July, 2013 | Meaningful HIT News

Surprising results in the HIT100 list

The third annual HIT100 list, ostensibly listing the 100 most influential Twitter accounts in health IT, has been published at Healthcare IT News, and I’m more surprised than flattered to be at No. 44, named 14 times by tweets carrying the #HIT100 hashtag. More accurately, I am in a five-way tie for No. 41, with the likes of: “social venture entrepreneur” Sherry Reynolds (9,000 Twitter followers); Beth Israel Deaconess Medical Center CIO and health IT rock star Dr. John Halamka (10,600 followers); health IT product strategist Lisa Crymes (2,200 followers); and pre-eminent health IT social media researcher Susannah Fox of the Pew Internet & American Life Project (13,800 followers).

That doesn’t seem right, does it?

It also doesn’t seem right that I’m ahead of: “E-Patient” Dave deBronkart; true digital health rock star Dr. Eric Topol; The Health Care Blog and Health 2.0 founder Matthew Holt; Chilmark Research’s John Moore, one of the most insightful analysts I’ve ever come across; KevinMD founder Dr. Kevin Pho (though he focuses on a lot more than just health IT); health economist and patient engagement guress Jane Sarasohn-Kahn; well-known EHR consultant Jim Tate; health IT policy expert Shahid Shah; and, coming in at 100 on the list, White House CTO and technology entrepreneur-in-residence Todd Park, who previously was CTO at HHS and co-founded Athenahealth.

It’s nice to be mentioned among and even above some of those names, and I thank those who voted for me. I also thank the more than 3,600 people who follow me on Twitter. But am I really more influential in health IT than any of the people I mentioned above? I doubt it.

What are your thoughts? Is there a better way of measuring influence than just counting the number of people who tweeted your name with the #HIT100 hashtag?

For the record, topping the list was Dr. Wen Dombrowski, who is about as active as they get when it comes to health IT social media. No arguments here, though I wouldn’t have objected either if Brian Ahier, Regina Holliday, Lionel Reichardt, Gregg Masters, Paul Sonnier (his Digital Health LinkedIn group just passed 19,000 members) or Keith Boone had been No. 1. A case also could be made for John Lynn, founder of the Healthcare Scene network, which hosts this blog.

And then, there’s this:

‘Bitter Pill’ only tells half the story

I finally got around to finishing “Bitter Pill: Why Medical Bills Are Killing Us,” the 24,000-word special report about healthcare costs that took up the entire feature section of the Feb. 20 edition of Time magazine. I was expecting to agree with most if not all of Steven Brill’s supposedly epic investigative piece. Instead, I was underwhelmed and quite disappointed that Brill, the founder of CourtTV (R.I.P., reincarnated as TruTV in Turner Broadcasting’s quest for more “reality” programming) and of American Lawyer magazine, only told half the story about all that ails the U.S. healthcare industry. Brill also editorializes far more than he should.

Granted, the story is about the high cost of care, but you can’t discuss cutting costs without also delving into the subject of improving outcomes. As has been stated in many other places, we have more of a sick-care system than a healthcare system. The incentives favor treating illness, not preventing it.

I have to say I learned a lot about how the racket known as the chargemaster works to keep the true costs of care opaque to patients. I suspect that, with the exception of uninsured people who are the only ones expected to pay full price, the public was unaware of the chargemaster system that hospitals guard like a state secret. Brill is right when he says, “Unless you have Medicare, the health care market is not a market at all. It’s a crapshoot.” But he’s not telling the full story. Medicare’s payment list is public, sure, but do Medicare beneficiaries really care what the federal government pays their hospitals and doctors? No, they, like everyone else with insurance coverage, only pay attention to their out-of-pocket cost.

Sure, Brill spends a lot of time discussing the perverse incentives in healthcare, particularly those that encourage expensive testing, and even touches on some of the reforms in the Patient Protection and Affordable Care Act that seem to have been left out of the debate over insurance coverage. Think the Medicare policy of not reimbursing hospitals for certain preventable readmissions.

But he completely neglects accountable care. Nor is there a mention of electronic health records and how interoperability can help reduce duplicate testing and unnecessary care. And he never addresses the elephant in the room, the shamefully high rate of medical errors that makes American healthcare far from the best in the world.

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July 23, 2013 I Written By Neil Versel

Filed Under: Accountable Care Organizations CMS consumerism EMR/EHR Finance health reform interoperability media medical errors Patient Protection and Affordable Care Act patient safety quality

Tags:"Bitter Pill" Accountable Care Organizations chargemaster healthcare costs insurance Medicare Patient Protection and Affordable Care Act patient safety Steven Brill uninsured

Say it with me: clinical decision support

I just read one of the worst articles I’ve ever seen about the quality of American healthcare, and it illustrates just how badly some reporters who don’t regularly cover healthcare can misunderstand this sector that accounts for more than one-sixth of the U.S. economy.

