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Health informatics pioneer Larry Weed dies at 93

Lawrence L. Weed, M.D., a pioneer in the world of health informatics and organization of patient information, has died at the age of 93. Weed passed away in Burlington, Vermont, on June 3 after a fall two weeks earlier, his son Lincoln said.

Weed created the who created the problem-oriented medical record (POMR) and the subjective, objective, assessment, planning (SOAP) format of progress notes that became ubiquitous. He had advocated for what now is known as clinical decision support for at least 60 years, talking often about “coupling” patient problem lists with medical knowledge that changes often.

“The unaided mind does not know what data to collect, and does not see many of the significant relationships buried in whatever data are collected,” Weed said in a 2004 story I wrote for Health-IT World, a former spinoff of Bio-IT World. Thus, according to Weed, paper records were inferior to computerization — and they were half a century ago.

While at the University of Vermont in 1976, Weed co-developed an early electronic medical record called the Problem-Oriented Medical Information System, or PROMIS.

In 1991, the Institute of Medicine report, “The Computer-Based Patient Record:  An Essential Technology for Health Care,” (revised 1997) said that the problem-oriented medical record “reflects an orderly process of problem solving, a heuristic that aids in identifying, managing and resolving patients’ problems.”

In a seminal 1968 article in the New England Journal of Medicine, Weed wrote:

Since a complete and accurate list of problems should play a central part in the understanding of and management of individual patients and groups of patients, storage of this portion of the medical record in the computer should receive high priority to give immediate access to the list of problems for care of the individual patient and for statistical study on groups of patients.”

To this end, Weed developed a system of “problem-knowledge couplers,” and founded PKC Corp. in 1982 to market his idea. The company landed a series of government contracts, but struggled to catch on in the public sector. Weed was forced out by investors in 2006, and PKC was sold to consumer health company Sharecare — founded by WebMD founder Jeff Arnold and TV doctor Mehmet Oz, M.D. — in 2012.

Weed described the framework of problem-knowledge couplers in a 1994 article in the journal Medical Interface.

A true Renaissance man fond of quoting Francis Bacon, Tolstoy, Copernicus, Galileo and other celebrated philosophers, Weed was known as a brilliant educator, deep thinker and an engaging speaker. At the age of 89, he commanded the stage for a good 75 minutes at the HIMSS13 Physicians’ IT Symposium, and received two standing ovations.

“The worst, the most corrupting of all lies is to misstate the problem. Patients get run off into the most unbelievable, expensive procedures … and they’re not even on the right problem,” Weed said during that memorable presentation in New Orleans.

“We all live in our own little cave. We see the world out of our own little cave, and no two of us see it the same way,” he continued, explaining the wide deviation from standards of care. “What you see is a function of who you are.”

Lincoln Weed lamented that health IT companies have not always paid attention to these ideas. “The informatics community hasn’t really caught up to my father’s work,” the son said. “It’s not about technology. It’s about standards of care.”

The problem-oriented medical record is a standard for organizing information in a record. Couplers are standards for collecting data to generate recommendations based on the ever-changing body of medical knowledge, according to Lincoln Weed.

Some of Larry Weed’s ideas did catch on, notably, the SOAP note. However, some have recently rethought that format for the digital age, swapping the first two and last two element to create the APSO note. Weed defended his approach in 2014.

Weed stayed active up until his last day alive, according to Lincoln Weed. The day Larry Weed died, he discussed a poorly adopted National Library of Medicine personal health records project with sons Lincoln and Christopher. Lincoln recalled that his father said the NLM tool needs to let patients enter their own health data.

“I’m hopeful that the NLM is close to jumpstarting that process,” Lincoln Weed said. “Dad died with more optimism than he had had in a long time.”

Indeed, it could be argued that Weed was a founding father of patient empowerment. Back in 1969, Weed wrote a book called “Medical Records, Medical Education, and Patient Care.” In that, he said, “patients are the largest untapped resource in medical care today.”

Lincoln Weed said that the late Tom Ferguson, M.D., who founded the journal Patient Self-Care in 1976, “thought Dad was one of the originators” of the empowered patient movement.

