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When you talk health reform, don’t forget quality and IT, in that order

In my previous post, I was perhaps a bit too critical of Maggie Mahar in her hosting of last week’s Health Wonk Review. I noted that there was not a word about health IT in that rundown, but that’s not her fault. A host can only include what’s submitted, and apparently nobody, myself included, who contributed to HWR bothered to submit a blog post about health IT this time around.

But I continue to be troubled by this fixation so many journalists, pundits, commentators, politicians and average citizens have on health insurance coverage, not actual care. I blame most of the former for the confusion among the populace. People within healthcare know that you can’t talk about reform without including the serious problems of quality and patient safety, and people within reform know that IT must be part of the discussion even if they don’t always say so.

I would like to draw your attention to a story of mine that appeared on InformationWeek Healthcare this morning, about a report on care integration from the esteemed Lucian Leape Institute. The report itself did not say a lot about IT, but the luminaries on the committee that produced the paper are aware of the importance.

I was lucky enough to interview retired Kaiser Permanente CEO David M. Lawrence, M.D., who told me there has been “little attention” paid to the importance of a solid IT infrastructure in improving care coordination and integration. “What you now have is too much data for the typical doctor to sift through,” Lawrence told me.

That’s exactly the message Lawrence L. Weed, M.D., has been trying to spread for half a century, as I’ve mentioned before. And that’s pretty much how longtime patient safety advocate Donald M. Berwick, M.D. — also a member of the Lucian Leape Institute committee that wrote the report — feels. Berwick hasn’t always advocated in favor of health IT in his writings and speeches, but he has told me in interviews that the recommended interventions in his 100,000 Lives Campaign and 5 Million Lives Campaign are more or less unsustainable in a paper world.

Isn’t about time more people understand that widespread health reform is impossible without attention to quality and that widespread quality and process improvements are impossible without properly implemented IT?

 

 

October 29, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Health Wonk Review: Special SCOTUS edition

To the surprise of nobody, the healthcare blogosphere was busy last week in the wake of the Supreme Court’s decision on the Patient Protection and Affordable Care Act. Because of this, Joe Paduda at Managed Care Matters put together a special edition of Health Wonk Review. In fact, he did a two-parter, and did it in just a couple of days. My post from Friday just barely made the cut, as the second-to-last entry mentioned in Part 2. Paduda had a lot of fun with Part 1, which he put up late Thursday night in the immediate aftermath of the decision.

I would be remiss if I didn’t also link back to the most recent regular edition of Health Wonk Review, also hosted by Paduda. It’s been up since June 22, but I forgot to mention it before. He included my post about the difficult task of informing the public that they have the right to access and correct their own medical records. Sorry  for the oversight, but better late than never. There’s a lot of other good stuff in there about the future of healthcare reform beyond the ACA, so please check it out.

July 5, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

A dubious honor from Health Wonk Review

For the very first time, I captured the top spot on the biweekly Health Wonk Review blog carnival, this time hosted by Dr. Jaan Sidorov of the Disease Management Care Blog. Unfortunately, I had to endure my dad’s untimely death after a miserable hospital experience in order to write the piece in question. But if it brings more traffic to that post and, more importantly, more awareness of multiple system atrophy (MSA) and the problem of poorly coordinated care and broken processes in hospitals, I’ll take it.

Since you’re here primarily for health IT, I’ll point you to a couple of relevant items that Sidorov summarizes. In a post actually written back in February, Martin Gaynor, chairman of the Health Care Cost Institute, discusses the organization on the Wing of Zock (the name is explained here) blog. The institute is aggregating claims information from the likes of Aetna, Humana, Kaiser Permanente, UnitedHealthcare and CMS to provide researchers with rich data sets related to healthcare costs and utilization.

“At its most basic, HCCI was formed because a better understanding of health spending can improve the quality of care and save money. If we generate information that makes a difference, then we will be a success,” Gaynor says.

Also, consultant Joanna Relth makes it known on the Healthcare Talent Transformation blog that she is no fan of ICD-10. “I’m sure that the intent of making this massive change to the codes is to improve the accuracy of diagnosis coding so providers will bill more accurately and insurance companies will pay providers and insureds in a more timely fashion. Seriously?? Did anyone ask a learning professional about how large a list is reasonable and at what point does the number of data points become impossible to follow?” she wonders in what comes off a little as an anti-government screed.

