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Adelphi U ad spreads health reform fallacy

The following ad has popped up several times on my mobile Facebook app recently:

Adelphi Facebook ad
That’s from Adelphi University in Garden City, N.Y., and the first sentence of that ad is absolutely false, not to mention poorly written. There is no government mandate for any healthcare facility to go paperless at all, much less by 2015.

As people in health IT and in healthcare management probably know, the federal Meaningful Use EHR incentive program calls for Medicare penalties starting next year for any provider that hasn’t achieved at least Stage 1 of Meaningful Use. But that’s not a mandate; hospitals and other providers still have the option of participating. Those who don’t see Medicare patients don’t face penalties anyway.

Even those that are able to meet all the Meaningful Use requirements still don’t have to be paperless, at least not according to the Stage 1 and Stage 2 rules. Nor have I seen any evidence that Stage 3 would contain such language, and even if it does, that phase does not start until 2017.

There are plenty of reasons why those who start work on a master’s in health informatics this year will be very much in demand next year. Why does Adelphi need to mislead people in an apparent attempt to create demand for its program?

June 29, 2014 I Written By

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

Digital health should get in on Health Affairs innovation action

The policy journal Health Affairs puts out an e-mail update every Sunday, for those of us who can’t get enough of reading work e-mail during the week. Today’s contained the following solicitation:

Health Affairs is planning a theme issue on health care and medical innovation in early-2015. The issue will span the fields of medical technology and public policy as well as private sector innovations that promote improvements in the delivery of care, lower costs, increased efficiency, etc. We plan to publish 15-20 peer-reviewed articles including research, analyses, and commentaries from leading researchers and scholars, analysts, industry experts, and health and health care stakeholders.

We invite interested authors to submit abstracts for consideration for this issue. To be considered, abstracts must be submitted by Wednesday, June 25, 2014. We regret that we will not be able to consider any abstracts submitted after that date. Editors will review the abstracts and, for those that best fit our vision and goals, invite authors to submit papers for consideration for the issue. Invited papers will be due at the journal by September 2, 2014.

Abstract submission requirements. Abstract submissions should not exceed 500 words, and should include (in this order): proposed title, author names and affiliations, abstract, name and contact information for the corresponding author below the abstract. Please consult our online guidelines for additional formatting instructions. http://www.healthaffairs.org/Abstract_Submission_FAQ.php

If you wish to submit an abstract, please send it as an e-mail attachment to abstracts_innovation@projecthope.org (note: there is an underscore between “abstracts” and “innovation”).

We thank you for your time and consideration. Please feel free to pass this invitation along to colleagues who might be interested. If you have questions about this request, please contact Senior Deputy Editor, Sarah Dine, at sdine@projecthope.org.

Presumably, a lot of the submissions will come from traditional medical device manufacturers, the pharma industry and managed care, but this seems like a perfect opportunity for some from the realm of digital health to prove that they really are disruptive, game-changing, revolutionary or any of a number of buzzwords and clichés the marketing people like to throw around.

The June 25 deadline doesn’t leave a lot of time, but that’s just to submit an abstract. The full description can come later. So get to work, digital health innovators. It’s time to prove to the establishment that your ideas are real and effective.

Click here for more information.

If you’re looking for my writing this week, I’ll be at WTN Media’s Digital Health Conference in Madison, Wis., Tuesday and Wednesday, helping WTN with its coverage. I’ve got to write at least three stories from that conference, which will be my priority once the meeting starts, though that doesn’t preclude me from posting elsewhere once that work is done.

June 22, 2014 I Written By

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

Browning out at IntelliBlast, PwC’s Wasden gets academic appointment

I have some personnel news from the world of digital health for you today.

This morning, I learned that Matthew Browning, founder of IntelliBlast Health, a healthcare communications platform formerly known as YourNurseIsOn, has resigned as CEO, in an apparent dispute with investors. Alliance Healthcare Partners made an undisclosed investment in IntelliBlast parent Targeted Instant Communications one year ago tomorrow.