I give you this Motley Fool story entitled, “The 5 Most Misdiagnosed Diseases,” written by Sean Williams. (His profile says he has experience investing in healthcare. Investing in companies is one thing. Figuring out how to fix a broken industry is another. And really, from a financial standpoint, plenty of people are getting rich off of others’ suffering.)

The story curiously discusses a 2009 study in the Internet Journal of Family Practice that found the five most misdiagnosed diseases, based on autopsy and malpractice data. I suppose Motley Fool might decide to run something that’s four years old in order to discuss current investment opportunities. This is where the story veers off the rails.

According to the article: “The benefit of this data is twofold: it exposes problem areas in diagnosing certain diseases, which should help improve attention to detail from both physicians and patients exhibiting those symptoms, and it highlights the potential for more accurate diagnostic equipment. As investors, it also gives us definable opportunities to take advantage of instances where certain medicines or diagnostics may greatly increase in usage to improve patients’ quality of life.”

Wrong.

The problem isn’t the accuracy of diagnostic equipment and the solution isn’t more expensive testing and treatment. The problem is accessing and processing data that physicians should already have but perhaps do not. The answer to this problem is an accurate, current and complete record with an accurate, current and complete patient history, run not through the physician’s brain on the spot but through a clinical decision support engine that matches patient-specific facts with known medical evidence.

Say it with me: clinical decision support.

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July 21, 2013 I Written By Neil Versel

Filed Under: clinical decision support Finance health information exchange health IT Healthcare IT Innovation media medical errors patient safety

Tags:diagnostic medicine Internet Journal of Family Practice investment misdiagnosis Motley Fool

More on Blue Button Plus and MU2

My last post, based on comments from Frost & Sullivan health IT analyst Nancy Fabozzi at last week’s Healthcare Unbound conference, has generated a bit of controversy. Fabozzi said that “Blue Button Plus is totally disruptive,” possibly eliminating the need for some providers to get full-fledged patient portals in order to meet Meaningful Use Stage 2 standards.

In the comments under that post, David Smith of HealthInsight.org, a health improvement consortium in three Western states, correctly pointed out that MU2 requires not just that providers give 50 percent of patients electronic access to their records, but also that 5 percent of patients actually view, download and/or transmit information back to their doctors or hospitals. I also got an e-mail from a GE Healthcare executive reminding me that of the view/download requirement as well as the fact that EHR technology had to be certified by an ONC-approved certification and testing body.

The viewing and downloading certainly can be accomplished with Blue Button Plus apps or widgets. In fact, ONC’s Lygeia Ricciardi has said Blue Button Plus could be part of the Stage 3 rules.

Transmitting would seem to necessitate a portal since HIPAA demands — and patients should expect — security when sending protected health information over the Internet. Standard e-mail doesn’t cut it, but e-mail following Direct Project protocols does. MU2 already sanctions Direct Project for health information exchange between healthcare entities. There is no reason why it can’t work for individuals as well, as Dr. Deborah Peel’s Patient Privacy Rights Foundation is trying to facilitate.

This might be a bit unwieldy, asking each patient to set up a Direct e-mail address, but remember, providers only need 5 percent to do so in Stage 2. I see it as perfectly feasible that some small physician practices could bypass the portal and just make do with freely available resources like Blue Button Plus — though Blue Button Plus app developers likely will charge fees — and open-source Direct standards.

UPDATE, July 18, 12:40 a.m. CDT:

HHS itself says Blue Button Plus meets MU2 standards.

From http://www.hhs.gov/digitalstrategy/open-data/introducing-blue-button-plus.html:

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology in the following ways —

Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture or Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button Plus adopts the requirements for sections and fields from Meaningful Use Stage 2.

Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button Plus uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.

It sounds to me like compliance is just a matter of making sure that a Blue Button Plus app is certified as an EHR module.

‘Blue Button Plus is totally disruptive’

AURORA, Colo.—”Blue Button Plus is totally disruptive,” Frost & Sullivan health IT analyst Nancy Fabozzi just told me at the Healthcare Unbound conference. Why? Because the enhanced Blue Button Plus format can eliminate the need for healthcare providers to invest in patient portals in order to meet Meaningful Use Stage 2.

I tend to agree. The Stage 2 rules don’t require a portal, just the ability to transmit records securely from provider to patient. Providers, whether they be hospitals, clinics or even small physician practices, can just put a Blue Button widget on their Web site and give patients easy access to their medical records, transferred securely by the Direct protocol, itself a disruptive force for health information exchange.

