Tag: HIT

The F Word …

Dec 1, 2019

By Margalit Gur-Arie

Fragmentation, Fee-for-service and Futile care are the trifecta of what is supposedly ailing our health care system, or non-system, as it is fashionably described nowadays. Modern health care has reached its crisis point not due to hordes of people keeling over and dying in the streets, as they did during historical health care crises brought on by plagues and famine, but due to exploding costs of delivering decent care to all people. Since the issue now is mostly financial, health care as a discipline is attracting the interests of those who practice the dismal science of Economics. Over the last two centuries, economists have successfully addressed the F words in other industries with spectacular results in developed countries, so why not apply lessons learned to health care?

The obvious reason to treat economists with suspicion in health care is the quintessential argument that people are not widgets, but there is another problem. Most tried-and-true solutions for increasing availability and quality while lowering costs of products are not accounting for the other explosion occurring as we speak – the Internet. How can this assertion be true when we are in the midst of a government sponsored spending spree to computerize medical records and adopt Health Information Technology (HIT)? Apparently, even those who lead and define the HIT revolution are reluctant (or unable) to grasp its full implication, thus they are consistently underestimating the power of the Internet to serve the individual, and as a result are hedging their bets on technology with classic industrial models from days gone by.

It Looks Like the Head of HIMSS Likes Us

Dec 1, 2018

By JONATHAN BUSH

The headline said that the chief of HIMSS sees “seismic shifts” in the health IT landscape.

I sure hope so because I’m betting on it.

As many of our employees know, HIMSS is a massively important leader in our space, and their annual conference—this year it was held in Orlando and set an attendance record of over 30,000 people and 1,000 vendors—is our chance to feel small and uninvited. It is a club of large vendors and large buyers. Very large deals, you might say ‘seismic’ deals, requiring long-term multimillion dollar commitments in EHR and practice management systems, go down at the HIMSS conventions.

Obviously, our consistent criticism has been that the balance sheet impact of such investments is not sustainable by any health care institution for long, BUT ALSO, the information that comes from such investment…well…sucks.

It doesn’t suck because the IT departments that buy and run these EHR andpractice management systems are bad (they may or may not be, I have no idea, but that isn’t the problem). It isn’t because the systems being purchased don’t work as advertised (I have no idea if they do, but I assume the answer is ‘yes’).

The Usefulness and Uselessness of Electronic Medical Records

Dec 1, 2018

By RICHARD REECE, MD

Nothing is so useless as a general maxim.

Lord MacCaulay (1800-1859), On Machiavelli (1827)

I dare say that I have worked off my fundamental formula on you that the chief end of man is to frame general propositions and that no general proposition is worth a damn.

O.W Holmes, Jr. (1809-1904), as quoted in The Practical Cogitator, 1962

The general maxim and general proposition behind the rationale of a national interoperative electronic medical record system in every physician’s office is that you can never get too much information and that government can use digital data to cut costs and improve care.

The Problem

Sounds good, doesn’t it? The problem is that so far, after nearly a decade of advancing this maxim and proposition, perhaps 80% of physicians in independent practice aren’t buying. And this, in face of the reality, that government has proposing spending $27 billion to get EHRs off the ground. And beginning this year, CMS will start offering as much as $44,000 per physician over a staggered five years if physicians make “meaningful” use of “certified” medical records. Many doctors regard such rhetoric as empty talk that will accompanied by unreasonable bureaucratic requirements, as surely as dawn following night.

Why no “buy-in” among doctors? Why have two national IT coordinators appointed by Obama, David Brailer,ND, in 2005 and David Blumenthal, MD, in 2011, resigned in frustration over the failure to persuade doctors that gathering electronic data and measuring care is a good thing? If universal EHRs are such a good thing, why have physicians and hospitals not raced to embrace EHRs?

As Steve Lohr of the New York Times, a leading thinker in health care innovation, says in yesterday’s Times (“Seeing Promise and Peril in Digital Records,”

“What is beyond doubt is that the promise of digital records will be unfulfilled if doctors refuse to adopt them, because they regard the technology as cumbersome, time consuming, and possibly dangerous.”