With patient-generated data and now genomic information making its way into clinical practice, a system for organizing medical records is more necessary than ever, Lincoln Weed said. Equally important, he said, is a computerized system for matching the patient problem list with all known, relevant information to address specific problems — couplers.

“I’m glad Dad has left me with these things to work on,” said Lincoln Weed, a retired attorney who co-authored “Medicine In Denial” with his father in 2011.

Weed, who earned his medical degree from Columbia University in 1947, is survived by five children, a sister, two grandchildren and two step-grandchildren, according to the Burlington (Vermont) Free Press.  He was preceded in death by his wife, Laura, a physician herself who died in 1997.

Weed’s public memorial will focus on his lifelong love of classical music. His children are planning a memorial concert on Sept. 17 at 4 p.m. Eastern time at Charlotte Congregational Church, 403 Church Hill Rd, Charlotte, Vermont, according to the Burlington Free Press.

Here is a video of Weed from a well-known grand rounds he presented in 1971. It was unearthed by a Weed disciple, Art Papier, M.D., of clinical decision support vendor VisualDx.

June 18, 2017 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 new focus: How to become empowered patients

Attention, kind readers. After years of doing this blog in fits and starts — particularly the two-year gap while I was essentially prohibited by a full-time employer from writing about health IT here or anywhere else but that company’s site — I have decided to refocus on healthcare consumers rather than industry insiders.

The “Meaningful HIT News” name itself has become dated, given that the Meaningful Use program from which this blog takes its name has evolved and kind of fallen out of favor. For those not up on the lingo, “meaningful use” is the standard healthcare providers must meet to qualify for Medicare and Medicaid bonus payments for use of health information technology and/or avoid penalties for not being “meaningful” users of electronic health records.

The program came about in 2009 with the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a bipartisan part of the very partisan American Recovery and Reinvestment Act (ARRA); ARRA was President Barack Obama’s $831 billion stimulus legislation. Despite what you may have read elsewhere, Meaningful Use was not part of the Patient Protection and Affordable Care Act, the 2010 bill that’s come to be known as Obamacare.

Meaningful Use was largely successful in getting hospitals and physician practices to adopt electronic health records, which was the goal of Stage 1 (2011-13, give or take). But it started to fall apart in Stage 2 (2014-16), which required participants to share data with other healthcare organizations. Now we have reached Stage 3, in which hospitals and doctors are supposed to prove that they are able to provide better, safer, less costly care with the help of their electronic records.

While all this was happening, Congress got impatient about the $35 billion in incentive money that has been distributed to date and passed legislation at the end of 2015 that changed how physicians are paid for treating Medicare patients. Long story short, Meaningful Use Stage 3, at least for doctors and other individual practitioners, is now part of a bigger calculation that pays for outcomes rather than for simply providing more services. The Meaningful Use program remains unchanged for hospitals.

I won’t bore you with any more details, but I think it’s time to look at the bigger picture, namely the rights and responsibilities patients have in making their own care better. Stay tuned for real patient stories and advice in the next few days. In the meantime, check out the post that represented a shift in my thinking, after my dad passed away nearly five years ago.

I want to help you become empowered patients. That, to me, is what is really meaningful.

I’ll categorize every relevant post as “The Patient Journey” so you can find these stories in the future.

 

March 30, 2017 I Written By

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

See you at the HIT Marketing Conference in Vegas

After several years of trying, John Lynn — host of the Healthcare Scene blog network, of which this blog is a part — has finally gotten me to speak on a panel at his Health IT Marketing and PR Conference, April 5-7 in Las Vegas. I’ve had schedule conflicts or disinterested bosses in the past, but now that I’m mostly unemployed, hey, let’s do it!

I will be on the panel entitled, “The Best Ways to Interact with the Health IT Press,” along with some familiar names: Author and freelance journalist Dan Munro; Scott Mace of H3.Group, publisher of HealthLeaders, DecisionHealth, HCPro, Patient Safety & Quality Healthcare and ACDIS; conference host John Lynn; and session moderator Shahid “The Healthcare IT Guy” Shah. The panel takes place April 6 at 1:30 p.m. PDT at the SLS Las Vegas, which I’m told is far nicer than the hotel it replaced on the south end of the Strip, the Sahara.