But I prefer to end this post on a happy note. In the comment section, Relth links to a video from EHR vendor Nuesoft Technologies that parodies Jay-Z’s “99 Problems.” Enjoy.

May 25, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

HIMSS12 sets record for tweets

The folks at HIMSS are claiming that the 2012 conference in Las Vegas a couple months ago set a world record for the most tweets at a health conference. (I’m checking to see who keeps such records.)

By the numbers, according to HIMSS:

  • The #HIMSS12 hashtag was used 28,434 times.
  • HIMSS12 averaged 167 tweets per hour.
  • HIMSS12 was mentioned 33,247 times in social media, more than double HIMSS11 (which itself was more than double HIMSS10).
  • The keynote by Twitter co-founder Biz Stone generated 7,595 tweets, beating out the 7,047 tweets from Dr. Farzad Mostashari’s keynote.

This infographic from HIMSS tells more of the story about the whole conference.

 

I am not surprised Brian Ahier and Regina Holliday had so much influence on social media at the conference. Ahier moderated the Meet the Bloggers panel I was on.

I was, however, surprised to the breakdown of mobile devices accessing the HIMSS conference’s mobile site. Apple with 70 percent sounds right, particularly when you consider how many iPads were in evidence, but I would have guessed Android would have more than 14 percent share because it’s so popular for smartphones and BlackBerry more than 2 percent because a lot of enterprises still use that platform. I guess I’m one of the few people left in health IT with a BlackBerry.

UPDATE, Friday, April 27: It was healthcare social media consulting firm Symplur that tracked the tweets and announced the record. There’s more data here, though my head starts spinning when someone discusses stuff like slopes of equations.

April 26, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Might as well cash in on fervor over new iPad

I’m not one to sell myself out, but I read a story in satirical newspaper The Onion today with the following headline: “This Article Generating Thousands Of Dollars In Ad Revenue Simply By Mentioning New iPad.” An excerpt:

“Furthermore, any subsequent mention of the new iPad in this article—as well as any mention of the fact that preorders for the device start today—is resulting in increased reader traffic and, thus, increased revenues for your company’s ad-based business model.” At press time, new iPad, new iPad, new iPad, new iPad, new iPad, new iPad, new iPad, new iPad, new iPad, new iPad.

Gotta love lame attempts at SEO! We’ll see if it works for me. ;)

March 7, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Video: ‘Meet the Bloggers’ panel from HIMSS12

As promised,  there is some video from the “Meet the Bloggers” panel I appeared on, and it comes to us from Dr. Chuck Webster of EHR Workflow Inc. and the EHR.BZ Report. (You may know him from his previous job as CMIO of EHR vendor EncounterPro, formerly known as JMJ Technologies.) Webster was there in the front row capturing parts of the session with a Bluetooth camera strapped to his hat.

The moderator is Brian Ahier and the panelist are, from left to right: Healthcare Scene boss and full-time healthcare blogger John Lynn; fellow Healthcare Scene contributor Jennifer Dennard (real job:  social marketing director at Billian’s HealthDATA/Porter Research/HITR.com); myself; and Carissa Caramanis O’Brien of Aetna.

Here are the results, hopefully in chronological order:

For the record, I do not use Google+. I have an account, and some readers have added me to their circles, but I have not posted a single word there. Google’s terms of service—both old and new—essentially gives the Don’t Be Evil company the right to use my content in any way it sees fit. From “Your Content in our Services”:

Some of our Services allow you to submit content. You retain ownership of any intellectual property rights that you hold in that content. In short, what belongs to you stays yours.

When you upload or otherwise submit content to our Services, you give Google (and those we work with) a worldwide license to use, host, store, reproduce, modify, create derivative works (such as those resulting from translations, adaptations or other changes we make so that your content works better with our Services), communicate, publish, publicly perform, publicly display and distribute such content. The rights you grant in this license are for the limited purpose of operating, promoting, and improving our Services, and to develop new ones. This license continues even if you stop using our Services (for example, for a business listing you have added to Google Maps). Some Services may offer you ways to access and remove content that has been provided to that Service. Also, in some of our Services, there are terms or settings that narrow the scope of our use of the content submitted in those Services. Make sure you have the necessary rights to grant us this license for any content that you submit to our Services.

