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‘Modest’ feedback

A couple of months ago, I posted, “A modest proposal,” my observations about a session on clinical decision support from the American Medical Informatics Association annual meeting. In it, I argued that medical informatics needed a rock star of sorts to help humanize the issue of clinical decision support and communicate the benefits of such technology to the general public.

I got three comments on that post—actually pretty high for this blog—as well as several e-mails. One correspondent said we need more than a rock star, we need the whole band. I passed that comment on to Dr. Bill Bria, CMIO of Shriners Hospitals for Children, who was part of the panel at the AMIA meeting, who told me that he once led an all-physician rock band called the Straight Caths. It still may take the Rolling Stones or perhaps an entire Woodstock to make some of the changes American healthcare needs. Then again, Thursday is Elvis’ birthday.

One non-physician wrote: “That was terrific. Thanks! Except, while I don’t disagree, maybe if they learned to speak English, too, it would help.” Actually, Joan Ash of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University made a similar point in said AMIA session.

CareGroup Healthcare System CIO Dr. John Halamka, himself a rock star in health IT circles for his incredible ability to juggle so many responsibilities (and perhaps for his Johnny Cash wardrobe), pointed me to one of his blog posts about his idea for ASP-style “decision support service providers”

One vendor executive wrote: “Its a shame that these guys seem to believe that CDS just means medication decision support when there are many other steps that use and benefit from DS.” This writer said there should be more of a focus on diagnosis decision support. The e-mail also included a quote from Dr. Donald Berwick: “Genius diagnosticians make great stories, but they don’t make great health care. The idea is to make accuracy reliable, not heroic”

Just think, a well-implemented clinical decision support system could finally give Cuddy a reason to fire House. I think about that every time I watch that show. It’s sad that trial and error can produce such great television.

January 6, 2009 I Written By

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

Gates Foundation to fund global informatics training

The American Medical Informatics Association will announce Monday that it has received a $1.2 million grant from the Bill and Melinda Gates Foundation to promote health informatics and biomedical education and training worldwide, particularly in developing countries.

This will be the first project of a new program called 20/20, in which the International Medical Informatics Association and its regional affiliates, including AMIA, will attempt to train 20,000 informatics professionals globally by 2020. This is an outgrowth of the AMIA 10×10 program to train 10,000 people in informatics in the U.S. by 2010. IMIA and its partners will discuss details of 20/20 this week at the Wellcome Trust in London.

AMIA will use the Gates Foundation money to develop “scaleable” approaches to e-health education, including a replicable blueprint for training informatics leaders, including physicians, medical records professionals, computer scientists and medical librarians.

“We envision the program will train leaders in low-resource nations by linking them and their institutions to partner institutions affiliated with AMIA to build capacity for managing and improving high-quality, low-cost healthcare in the less-developed economies,” AMIA explains in a statement. AMIA President and CEO Don Detmer, M.D., says this element of 20/20 is aimed at career informaticians “so there won’t be a brain drain.”

Other elements of 20/20 will include individual and degree-track courses at colleges and universities—similar to existing 10×10 curriculum—and skills training, not necessarily specific to medical informatics. “We’re also looking at ways of creating seminars and executive training for people to advocate for this in their home countries,” Detmer says.

Detmer, who is retiring at the end of the year, says the skills training will happen in “bits and bites” to help build incremental capacity in the global e-health workforce. Some planning in this area has been supported by the Rockefeller Foundation as part of a $500,000 grant the charity gave to AMIA to lead one of the Making the eHealth Connection conferences last summer in Bellagio, Italy.

The 20/20 program is chaired by N.T. Cheung, head of IT for the Hong Kong Hospital Authority. Other confirmed or likely participating organizations include the European Federation for Medical Informatics, the Asia Pacific Association for Medical Informatics and the Health Informatics Society of Australia.

December 7, 2008 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 modest proposal

Medical informatics needs a rock star. Not a David Brailer-esque figure who could excite people in the technology sphere, but perhaps a Don Berwick type who can reach every level and constituency of healthcare, and even capture the imagination of the general public.

I had this thought yesterday during a highly engaging session at the American Medical Informatics Association‘s annual symposium in Washington, a session with the mouthful of a title, “Harnessing Mass Collaboration to Synthesize and Disseminate Successful CDS Implementation Practices.” In English, that means panelists were discussing the forthcoming “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide” and related feedback mechanisms, including a wiki.

During the session, panelists discussed the difficulties they’ve had in getting clinical decision support integrated into EMR and quality-improvement projects, as well as into medical practice itself. One commenter from the audience, a Veterans Affairs doctor, noted that to too many people in healthcare, CDS sounds like an IT issue, not something related to quality.