Some of you PR and marketing types might find this ironic because I’m notoriously prickly when it comes to dealing with some of you, particularly in the weeks leading up to HIMSS each year. I can’t speak for the other panelists, but I’m hoping that this discussion can help shed some light on how I think when dealing with a seemingly endless flow of pitches, how journalists and publicists can make best use of each other’s time and how we can forge better working relationships.

I haven’t decided exactly what I’m going to say yet because I’m still mostly flying by the seat of my pants, having lost my full-time job less than three weeks ago.

(Yes, I’m still looking for something full-time, but accepting freelance gigs for now, with a major caveat: I can’t take one-off gigs for vendors or anyone else I might cover because that creates conflicts of interest with other work I do. Here’s an idea of what I’m thinking. And while you’re at it, go read my posts at Forbes.com because I get paid by the click. So does Munro, another Forbes contributor.)

It will be a quick trip to Vegas, less than 24 hours on the ground, but it should be worthwhile. I hope to see you there.

March 21, 2017 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: AliveCor’s AI launch, plus $30M investment from Omron and Mayo

I did a video interview this week with AliveCor COO Doug Biehn about that company’s launch today of a physician-side artificial intelligence platform for mining ECG readings for signs of atrial fibrillation, a key early marker of stroke risk. AliveCor also announced it has closed a $30 million Series D investment round, led by Omron Healthcare and Mayo Clinic.

You can read my recap on my Forbes page, but here’s the full video interview.

I goofed in one spot as I was editing the video after midnight: I was in Chicago, not Silicon Valley, as you might be able to tell from the artwork behind me. The error is sorta fixed if you’re watching on a desktop computer, but YouTube annotations don’t show up on mobile devices. (In fact, YouTube is phasing out video annotations this month for that very reason.)

Your feedback is always welcome.

March 16, 2017 I Written By

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

Did Republicans just say they were fine with ‘death panels’ themselves?

Remember the “death panels” hysteria in 2009 or so when the Affordable Care Act was under development? (PolitiFact called “death panels” the “lie of the year” for 2009, not surprising, since the idea apparently originated with that truth stretcher extraordinaire, former Alaska Gov. Sarah Palin.)

As you may have heard, that rhetoric resurfaced during town halls held by a few Republican members of Congress.

That idiocy came from language in the ACA that authorized Medicare to pay for voluntary end-of-life counseling. It was falsely projected as a “mandatory” activity every five years.

Some of the hysteria also stemmed from a specific clause in the ACA that said:

Establishes an Independent Payment Advisory Board to develop and submit detailed proposals to reduce the per capita rate of growth in Medicare spending to the President for Congress to consider. Establishes a consumer advisory council to advise the Board on the impact of payment policies under this title on consumers.

The fear, from the right-wing punditry was that bureaucrats would start to deny care to older, sicker Americans.

Well, the American Health Care Act leaves that provision in place, according to an analysis by the Kaiser Family Foundation:

Other ACA provisions related to Medicare are not changed, including:
* Increase Medicare premiums (Parts B and D) for higher income beneficiaries (those with incomes above $85,000/individual and $170,000/couple).
* Authorize an Independent Payment Advisory Board to recommend ways to reduce Medicare spending if the rate of growth in Medicare spending exceeds a target growth rate.
* Establish various quality, payment and delivery system changes, including a new Center for Medicare and Medicaid Innovation to test, evaluate, and expand methods to control costs and promote quality of care; Medicare Shared Savings Accountable Care Organizations; and penalty programs for hospital readmissions and hospital-acquired conditions.

So, is the GOP plan embracing death panels, or is Republican leadership simply admitting that they were lying all along to whip up paranoia?

March 14, 2017 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: John Lynn talks CES and telemedicine

Since I took the full-time job at MedCity News last April, I haven’t been able to post a whole lot on this blog. Time certainly is one factor, but also there’s the little business of not wanting to compete with myself (and risk getting fired).