You can find more information about how Google uses and stores content in the privacy policy or additional terms for particular Services. If you submit feedback or suggestions about our Services, we may use your feedback or suggestions without obligation to you.

As someone who makes a living creating content, this scares me. Google effectively can steal and modify my content without compensation. No, thanks.

I also should give a belated shout-out to Joe Paduda of Managed Care Matters, who hosted last week’s Health Wonk Review. My HIMSS12 wrap made the review of healthcare news from the blogosphere.

 

March 6, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

HIMSS12 notes

I’ve just returned home from HIMSS12. As usual, it was a grueling week, made more grueling by the fact that I arrived a day earlier than usual. But I do have to say that this was the least stressful HIMSS I have been to in years.

Maybe it’s because the conference layout within the massive Venetian-Palazzo-Sands Expo complex was surprisingly compact for my purposes, and I didn’t have to do as much walking as normal. Maybe it was because I only set foot on the show floor once, thanks, in part, to the announcement of the Stage 2 “meaningful use” proposed rules on Wednesday, which caused me to cancel one vendor meeting (in the exhibit hall) and cut another one (in the media interview room) short so I could knock out my story for InformationWeek. Or maybe it’s because I spent too much time in the casinos. Let’s go with the first two, OK?

HIMSS12 broke all kinds of records, drawing 37,032 attendees, beating last year’s former record of 31,500 by nearly 18 percent. The final exhibitor count was 1,123, also the most ever. After I tweeted the attendance figure, at least one person thought this rapid growth was an indication that the conference was “jumping the shark”:

jumping the shark? RT @: #HIMSS12 draws record 37,032 attendees, crushing last year's mark of 31,500. http://t.co/Mw1TDYSA #HealthIT
@apearson
Aaron Pearson

I have thought in recent years than HIMSS may be becoming too big for its own good. This time around, I heard mixed reviews.

Personally, like I said, it was less stressful than normal. It’s always good to catch up with old friends, particularly my media colleagues. This year, I also met up with a couple of friends from back home who happen to work for vendors. We kept the fun going all the way back to Chicago, since at least three other health IT reporters and a few others I know were on the same flight as me.

I also have to say I had a wonderful time on a “Meet the Bloggers” panel on Wednesday afternoon, where I joined Healthcare Scene capo John Lynn, fellow Healthcare Scene contributor Jennifer Dennard, Carissa Caramanis O’Brien of Aetna and moderator Brian Ahier for some lively dialogue about social media in health IT. I know that at least one audience member took some video, and I’ll link to that once it’s posted.

Later that evening, I saw nearly every one of the same people at Dell’s Healthcare Think Tank dinner, where I participated in a roundtable discussion about health IT with a bunch of supposed experts. It was streamed live, and I believe the video will be archived. Many of the participants, including myself, tweeted about it, using the hashtag #DoMoreHIT. I really am adamant about the public needing to be explained the difference between health insurance and healthcare.

Speaking about misunderstandings, I am in 100 percent agreement with something Dr. Wendy Sue Swanson, a.k.a. Seattle Mama Doc, said during an engaging presentation Monday at the HIMSS/CHIME CIO Forum. She made the astute observation that there needs to be better distinction between expertise and merely experience when it comes to celebrities being held up as “experts” in healthcare and medicine. Let’s just say that Swanson, as a pediatrician, is no fan of some of the things Jenny McCarthy and Dr. Mehmet Oz have told wide audiences.

There definitely were some people among the 37,000 who were not enamored with the cheerleading at HIMSS. There was talk around the press room that HHS really dropped the ball by not having the meaningful use Stage 2 proposal out a week earlier, before the conference started. In reality, blame the delay on the White House. Every federal rule-making has to be vetted by the bean counters and political operatives in the Office of Management and Budget, and it’s hard to tell how long the OMB review will take once an administrative agency, in this case, HHS, sends the text over.

I admit, I was wrong in expecting the plan to be out earlier, too. Instead, we got the news Wednesday morning and saw the text Thursday morning, forcing thousands of people to scramble to scour the proposed rules.

I know HIMSS had a team at the ready, who dropped everything to read the proposal and get a preliminary analysis out by the end of the day Thursday. Lots of consulting firms did the same. I’ll save some of the commentary I received for another post.

The wireless Internet in the Venetian’s meeting areas was truly terrible. Either that, or I need to replace my aging laptop. I’m thinking both.