To this, Dr. Bill Bria, chairman of the Association of Medical Directors of Information Systems, said, “Our profession has really stumbled on this one.”

Then, AMIA CEO Dr. Don Detmer asked if the informatics community could identify perhaps the top five serious preventable outcomes and create “poster children” for quality improvement via CDS. He said much of the problem with low adoption of clinical IT is related to communications, though there are some scientific and technology issues as well.

I immediately thought of Berwick and his 5 Million Lives Campaign, a nationwide initiative to help prevent 5 million harmful incidents in healthcare from December 2006 to December 2008 by encouraging hospitals to commit to a series of proven interventions. This, of course, grew out of the 100,000 Lives Campaign, which Berwick’s Institute for Healthcare Improvement says successfully prevented more than 100,000 deaths in U.S. hospitals over a year and a half.

I was at Washington Hospital Center in D.C. just a week ago because my dad had surgery there. Everywhere I looked were signs reminding staff to take action to prevent errors and complications, particularly methicillin-resistant staphylococcus aureus infections. At just about every turn in the hospital corridors, wards, waiting rooms and cafeteria were hand sanitizers.

I’m fairly certain this high level of awareness is directly related to the IHI campaign. In fact, my dad picked Washington Hospital Center over another hospital much closer to his suburban Maryland home because the other place had been in the news of late for its high rate of MRSA. Yes, the public is very aware of the danger of hospital-acquired infections, and Berwick has had a lot to do with raising the issue.

Healthcare needs someone similar to take the lead in communicating the benefits of clinical decision support to the masses. Does informatics have a rock star out there? It’s time to come forward.

November 13, 2008 I Written By

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

Scoop: AMIA’s 10×10 going global

CHICAGO—This is just a quick post to draw your attention to a story posted on Digital Healthcare & Productivity this morning: The American Medical Informatics Association is expanding its 10×10 program internationally, with the goal of training 20,000 informatics professionals outside the U.S. by 2020.

AMIA chief Dr. Don Detmer will make the announcement during his annual “state of the association” speech at 12:30 pm CST today. But you heard it here (or at DHCP) first.

Also coming in today’s DHCP newsletter is news from today’s American Health Information Community meeting here in Chicago that the Federal Communications Commission will award $400 million in grants over the next three years to connect small and rural healthcare facilities in 42 states and three territories.

November 13, 2007 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 gig!

Ladies and Gentlereaders,

I am proud to announce that I have a new gig. I am writing a monthly supplement to the weekly Part B News called Physician Office Technology Report. It’s published by Decision Health of Rockville, Md.

The title pretty much speaks for itself, and the audience is primarily physician practice managers, similar to my last full-time job at a publication that shall remain nameless because I don’t want them to have the publicity.

So yeah, there was a good reason why I was in Philadelphia last week for the Medical Group Management Association‘s annual conference and yet another reason why my blogging has been rather spotty of late.

The first issue of the Part B News Physician Office Technology Report came out this week. Look for it the first week of each month.

Speaking of conferences I’m covering, I will be at the American Medical Informatics Association confab here in Chicago next week. The last time I saw Don Detmer’s crew was in Australia for MedInfo in August. Let’s see, 17 hours of flying vs. 25 minutes on the bus. Discuss.

The AMIA meeting at the Sheraton overlaps with the AHIP Business Forum, which is at the Renaissance Chicago about five blocks away, so it’s unlikely I’ll spend much time with the health insurers.

I did go to the AHIP annual meeting in Las Vegas in June (much warmer than Chicago in November, or, for that matter, Chicago in October 1871), but I’m not sure how much I’d get out of next week’s meeting.

A poll question in an AHIP “SmartBrief” last week asked which of the following trends was most significant in 2007:

1. CMS ruling not to reimburse costs for preventable errors.
2. Expansion of walk-in clinics in retail health settings.
3. Efforts to provide more insurance options for young people.
4. Obesity epidemic continuing.

Notice that health IT didn’t register. It’s not a top-tier issue on the national healthcare scene at the moment, a point further driven home at another event I dropped in on last week: the 25th anniversary celebration for Health Affairs. There, representatives from nine or 10 presidential campaigns participated in a roundtable discussion of healthcare issues.

The way it sounded to me was: “Access. Cost. Access. Cost. Medicare reform. Access. Cost. Health savings accounts. Access. Cost. Access Cost.” John McCain’s representative did mention health IT and, at the very end, Barack Obama’s guy alluded to quality. And you wonder why national HIT legislation hasn’t gone anywhere?