Longtime readers might recall that I had dissed Blue Button in the past. More than once, in fact. That’s because the original Blue Button format was plain, unstructured text when it was an experiment at the VA. My opinion changed this week, when I realized that Blue Button Plus adds structure such as the Continuity of Care Document, and third-party vendors like Humetrix, make of the iBlueButton mobile app, provide additional context.

I don’t think this will kill the portal business because portals provide additional services such as secure messaging, appointment scheduling, refill requests and online bill payment. But it will make a lot of providers think twice about springing for an advanced portal when Blue Button Plus will fill the Meaningful Use need so easily.

See you at Healthcare Unbound

Happy 5th of July! I hope you had a happy 4th, and that you don’t have to work today as I have to.

I just wanted to let everyone know that I will be on a panel next Thursday at the 10th annual Healthcare Unbound conference at the University of Colorado Anschutz Medical Campus in Denver:

TRACK C: PANEL DISCUSSION: WHAT’S NEXT FOR mHEALTH?

The market for mobile health (mHealth) products and services is an important area which can be a catalyst for healthcare’s evolution, dramatically altering healthcare delivery and the patient experience. In the health system of the future, patient care will be greatly enhanced by a connected and seamless information flow between patients and other stakeholders, with mobility being a core need for all users of health information. With a growing ocean of mHealth applications, scalability, sustainability, security, interoperability are some of many points which will continue to be vital for developers.

mHealth can provide new ways for patients to be engaged in their health, beyond those interested in the “quantified self”, to shift the focus in healthcare from treatment to wellness. The healthcare industry therefore has the unique chance to harness this opportunity to create positive change.

There is the argument that regulation and restrictions could impede innovation, as the freedom of the market has fostered the rapidity of modernization in mHealth technology. However, other hurdles exist for developers, such as achieving adoption and sustained use of mobile applications, where users from physicians, to patients need to better understand what apps can make a real difference and which are just noise.

The panel will explore some of the ways mHealth is transforming healthcare and also tackle some of the serious questions, offering insight and solutions for those facing mHealth’s distinct challenges.
Moderator:
Daniel Ruppar, Research Director, Connected Health, Frost & Sullivan

Panelists:
Proteus Duxbury, , Director of Technology Strategy – Virtual Health Services, Catholic Health Initiatives
Wayne Guerra, MD, MBA, Co-Founder & Chief Medical Officer, iTriage
Keith Toussaint, Executive Director, Business Development, Global Business Solutions, Mayo Clinic
Neil Versel, Contributing Editor, MobiHealthNews
Malinda Peeples, RN, VP Clinical Advocacy, WellDoc

This breakout session starts at 4:15 p.m. MDT. As the last thing standing between conference attendees and happy hour that day, we sure had better be engaging. Hopefully there will be video available after the fact. If there is, you can be sure I will post it here.

To register for the conference, click here.

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July 5, 2013 I Written By Neil Versel

Filed Under: health IT Healthcare IT mobile

Tags:conferences Healthcare Unbound mobile

Comprehensive coverage of WTN Media’s Digital Health Conference

As you may know from at least one of my earlier posts, I was in Madison, Wis., last month for a great little health IT event called the Digital Health Conference, a production of the Wisconsin Technology Network and the affiliated WTN Media. In fact, WTN Media hired me to cover the conference for them, so I did, pretty comprehensively. In fact, I wrote eight stories over the last couple of weeks, seven of which have been published:

I still have an overview story that should go up this week.

Why do I say it’s a great little conference? The list of speakers was impressive for a meeting of its size, with about 200 attendees for the two-day main conference and 150 for a pre-conference day about startups and entrepreneurship.

Since it is practically in the backyard of Epic Systems, CEO Judy Faulkner is a fixture at this annual event, and this time she also sent the company’s vendor liaison. Informatics and process improvement guru Dr. Barry Chaiken came in from Boston to chair the conference and native Wisconsinite Judy Murphy, now deputy national coordinator for programs and policy at ONC, returned from Washington. Kaiser Permanente was represented, as was Gulfport (Miss.) Memorial Hospital. IBM’s chief medical scientist for care delivery systems, Dr. Marty Kohn, flew in from the West Coast, while Patient Privacy Rights Foundation founder Dr. Deborah Peel, made the trip from another great college town, Austin, Texas. (Too bad Peel and Faulkner weren’t part of the same session to discuss data control. That alone would be worth the price of admission.)

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July 2, 2013 I Written By Neil Versel

Filed Under: EMR/EHR health IT health reform Healthcare IT hospitals Innovation interoperability meaningful use ONC Patient Protection and Affordable Care Act patient safety physicians privacy public health quality RHIO standards vendors

Tags:Barry Chaiken Deborah Peel entrepreneurs Epic Gulfport (Miss.) Memorial Hospital IBM interoperability Judy Murphy Kaiser Permanente ONC privacy standards usability venture capital WTN Media

AHIMA board chair dies

The American Health Information Management Association (AHIMA) announced this morning that board President and Chair Kathleen A. Frawley died Friday at the age of 63. The cause of death was not disclosed.