I had no trouble getting my e-mail over the Wi-Fi network, but I really couldn’t do anything on the Web unless I was hard-wired to one of the limited number of Ethernet cords in the press room, and those workstations filled up fast. Bandwidth was particularly poor on Thursday, when I presume thousands of people were downloading the Stage 2 PDF. CMS officials said the Federal Register site crashed from the heavy demand, and I’m sure a lot of it came from inside the Venetian and the Sands Expo.

There didn’t seem to be enough attention paid to safety of EHRs, at least according to Dr. Scot Silverstein of the Health Care Renewal blog, who wrote this scathing critique of the sideshow the exhibit hall has become, making Las Vegas perhaps “fitting for people who gamble with people’s lives to make a buck.”

Personally, I thought ONC and CMS took the recent Institute of Medicine report on EHR-related adverse events pretty seriously. Plus, one of the IOM report authors, Dr. David Classen, presented about the study findings at the physician symposium on Monday and again during the main conference.

Mobile may also have gotten a bit of a short shrift, despite the recent launch of mHIMSS and last’s week’s news that HIMSS had taken over the mHealth Summit from the NIH Foundation. The mobile pavilion was relegated to the lower level of the Sands, the area with low ceilings and support pillars every 30 feet or so. (I called that hall “the dungeon.”) I have a feeling you will like Brian Dolan’s commentary in MobiHealthNews next week. I’m still figuring out what I will write for that publication, but I have to say I did hear some positive things about mobile health this week.

I still don’t know what GE and Microsoft are doing with Caradigm, their joint venture in healthcare connectivity and health information exchange that didn’t have a name until a couple of weeks ago. The name and the introductory reception they held Tuesday evening at HIMSS seemed a bit rushed, IMHO. The Web address the venture reserved, www.caradigm.com, currently redirects to a GE page. Other than the fact that Microsoft is shifting its Amalga assets to Caradigm, I’m at a loss.

Popular topics this year were the expected meaningful use and ICD-10, plus the buzzwords of the moment, business analytics and big data. I’d be happy I never hear the word “solution” as a synonym for “product” or “service” again. To me, that represents lazy marketing. Get yourself a thesaurus.

 

February 24, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Not so elementary, my dear Watson

In just the last few hours, I’ve seen a huge wave of pushback and doubt about Watson, the IBM supercomputer, being used for clinical decision support.

Yesterday, I covered a “healthcare leadership exchange” at IBM’s new Healthcare Innovation Lab in downtown Chicago. I posted some of my observations on the EMR and HIPAA blog, and made the case for diagnostic decision support.

I also wrote a story for InformationWeek, but that hasn’t run. Instead of posting my story, InformationWeek healthcare editor Paul Cerrato wrote a column about Watson already being “beaten in the medical diagnostics race” by Isabel Healthcare, a diagnostic decision support tool that’s been available for years. I have to admit, he’s right. I first interviewed Isabel founder Jason Maude probably in 2002 or so, and I first blogged about the company in 2005. I mentioned Isabel in a 2007 post that, interestingly, also alluded to the work of Don Berwick and Larry Weed.

Cerrato mentioned Jerome Groopman’s 2007 book, “How Doctors Think,” which discussed, in part, how IT could help doctors avoid many types of cognitive errors. “[D]octors tend to lean toward diagnoses that are most available to them in their day-to-day routine,” Cerrato wrote (emphasis in original). That’s exactly what Weed has said for decades, and exactly what Atul Gawande talked about in his groundbreaking book, “Complications.” Computers should not make decisions for physicians, but rather should help them reach the right conclusions, particularly when they see rare cases.