Finally, though, I have a reason to share something health IT-related on this blog. That’s because the esteemed blogger John Lynn, owner of the Healthcare Scene network that this blog is part of, appeared Friday on MedHeads, MedCity News’ weekly webcast. We discussed last week’s International CES, which John and one of my MedCity colleagues were at, as well as some telemedicine news I broke: HealthSpot ceased operations at the end of 2015.

Click here, then scroll to the bottom of the page to watch the archived video.

January 11, 2016 I Written By

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

Join me for some upcoming speaking gigs

Hey all. I bet you thought I abandoned this blog when I took the job with MedCity News in April. I kind of did, because this is a health IT blog, and the people who pay my salary want me covering health IT exclusively for them. However, I’m allowed to promote myself, so promote I shall. As a bonus, all of what I’m about to tell you is related to health IT, which is why you came here in the first place.

I’ve got several speaking gigs coming up next month. Some are open to the public, others are not.

  • Oct. 1, I will moderate a panel discussing trends in patient engagement as part of the kickoff event for the new Chicago chapter of Health Technology Forum. RSVP here for the event, which starts at 6 pm CDT at SAS Institute’s Chicago office, Two Prudential Plaza, 180 N. Stetson Ave., Suite 1600. Panelists TBA.
  • Oct. 7, I will be at the Surescripts 2015 Customer Forum in Alexandria, Va., on a panel hosted by Surescripts CEO Tom Skelton. I’ll be joined by my friends Mandi Bishop of Dell and Shahid Shah, a.k.a. the Healthcare IT Guy, to discuss interoperability. That session runs 8:30-9:15 a.m. EDT.
  • Oct. 26, I am scheduled to be on a panel called “The Intersection of Digital Health and Patient Centricity,” alongside Sean Katz, CIO of the Vitality Group, and Maryam Saleh, director of member experience at health technology incubator Matter. That’s hosted by marketing firm APCO Worldwide, and starts at 5:30 p.m. CDT in the Wacker Room of the CME Building, 10 S. Wacker Drive, Suite 1200, Chicago.

Perhaps I’ll see you at one or more of those.

September 18, 2015 I Written By

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

Remember, HIMSS is a marathon, not a sprint

At the risk of sounding too cliché, I’m going to say that HIMSS is a marathon, not a sprint. (Actually, I said it twice, if you count the headline.) And I’m exhausted already.

Planning for the annual madness, which starts this weekend here in Chicago, is almost as grueling as the conference itself, and I got a late start because I didn’t know until a couple weeks ago who I would be covering the event for. In case you were still wondering, I’m now a full-time staffer for MedCity News, so you can read my work there. In less than a week on the job, I’m already feeling a better vibe than I ever did with the last attempt at full-time work.

I have a feeling others are as exhausted as I am, or at least can empathize with all the scheduling that has to go into HIMSS  for a journalist. I need to find stories, but I also need to leave myself time to, you know, actually write the stories. We shall see if I succeed, because I feel overscheduled already.

How do I know it’s a common feeling? This semi-exasperated tweet I sent out a few days ago has gotten favorited a dozen times, which is just about a record for me.

 

The “1,400 of you, one of me” line has kind of become a mantra for me when dealing with people who are begging for a bit of my time. I did not violate my Rule #2 of HIMSS, which is never schedule back-to-back meetings in different locations. (Rule No. 1, of course, is wear comfortable shoes.)

I just hope I can get all my work done, and that I can get a solid six hours of sleep a night next week, even though it’s a home game for me this year. I’m not terribly far from McCormick Place, but it’s a pain to get to from where I am on the North Side. It’s either an hour-plus on public transit, with one transfer, or $21 per day to park. I’d ride my bike down there, but you probably don’t want to see me in spandex. I still may do that on Saturday before most of you are in town. Be warned.

I probably won’t be blogging on this site during HIMSS, though I may have some multimedia to post at some point. If you want to read my coverage, head over to MedCity News. My HIMSS preview should be up by the time you get to town this weekend. And if you haven’t done so already, click on the above tweet and follow me on Twitter.