Here is the text of the AHIMA press release:

AHIMA Mourns Passing of Kathleen A. Frawley, AHIMA Board President/Chair

CHICAGO – July 1, 2013 – With profound sadness, the American Health Information Management Association (AHIMA) announces the passing of Board President/Chair Kathleen A. Frawley, JD, MS, RHIA, FAHIMA on Friday, June 28. Frawley, 63, also was a professor and chair of the health information technology program at DeVry University’s North Brunswick, N.J. campus.

“Kathleen had an inspiring and unwavering belief in the importance of health information management and how AHIMA members could lead the profession,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, FACHE, CAE, FAHIMA. “She touched the lives of so many of her colleagues in HIM, AHIMA members and her students. She will be missed by the entire AHIMA family.”

Angela Kennedy, EdD, MEd, MBA, RHIA, CPHQ, will serve as Board President/Chair effective immediately. Kennedy became President/Chair Elect in January, which was the same time Frawley began her one-year term.

“On behalf of the board and everyone at AHIMA, our thoughts are with Kathleen’s family during this difficult time,” Kennedy said. “Kathleen’s theme during her presidency was ‘dream big and believe.’ It is incumbent upon all of us at AHIMA to continue to move forward with the work and initiatives to advance the profession and the quality of care for patients everywhere as Kathleen would have wanted.”

For more than three decades, Frawley played an integral role at AHIMA. From 1992 to 2000, Frawley was AHIMA’s vice president of legislative and public policy services. The following year, she was a recipient of the AHIMA Distinguished Member Award. In 2011, she was the recipient of the New Jersey Health Information Management Association Distinguished Member Award.

As an educator, Frawley spent a great deal of time focused on the future of HIM education and making sure her students made the most of their opportunities. In a Journal of AHIMA Q and A from October 2012, Frawley said, “(one) of my projects is identifying and assisting students who are at risk of failing or dropping out of school. I did a presentation (on this) at the Assembly on Education and Faculty Development a couple of years ago; I want to identify barriers that prevent students from being successful.”

Frawley was particularly proud to serve as President/Chair during AHIMA’s 85^th anniversary year. She inherited a love of history from her late father, and during her speech at the 2012 AHIMA Convention and Exhibit, she outlined how she always made it a point when she was at the AHIMA office to look at the pictures showcasing AHIMA’s founders and past CEOs. In fact, it was her idea to turn this wall of pictures into a mini-museum to celebrate AHIMA’s history.

Frawley, who spoke on health information privacy issues to a number of national outlets including Good Morning America, earned a bachelor’s degree in English from the College of Mount Saint Vincent. She received a master’s degree in health services administration from Wager College and a juris doctorate from New York Law School.

AHIMA will establish a scholarship in Frawley’s name to honor her contribution to the association as a staff member, board member and president, and long-time AHIMA member.

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July 1, 2013 I Written By Neil Versel

Filed Under: obituaries

Tags:AHIMA Kathleen A. Frawley Lynne Thomas Gordon

Video: My interview with Hands On Telehealth

I recently was a guest on a vodcast with Nirav Desai, founder and CEO of telehealth consulting firm Hands On Telehealth, whom I met because I moderated a panel he was on at the American Telemedicine Association‘s annual conference in May. In a Skype interview that went up late Friday, we chatted for 45 minutes about telehealth, the broader health IT landscape and how it all fits into U.S. healthcare reform.

I’m unable to embed the video on this page, so please visit the Hands On Telehealth page to watch the interview. (That’s a screen grab below.) The page contains a detailed description of the interview, much as I like to have for my own podcasts. Perhaps next time I’ll spend more time looking directly at the camera. :)

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I Written By Neil Versel

Filed Under: care coordination EMR/EHR health IT health reform Healthcare IT medical errors Patient Protection and Affordable Care Act reimbursement remote monitoring Telehealth video

Tags:American Telemedicine Association CIOs EMR Hands On Telehealth interoperability patient engagement Patient Protection and Affordable Care Act Physician Resistance quality telehealth telemedicine Triple Aim

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‘Bitter Pill’ only tells half the story

Say it with me: clinical decision support

More on Blue Button Plus and MU2

‘Blue Button Plus is totally disruptive’

See you at Healthcare Unbound

TRACK C: PANEL DISCUSSION: WHAT’S NEXT FOR mHEALTH?

Comprehensive coverage of WTN Media’s Digital Health Conference

AHIMA board chair dies

Video: My interview with Hands On Telehealth

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