Wouldn’t you know, “e-Patient” Dave deBronkart commented on my EMR and HIPAA post to say he just finished reading Groopman’s book. He tweeted a link to my post, which a few of his 6,500 other Twitter followers noticed. They also noticed EMR and HIPAA grand poobah John Lynn’s comment that the example in yesterday’s Watson demo, a 29-year-old pregnant woman being prescribed doxycyline was “pretty weak.” (He’s right, by the way.) Aurelia Cotta, who blogs about issues such as infertility and adoption, started this thread that also got South Carolina nurse Sunny Perkins Stokes interested:

@ @ @ I can see great uses for this, but I find it funny the example they give of doxy in pg is wrong.
@AureliaCotta
Aurelia Cotta
@ @ @ because it's still using the FDA's pg categories, which are 30 years out of date. GIGO anyone. Heh
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ find it funny the example they give of doxy in pg is wrong.| How so?
@sunnystill
Sunny Perkins Stokes
@ @ @ sorry to reply late--but FDA is binary, and Motherisk is risk vs reward ratio. Critical difference
@AureliaCotta
Aurelia Cotta
@ @ @ doxy is an excellent drug, and cheap. Lyme disease can cause m/c + stillbirth. What if pt needs it?
@AureliaCotta
Aurelia Cotta
@ @ @ baby teeth that have a line on them as a remote chance, might be worth the risk to a pt with no $
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ baby teeth might be worth the risk to a pt with no $ ?Amoxicillin not just as good?
@sunnystill
Sunny Perkins Stokes
@ @ @ maybe to you, but what if the pt is allergic? Or they've already tried amoxicillin, and it didn't work?
@AureliaCotta
Aurelia Cotta
@ @ @ context matters is all, and I just think any sources used should be good, not "lawyer endorsed"
@AureliaCotta
Aurelia Cotta

 

Well, there’s a reason why I call myself a “healthcare” reporter and not a “medical” reporter. I don’t know the science, and I do occasionally get myself in trouble when I start talking about things like whether doxycycline is contraindicated during pregnancy. (To my credit, I did attribute the statement to IBM’s chief medical scientist, Dr. Marty Kohn.)

As I was reading the above tweets and contemplating this blog post, I came across a link to some tongue-in-cheek pushback against Watson in healthcare. An anonymous radiologist who blogs about PACS as “Dr. Dalai” compared Watson to HAL, the diabolical mainframe in “2001: A Space Odyssey.” Dr. Dalai wrote: “Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.” Jennings, of course, is the Jeopardy! champion whom Watson beat earlier this year.

At first glance, I thought Dr. Dalai was yet another whiny physician clinging to the status quo. But he hit on the real issue: application of knowledge. Quoting from an interview with one of Watson’s programmers, Dr. Dalai noted that the supercomputer is being loaded with all kinds of medical reference material in preparation for “learning” human physiology and ultimately gathering experience in medicine. “This isn’t fair!  If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!” he wrote.

Yeah, isn’t that the whole point of clinical decision support?

June 3, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

A soliloquy for meaningful use?

Lots of journalists such as myself don’t have journalism degrees. When people ask me about my non-clinical background, I’m proud to say I’ve got a degree in history. I like to think it gives me an advantage over some journalists since a solid liberal-arts education taught me how to do more than just regurgitate information. I learned how to research, how to analyze, how to ask questions and, above all, how to think. Once in a while, I wonder how my career may have turned out had I actually studied journalism or perhaps pursued a master’s, but not often. One thing I’ve never wondered, is where I might be now if I had gotten a degree in English instead. Until today.

Having just read “An Eligible Professional’s Soliloquy” on the HITECH Answers blog, I bow to the superior literary skills of Wayne Singer. Who says Shakespeare can’t teach us a few things about health IT?

 

May 2, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Spring training for Health Wonk Review

 

The sun is shining here in Chicago and the mercury is supposed to hit 60 degrees today for the first time in months. That could mean only one thing: Spring is in the air, and hope springs eternal, even for the star-crossed Cubs. Though it’s still spring training, noted Yankees fan Glenn Laffel of the Pizaazz blog is in midseason form as he hosts this week’s Health Wonk Review, with an all-star lineup of contributors.

My impassioned defense of Don Berwick makes the big-league roster among the sluggers (health policy), while health IT gets its due respect as a disruptive force by being categorized as the base-stealers.

Of note, longtime HIT blogger Shahid Shah, known as the Healthcare IT Guy, talks security. “I hear a lot of naive talk about how systems are secure because ‘we use SSL encryption’ or ‘we’re secure because we have a firewall.’  Anybody who’s been security and privacy work for more than a few months would know how false those statements are,” he writes. To continue the baseball analogy, it’s like a pitcher making a couple of light tosses over to first to keep the base runner honest, then leaving the next pitch out over the middle of the plate.

And now back to an afternoon of watching basketball, er, I mean, answering e-mail or something. o:-)

 

March 17, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.