Want another sign that physicians are lagging on the IT front? I’m going to scrape the very bottom of the barrel for some evidence contained in a spam e-mail. Yeah, I know.

Someone trying to sell physician mailing lists said there were 788,974 total licensed physicians in the U.S. That sounds about right. This particular outfit claimed to have e-mail addresses for 17,042 of them. That works out to about 2 percent. Even if you consider only the 600,000 or so practicing docs, you’re only taking about 3 percent.

OK, enough with the spam. Here’s a public service for some people I’ve worked with, either directly or indirectly: Job listings.

First, blogger Matthew Holt is looking for 2-3 unpaid interns for the next health 2.0 conference, scheduled for San Diego next March. He’s based in San Francisco, and I assume most of the work is too. (Maybe I shouldn’t mention that the current issue of another pub I contribute to, Inside Healthcare Computing, has a commentary headlined “Our Take: Health 2.0 Is Really Advertising 2.0.”)

Also, E-Health Media in the UK, publisher of E-Health Insider, is putting on a healthcare IT careers forum in London on Nov. 30.

If you go to the latter, bring me back some British pounds. They’re worth about $2.11 as of this writing. Heck, I’d settle for Canadian or Aussie dollars, euros, yen, whatever.

November 5, 2007 I Written By

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

Google’s health plans, and more on CMIOs

BRISBANE, Australia—I’m at the other end of the world this week for the 12th World Congress on Health (Medical) Informatics, otherwise known as MedInfo, so things have been a bit nutso, what with the travel, the change of 15 time zones and the acclimation to a rainy winter in a region that’s had drought conditions for several years, at least until I arrived Sunday.

That said, I have a couple of things to share that I carried with me for some 9,000 miles. Yeah, so what if I carried them on a tiny USB drive? I still brought them to Australia.

First off, thanks to Fred Trotter and Dr. Scott Shreeve for cluing me in to a sneak peek at Google Health, allegedly code named “Weaver.” See this post at Google Blogoscoped, complete with screen shots. Happy scoping.

Secondly, a story I wrote for Digital HealthCare & Productivity late last month caught the attention of Dr. Scot Silverstein, director of the Institute for Healthcare Informatics at Drexel University in Philadelphia. Dr. Silverstein agreed with the quote from Gartner‘s Vi Shaffer about chief medical information officers: “Direct report to the CIO is a wedge of separation from the medical staff.”

Silverstein e-mailed me to say he e-mailed the story to members of the AMIA clinical information systems workgroup. “We’ve been discussing how to empower the CMIO role and trying to organize a workshop on same, although the proposal was rejected for November,” he wrote.

Silverstein also referred me to an essay he wrote several years ago, entitled, “Ten critical rules for applied informatics positions: What every Chief Medical Informatics Officer (CMIO) should know,” which he said was still relevant.

From that essay:

Rule 6 : Reporting should preferably be to senior medical leadership or medical records (health information management).

Physicians and other clinicians, being the primary enablers of healthcare, should report to personnel who understand clinical issues, matrixing with those who facilitate care. Reporting to non-medical personnel should be done only if the chemistry between the two parties is very good, and the senior party is well-rounded and has experience in working as a direct supervisor to medical personnel. Unfortunately, this is not very common.

Rule 9 : Have a direct, open channel to organization’s CEO.

Also make sure the CEO and other senior executives understand what medical informatics is about, and its strategic value. Direct them to this web site, for example … Medical informaticists may unfortunately be viewed by healthcare executives as “clinical consultants who know a little about computers”, as opposed to leaders in clinical computing.

I then referred Silverstein to a Digital HealthCare & Productivity editor to submit a commentary, which ran Aug. 7. Click here to read.

August 22, 2007 I Written By

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

Just short of begging

I’m teetering on the brink of attending MedInfo next month, the triennial meeting of the International Medical Informatics Association, which is represented in the United States by the American Medical Informatics Association. I went to the 2004 edition in San Francisco and came out of it with six months of story ideas. This time, the only problem for me is that MedInfo is in Brisbane, Australia, August 20-24.

So, rather than begging for cash (which I’m certainly not above doing), I’m willing to work for it. Therefore, I am publicly offering my services, for a fee, of course, for any publication interested in coverage of MedInfo and other conferences in Australia going on in August. These are:

The types of publications I’d like to find as freelance clients for MedInfo include:

  • Home health
  • Surgical IT
  • Public health
  • Linguistics
  • Open-source software
  • Nursing informatics
  • Dental informatics
  • African health/technology

If you have any information that might help me afford the trip, please e-mail me.

Thanks much for indulging me and for your continued interest in this blog.

July 30, 2007 I Written By

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