Browning’s wife, Phoebe, remains CFO of the New Haven, Conn.-based company for the time being, but probably not much longer.

Also, Chris Wasden, managing director of PricewaterhouseCoopers’ healthcare innovation practice for nearly seven years, has been named executive director of the Sorenson Center for Discovery and Innovation at the University of Utah’s David Eccles School of Business and the associate executive director of the university’s Center for Medical Innovation. Wasden remains with PwC as a consultant.

 

June 10, 2014 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: StartUp Health co-founder talks Health Datapalooza on CNBC

Unity Stoakes, co-founder and president of entrepreneurship academy StartUp Health, was in Washington this week for Health Datapalooza. Tuesday morning, with the Capitol dome serving as a picturesque background, he appeared on CNBC’s “Squawk Box” to talk innovation in digital health. Stoakes used more than a couple of buzzwords, such as “revolution” (see my commentary for Forbes on Apple’s just-announced HealthKit mocking the notion of a revolution) and “creative destruction,” and CNBC added a few more, like “disruptive” and “tectonic shift”

But he did temper the enthusiasm with a reality check. “To be quite honest, there’s a lot of uncertainty,” Stoakes said when asked about who the losers would be in the new healthcare world. Have a look, and share with your friends outside of healthcare so they get a bit of a sense about what digital health is and where true healthcare reform might come from.

Visit NBCNews.com for breaking news, world news, and news about the economy

In case you missed it, I interviewed Stoakes last month for a story in Healthcare IT News about breaking down data silos in digital, mobile and “connected” health.

June 5, 2014 I Written By

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

Justin Barnes lands at Georgia Tech’s startup incubator

Here’s some more personnel news for you: Justin Barnes, who last month stepped down as chief of industry affairs and government affairs for EHR vendor Greenway Health, has been named entrepreneur-in-residence at Georgia Tech’s Advanced Technology Development Center.

The startup incubator isn’t specific to healthcare, but it sounds like Barnes will be focusing a lot of his energy on the healthcare sector. Per his bio: “He mentors and provides strategic entrepreneurial advice as well as key business connections to help grow a wide range of organizations including healthcare and IT companies, industry collaboratives, health systems and physician practices.” Barnes does have a lot of experience in healthcare. Before he spent 11 years at Greenway for 11 years, he was a founding vice president of Healinx, the precursor company to RelayHealth. Barnes also worked at HBO & Co. when that company was acquired by McKesson.

June 2, 2014 I Written By

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

Palomar Health innovation officer Portale stepping down June 30

Late word from the West Coast on Thursday is that Orlando Portale, chief innovation officer of Palomar Health in San Diego County, Calif., for the past seven years, is leaving at the end of June.

According to a quick e-mail from Portale, “I’m going to focus on advising health technology companies, private equity firms and healthcare organizations.” He already has dabbled in some of those areas, helping Palomar start up Glassomics, which he calls the world’s first incubator for healthcare applications and technology that run on wearable computers, including Google Glass.

Qualcomm Life provided an operating grant to Glassomics, so I wouldn’t be surprised if Portale ends up at that San Diego-based venture. Then again, Portale has a deep résumé, including senior positions at the former Sun Microsystems, health insurer WellPoint and government IT contractor Science Applications International Corp. (SAIC).  I’m sure he will have plenty of opportunities coming his way in short order.

In an e-mail to Portale — and copied to executives and board members — Palomar CEO Michael Covert said: “I want to personally thank you for everything that you have done for Palomar Health. Your efforts have put us on the map in the world of innovation and technology. We had a vision of what we could be and you helped to make it a reality. I am forever in your debt. Please let me know if I can be of support or help to you in the future. … I wish you only the best. Let us stay in touch as your career moves forward.”

 

May 29, 2014 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: Aneesh Chopra on ‘The Daily Show’ for a long interview

Everybody else has the news about CMS offering leniency with Stage 2 Meaningful Use, letting providers use EHRs with 2011 certification to meet Stage 2 standards because so few vendors have been certified to the 2014 standards previously required for Stage 2. I won’t rehash here.

