t the $250 million theme park that this little girl (and her dad) is going to remember. It’s the brief, meaningful interaction with a staff member who put forth just a little bit more effort than expected that made all of the difference.

In the clinical world, sometimes even the smallest things can improve a patient’s satisfaction with their healthcare encounter. A study out of the University of Kansas Hospital demonstrated than when physicians sit down during a bedside encounter rather than stand up, despite spending less time with the patient, they were perceived as having spent 40 percent more time in the room. The patients reported that they were more satisfied with the encounter and had a better understanding of their condition. 

High levels of customer service don’t have to cost a significant amount of money, just an understanding of what your customers want and are willing to pay for and a culture that empowers your team members to go the extra mile to meet the customer’s needs. We can provide this high level of service to our provider clients by actively listening to them and selling them what they want or need to do their job effectively (e.g., single sign on, interface between an application and their EHR, automation of a manual process, etc.)

In the health IT world, where technology road blocks can interfere with patient safety, it is critical that we play our part – and play it well.  

Ryan Secan, MD, MPH is chief medical officer of MedAptus.