To date, most doctors, except for enthusiastic early adopters, IT nerds, and those in large organizations, have found EHRs “useless” in their daily work. EHRs cost excess money, show little return on investment, change the very nature of practice, slow productivity, tell no narrative tales, cause conflicts among staff and colleagues, require extensive record keeping, are subject to hacking, and, more often than not, are useless as a tool for communicating to colleagues, hospitals, and other doctors outside your practice.

When the government establishes “usability standards” that work, maybe doctors will come on board the electronic train. Until then, says Dr. Edward H. Shortliffe , a professor at the University of Texas Health Science Center in Houston, “Usability is going to be the single greatest impediment to physician acceptance. “

If EHRs are not made more useful and soon, universal digital records may turn out to be a giant boondoggle rather than a scientific bonanza.

Richard L. Reece, MD, is pathologist, editor, author, speaker, innovator, and believer in abilities of practicing doctors and their patients to control and improve their health destinies through innovation. He is author of eleven books. Dr. Reece posts frequently at his blog, Medinnovation.

E-Prescribing: Experiences from Physician Practices and Pharmacies

Sep 1, 2018

By Teresa Zayas-Cabán

The May 2012 edition of the Journal of the American Medical Informatics Association (JAMIA) offers the opportunity for a second look at an important recent study on e-prescribing. The study, “Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies,” examines practitioners’ experiences with this potentially game-changing technology.

The study, first available on the AMIA web site in November 2011, is now one of 12 articles included in the JAMIA issue on the “Focus on health information technology, electronic health records and their financial impact.” (It is available at no cost at http://jamia.bmj.com/content/current.) In the article, Joy M. Grossman, PhD, and colleagues from the Center for Studying Health System Change (HSC) conducted a qualitative analysis of 114 telephone interviews with representatives from 97 organizations including 24 physician practices, 48 community pharmacies, and three mail-order pharmacies actively transmitting or receiving e-prescriptions. This study is part of a larger qualitative project on e-prescribing. An earlier publication, released in May 2011, explored physician practice use of e-prescribing to access external information on patient medication histories, formularies and generic alternatives. It can be found at http://www.hschange.org/CONTENT/1202/.

Will Palo Alto Ever Make a Successful Healthcare IT Company?

Jun 1, 2018

[youtube width=”560″ height=”270″]http://www.youtube.com/watch?v=M16lw6Piias[/youtube]

From CurrentMedicine.TV:

With the troubles at the medical doctor social network Sermo, we thought it would be interesting to speak with a healthcare IT venture capitalist about the reasons why the healthcare sector has not adopted Internet technologies such as LinkedIn or Facebook, or other IT business models. We interviewed Bijan Salehizadeh, MD, Managing Director at Navimed Capital in Washington, DC.

HIT: Where We Stand and Where We Go From Here

Apr 27, 2015• 3

By KAREN DeSALVO

This post is adapted from DeSalvo’s talk at the annual meeting of the Health and Information Management Systems Society in Chicago last week.

I am optimistic about the bright future we have to leverage health information technology to enable better health for everyone in this country.

One year ago, we called upon the health IT community to move beyond adoption and focus on interoperability, on unlocking the data, so it can be put to the many important uses demanded by consumers, doctors, hospitals, payers, and others who are part of the learning health system.

ONC spent the year listening to the health IT community to understand the challenges and opportunities and developing strategic roadmaps to guide our way. Our goal was to evolve to be best able to lead where appropriate, and partner wherever possible, as we all shift the national strategic focus towards interoperability. I hope you all have felt that shift.

Ebola Offers a Teachable Moment For Health Information Technology

Oct 9, 2014• 19

By ADRIAN GROPPER, MD

The essence of controlling Ebola is surveillance. To accept surveillance, the population must trust the system responsible for surveillance. That simple fact is as true in Liberia as it is in the US. The problem is that health care surveillance has been privatized and interoperability is at the mercy of commerce.

Today I listened to the JASON Task Force meeting. The two hours were dedicated to a review of their report to be presented next week at a joint HIT Committee Meeting.

The draft report is well worth reading. Today’s discussion was almost exclusively on Recommendations 1 and 6. I can paraphrase the main theme of the discussion as “Interoperability moves at the speed of commerce and the commercial interests are not in any particular hurry – what can we do about it?”

Health information technology in the US is all about commerce. In a market that is wasting $1 Trillion per year in unwarranted and overpriced services, interoperability and transparency are a risk. Public health does not pay the bills for EHR vendors or their hospital customers.