I will, however, share the very extended interview Jon Stewart had last night with former White House CTO — and, before that, HHS CTO — Aneesh Chopra on “The Daily Show.” Stewart is a comedian with a known liberal bias, but he is not a bad interviewer when dealing with a serious subject.

Stewart has been hammering the VA over its backlog of new registrations, and stepped it up in the wake of the recent revelation that VA bureaucrats in Phoenix were gaming the system to make it look like waits weren’t as bad as they really were. He’s also criticized the federal government for failing to link medical records between the Military Health System and the VA — you know, what we in health IT call interoperability. (In Part 4, Chopra discusses lack of interoperability in the broader healthcare sense.)

I found out about Chopra’s appearance last night shortly before the show aired. Unfortunately, we were having heavy rain at the time, and my satellite TV got knocked out, so I missed it. It’s OK, because the Chopra interview was long — more than 22 minutes — and the version that was on TV is heavily edited. Here’s the full interview of the “Indian Clooney,” as Stewart called Chopra, from the show’s Web site.

Part 1  (4:41)

 

Part 2 (7:27)

 

Part 3 (5:19)

Part 4 (5:35)

 

May 21, 2014 I Written By

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

APSO vs. SOAP, continued

A couple weeks ago, I had a story in Healthcare IT News about the growing use of the “APSO” notes for documenting patient encounters. APSO flips around the traditional SOAP format (subjective, objective, assessment, plan), ostensibly making it easier to view progress notes in electronic health records.

As I reported, APSO is in wide use at University of Colorado Health and at Lucile Packard Children’s Hospital in Palo Alto, Calif. Baystate Health in Springfield, Mass., found that hospitalists focused most of their attention on the “impression and plan” sections of patient records, essentially the AP part of APSO/SOAP. Physicians at Epic Systems, according to University of Colorado’s Dr. C.T. Lin, are recommending APSO as a best practice.

Yet, the inventor of the SOAP note, Dr. Larry Weed, still believes his format is superior. You saw his comments in the Healthcare IT News story. But every time I have the privilege of speaking to the nonogenarian Renaissance man, he always has more to say than I can fit into the average article. I often can’t keep up in my note taking, but, fortunately, in this case, Weed and his son/occasional co-author Lincoln, took the time to put their thoughts in writing for me.

I left most of their comments out of the story due to space limitations. I don’t have that problem here, so I present their entire statement to me:

The following represents our collective thoughts, including references to relevant portions of Medicine in Denial [their 2012 book].

The supposed advantage of the APSO alternative — that it begins with the physician’s assessment rather than data — is actually a failing. This sequence tends to make the note provider-centered rather than patient-centered, and judgment-based rather than evidence-based.  In contrast, beginning the progress note with data disciplines the provider’s assessment. The provider must think in terms of specific data, specific problems on the problem list to which the data relate, and the interrelationship of each problem to the other problems on the list. Moreover, it’s important to begin the progress note with subjective (symptomatic) data from the patient rather than so-called “objective” data,  As Medicine in Denial states (p. 168):
“… progress notes should begin with subjective data, because progress should be assessed from the patient’s point of view.  Practitioners should be alert to discrepancies between subjective and objective data (for example, where the patient does not feel better when lab results show improvement). These discrepancies may signal an error in data or misstatement of the patient’s problem.”
In short, provider thinking can be disciplined with problem-oriented SOAP notes as a standard of care. Yet, regulators and academics who are in a position to act on this issue have shied away from the whole notion of standards of care for organizing data in medical records. See our comments on ONC’s Stage 2 regs and our comments on the PCAST Report.
The need for standards of care in medical records goes far beyond the SOAP vs. APSO issue in progress notes. In fact, that issue is secondary. Two more fundamental issues for medical records are the following:
  1.  Determining initial inputs to the record. Initial inputs are determined by selection of data needed for the patient’s problem situation, and once the data are collected, analysis of the results.  Both selection and analysis are fatally compromised when determined by the physician’s clinical judgment. External standards and tools, based on a combinatorial standard of care, must govern the selection and analysis. Once that happens, then judgments of patient and practitioners (not just physicians) may supplement the combinatorial minimum standard.  See Medicine in Denial, pp. 53-61, 69-79, 136-37, 145-52.
  2.  Organizing the medical record around the problem list. Once initial data are collected and a complete problem list is defined, then care plans, orders, and progress notes should be problem-oriented, that is, labeled by the problem(s) to which they relate on the problem list. This disciplined practice is essential to justifying provider actions in terms of defined patient needs. Yet this practice is not followed or enforced with consistency. Indeed, some EHR systems do not even enable electronic links between the problem list and care plans, orders and progress notes. See Medicine in Denial, pp. 134-35, 144, 159-60, 166-67.
Like so much else in medicine, medical record practices are a Tower of Babel. Medicine need standards of care for managing clinical information (knowledge and data) no less than the domain of commerce needs accounting standards for managing financial information. This failing is a primary root cause of the health care system’s failures of quality and economy.