Welcome to Chicago.

 

April 9, 2015 I Written By

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

I’m joining MedCity News

Three months after my ill-fated decision to take a job with Clinical Innovation + Technology (I never did get an explanation or even a returned call from that cowardly boss, but it probably was about money), I am taking another plunge. Starting next week, I will be a staff writer, covering health IT for MedCity News, just in time for the HIMSS conference the following week.

How do I know it will be different and that I won’t be cut loose after less than three weeks? MedCity has new ownership as of January, namely New York-based Breaking Media. (The press release is still up at the top of the home page.) Breaking Media, which operates online publications in a half-dozen industries other than healthcare, seems committed to growing MedCity, and won’t run out of money, as CI+T’s publisher apparently is; three other reporters were let go a few days before I was cut loose.

You may have noticed that I’ve been contributing commentary to MedCity once a week for the last month or so. That has been on a freelance basis, as is the piece that should appear over the weekend. I’m still winding down some other freelance work, so I won’t be able to dive right in and write a lot for MedCity starting Monday, but I should be cranking out a lot of stories by the time HIMSS rolls around.

And now I know what I’ll be doing during HIMSS, it’s time to get back to all the publicists I’ve shooed away for a month and piece my schedule together. I’ll have to have time to cover some of the pre-conference, keynote and educational sessions and then write about three stories a day, so I won’t be scheduling a whole lot of vendor meetings, but I’ll see what I can do. As I’ve said for a long time, I can either meet with a lot of companies at HIMSS or I could get my actual work done.

I’m excited about this new chapter and I’m ready for the challenge of covering my 14th consecutive HIMSS conference. Best of all, I can sleep in my own bed this time.

April 3, 2015 I Written By

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

CMS publishes Stage 3 Meaningful Use proposal

The rumor I heard this morning was true. CMS has published its proposed rules for Stage 3 of Meaningful Use, once again waiting until late on a Friday to release a major document. Stage 3 will start no earlier than 2017.

Simultaneously, ONC released its proposed update to EHR certification regulations, to be known as the 2015 edition.

Both documents will appear in the Federal Register March 30, triggering a public comment period. CMS will take comments on the MU rule through May 29, while ONC will do so on the certification plan through June 30. Expect to see final rules before the end of the year.

From an HHS e-mail announcement:

Together, these proposed rules will give providers additional flexibility, make the program simpler and reduce burden, drive interoperability among electronic health records, and increase the focus on patient outcomes to improve care.

The proposed rules are one part of a larger effort across HHS to deliver better care, spend health dollars more wisely, and have healthier people and communities by working in three core areas: to improve the way providers are paid, improving the way care is delivered, and improving the way information is shared; to support transparency for consumers, health care providers, and researchers; and to strengthen decision-making.

“The flow of information is fundamental to achieving a health system that delivers better care, smarter spending, and healthier people. The steps we are taking today will help to create more transparency on cost and quality information, bring electronic health information to inform care and decision making, and support population health,” said HHS Secretary Sylvia M. Burwell.

The Meaningful Use Stage 3 proposed rule issued by CMS specifies new criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet to qualify for Medicaid EHR incentive payments (Medicare incentive payments end in 2016). The rule also proposes criteria that providers must meet to avoid Medicare payment adjustments (Medicaid has no payment adjustments) based on program performance beginning in payment year 2018.

The 2015 Edition Health IT Certification Criteria proposed rule aligns with the path toward interoperability – the secure, efficient, and effective sharing and use of health information – identified in ONC’s draft shared Nationwide Interoperability Roadmap. The proposed rule builds on past editions of adopted health IT certification criteria, and includes new and updated IT functionality and provisions that support the EHR Incentive Programs care improvement, cost reduction, and patient safety across the health system.

The Stage 3 proposed rule’s scope is generally limited to the requirements and criteria for meaningful use in 2017 and subsequent years. CMS is considering additional changes to meaningful use beginning in 2015 through separate rulemaking.

Enjoy perusing the 301 pages of the Stage 3 proposal and 431 pages of the certification proposal this weekend!

March 20, 2015 I Written By

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