Ceci Connolly: Will Technology Replace Doctors?

Sep 26, 2014• 35

Ceci Connolly

It’s a provocative question, but it’s also the wrong one.

The question ought to be: When will healthcare fully embrace technology and all it has to offer?

It’s widely known that the $2.8 trillion US health system has significant waste and errors – between 25% and 30% of our health dollars go to services that do not improve health. Technology has the ability to put a big dent in that through standardization, real-time insights, convenient gadgets and complex data analysis the human brain simply cannot perform.

Consider some of the early innovators. There’s the heart monitor in the phone. The wristbands that count steps. And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.

The Data Response Curve (In Honor of the Dose Response Curve)

Aug 24, 2014• 10

By JORDAN SHLAIN, MD

All medical students learn about the dose response curve in pharmacology lectures. The dose-response curve informs us of how we should dose a medication in the context of its efficacy and its toxicity. Too little medicine won’t have the desired effect, and too much medicine can be toxic.

In the era of digital health, data have become the new “big pharma,” and we are facing the emergence of a data-response curve in which access to too little data is inactionable, and access to too much data can be overwhelming. Digital health devices abound today, and has enabled quantification of nearly every health and wellness metric imaginable. Sadly, in our exuberance about these new sources of data, we often conflate “more data” with “better data.”

In the era in which data have become the booming commodity of exchange in healthcare, we describe an emerging data-response curve. Large data sets can be at best clarifying or at worst self-contradictory. Too little data on the data-response curve, as with medication dosing, can be insufficient for effective action or decision-making. Too much data can be toxic to the user such as the physician, leading to poor decisions or worse, to analysis paralysis.

We live in a world of exploding data, and we need to be thoughtful. Medicine is a people business in need of data, not a data business on need of people. In reductive form, all humans make decisions based on inputs (data) from their environment and on individual analysis of the data in the form of non-linear, non-quantifiable perception. When we as doctors, policy-makers, or simply as human beings receive these inputs, one of three things happens: 1. We make a decision to do something (for example a treatment decision based on abnormal data), 2. We make a decision to do nothing (for example, normal data which we believe requires no action), or 3. We need more data in order to make an informed decision to do item #1 or item #2. More does not necessarily equal better data. More data is simply more.

Better data are actionable data wrapped in the context of the patient and the patient’s condition. Imagine each piece of objective data connected to concurrent subjective data, and surfaced in the context of a specific condition relevant to the patient. HealthLoop enables patients to generate contextual objective data married to their subjective symptoms and served to a clinician in an actionable context. High signal and low noise are the digital health equivalents of on the dose-response curve of a favorable therapeutic window.

See where some folks live on the Chart. Where do you live?

Should We Send Docs to Tech School?

Aug 19, 2014• 5

By BILL CROUNSE, MD

An article in Information Week caught my eye recently . It reviews a new program offered by Texas A&M with support from Dell to help medical students and other healthcare professionals “come to terms with the ways technology is changing their jobs”. The article, Doctors Can Go Back to Tech School, says Texas A&M will launch its new health technology academy later this year as part of its continuing medical education program.

Now, don’t get me wrong. I’m all for education and career improvement. I’m just not sure that the best way to improve Health IT is to get more physicians trained in IT so they can, as the article suggests, move into IT roles. How about giving full time clinicians who have an interest in improving Health IT some extra support and time so they can help those who work in IT better understand what clinicians need to do their jobs efficiently and safely? How about just a little paid time away from the daily treadmill of patient care to educate IT about the nuances of medicine and clinical workflow? I believe understanding that would do more to help IT deliver better solutions.

Over the course of my career, I’ve been many things. First and foremost, I am a physician. Only a true clinician understands how clinicians think and work. For many years, I continued to practice even when it no longer made a whole lot of sense with regards to my income or available time. I was a biology major in college. I went to medical school and did a residency in family medicine. I never had any formal training in either business or technology. I learned the ropes by doing. It was often trial by fire. I’ve had my share of success as well as a few failures along the way. When I advanced into the role of a hospital CIO and CMIO, it wasn’t because I knew tech. When my then CEO asked me to step into the CIO role, I’ll never forget what he said to me. He said, “I want to put a civilian in charge of the military”, meaning a doctor in charge of a department that existed to serve clinicians and their patients but had become a renegade army running out of control and way over budget.