For that matter, Lin had more to say than what you saw in the story. He discussed the supposed importance of the subjective and objective elements. “That’s true in cases where there is diagnostic uncertainty,” Lin said. But he added that those components are still there for reference, jut not up front.

Lin called SOAP “a phenomenal innovation,” but suggested that EHR complexity sometimes makes it difficult to find the assessment and plan. For example, he said that a non-Epic EHR in the emergency department at UC Health has as many as 17 different screens for progress notes. “At least with APSO, you would collect the assessment or plan in the first half,” Lin said.

Because SOAP is so entrenched, Lin ran into much resistance when he proposed switching to APSO at 40 affiliated practices. He, of course, heard the tired, “But we’ve always done it this way” defense.

“I learned myself about culture change very acutely,” Lin said. “I was literally shouted out of the room by our physician leadership.” He had neglected to prepare the heads of various departments and clinics for the change in advance of the meeting where he announced the plan.

He subsequently had to have individual conversations with all 40 practice directors. And then Lin dropped a great quote from none other than Niccolo Machiavelli (speaking of Renaissance men): “Those who benefited from the old order will resist change very fiercely.”

Yes, that’s absolutely perfect for an industry as resistant to change as healthcare. But is APSO superior to SOAP? I’d love to hear your thoughts.

May 20, 2014 I Written By

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

Some truths about health IT and innovation

This morning at the annual SAS Health Analytics Executive Conference in Cary, N.C., former national health IT coordinator Dr. Farzad Mostashari dubbed Dr. Eric Topol “the high priest of personalized medicine.”

That reminded me of an e-mail I received a couple weeks ago, suggesting that someone should start a blog called, “What’s Eric Saying?” As this correspondent explained it, all you need to do is read Topol’s Twitter stream to know where health IT and the practice of medicine are headed. I checked it out. It’s true.

Some examples:

 

 

 

And that’s just since Monday.

Meanwhile, Mostashari added some truisms himself this morning. “Med speed is slow. Tech speed is fast,” he said, apparently paraphrasing current TEDMED owner Jay Walker. Then, speaking as a physician, Mostashari said, “Most of what determines our outcomes isn’t what happens in our office.” Which is kind of what Topol has been trying to get across for several years.

If only the financial incentives would encourage care outside the office, we might be getting somewhere. It’s starting to happen, but, as it says above, med speed is slow.

May 14, 2014 I Written By

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

Still no consensus on digital/mobile/connected health

A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless health, mobile health and telehealth, and surmised that the results would not be conclusive. On that part, I was right:

digital health poll resultsHowever, I was surprised that connected health, a relatively underutilized term, did so well and that telehealth got but one vote. Wireless health certainly has kind of become passé, but I was surprised nobody picked it at all.

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

May 6, 2014 I Written By

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