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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.

Athenahealth-EHRA news significant only that it shakes up the status quo

By now, you’ve likely heard the news that Athenahealth has decided to quit the HIMSS EHR Association. As Athenahealth’s Dan Haley put it in a blog post: “At the end of the day, athenahealth left the EHRA because we never really belonged there in the first place. The EHRA was founded in 2004 by a group of EHR software vendors. Today, a decade into the age of cloud technology, the EHRA is still dominated and governed by a group of EHR software vendors.”

Athenahealth long has billed itself as a services company, not a software vendor, going so far as to hold a jazz funeral for the “death of software” at HIMSS13 in New Orleans. Athenahealth didn’t join the EHRA until 2011 anyway. It sounded like a bad fit.

I contacted Athenahealth, and was told that the company remains “fully committed” to the CommonWell Health Alliance, a coalition of health IT companies — also including Allscripts, Cerner, CPSI, Greenway Health, McKesson and Sunquest Information Systems — that came together for the stated purpose of “developing, deploying and promoting interoperability for the common good.” (There’s also the unstated purpose of fighting the dominance of Epic Systems.)

Athenahealth is staying on the interoperability path, but as is befitting the corporate culture, is going rogue when it comes to EHRs. It’s not the first time. It won’t be the last time, because it’s not like most of the other vendors/service providers, if for no other reason than CEO Jonathan Bush doesn’t fit the buttoned-down model of an executive. For that matter, neither did his co-founder, Todd Park, whom I often called an “anti-bureaucrat” during his time with the federal government. Park’s brother, Ed, is COO of Athenahealth, and also has unconventional tendencies.

I can relate to this mentality in a way. I quit the Association of Health Care Journalists years ago because it didn’t feel like a good fit for me. That group tried to include health IT in its programming, but it really was an organization for consumer and scientific reporters, not those of us in the business and trade press. Eight years later, I still don’t think the national media are doing such a great job covering health policy or explaining the nuances of this complicated industry. And, as I’ve said many times before about healthcare, the status quo is unacceptable.

 

April 23, 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.

It’s not exactly official, but don’t count on MU3 starting before 2017

MADISON, Wis.—As the headline says, don’t count on Stage 3 of Meaningful Use starting before 2017.

Speaking at WTN Media’s annual Digital Health Conference on Wednesday, ONC’s deputy national coordinator for programs and policy, Judy Murphy, R.N., recalled that national coordinator Farzad Mostashari, M.D., and CMS Administrator Marilyn Tavenner said at HIMSS13 in March that there would be no more activity on Stage 3 regulations this year. “The focus this year is on helping people understand the Stage 2 criteria,” Murphy said.

Then she discussed how long it takes to go through the regulatory process, including issuing a proposed rule, taking public comments, reviewing the comments, then issuing a final rule. “If you do an extrapolation of that, 2016 would be a problem,” Murphy said.

That was not exactly an announcement that Stage 3 will be pushed back to 2017 — or three years after a provider gets to Stage 2 — but it might be the strongest hint to date. It’s not a huge surprise since so many entities have called for slowing down the program, but there you have a bit more evidence that the federal government is leaning that way.

Look for more coverage of this conference from me at Wisconsin Technology Network’s WTN News.

June 12, 2013 I Written By

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

HIMSS CIO survey visualized

I already reported the results of the annual HIMSS healthcare CIO survey in a story I wrote for InformationWeek the other day. Since everybody seems to love infographics these days, HIMSS produced one visualizing some of the highlights, including the finding that two-thirds of U.S. hospitals already have met Stage 1 meaningful use. Based on this, I’m guessing that close to 90 percent should be there by the end of the year, which means that CMS and ONC will have achieved their objectives for Stage 1, at least on the hospital side. (Of course, the physician part is proving to be much more difficult.) Someone in the know at ONC told me last night that people in that office are expecting 80 percent hospital success by the time fiscal year 2013 closes Sept. 30.

March 7, 2013 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: Live from HIMSS with Athenahealth CEO Jonathan Bush

NEW ORLEANS—I made my debut for the new Health Innovation Broadcast Consortium last night with a live webcast interview with Athenahealth CEO Jonathan Bush. As usual, I didn’t need to prepare much for the interview because Bush almost interviews himself, so I just decided to wing it. Also as usual, we kept it light, as each of us had a beer in our hand, since we were at the House of Blues in the French Quarter, where Athenahealth had its annual HIMSS party. (This year featured a jazz funeral marking the “death of software.”) But we did discuss some topics actually relevant to health IT, including meaningful use and Athenahealth’s recent acquisition of Epocrates. Enjoy.

Watch live streaming video from hibc at livestream.com

March 4, 2013 I Written By

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

Podcast: HIMSS CEO Steve Lieber: 2013 edition

Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization’s Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.

Here it is late Friday and I’m finally getting around to posting the interview, but it’s still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.

Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.

1:00        Industry growth and industry consolidation
2:50        mHIMSS
3:45        Why Dr. Eric Topol is keynoting
6:00        New Orleans as a HIMSS venue
6:50        Changes at HIMSS13, including integration of HIT X.0 into the main conference
8:55        Focus on the patient experience
9:35        Global Health Forum and other “conferences within a conference”
13:00     Criticisms of meaningful use, EHRs and health IT in general
17:00     Progress in the last five years
20:45     Healthcare reform, including payment reform
22:30     Why private payers haven’t demanded EHR usage since meaningful use came along
23:50     Payers and data
26:28     Potential for delay of 2015 penalties for not meeting meaningful use
29:15     Benefits of EHRs
30:40     Progress on interoperability between EHRs and medical devices
32:52     Efficiency gains from health IT
35:27     Home-based monitoring in the framework of accountable care
36:55     Consumerism in healthcare
39:40     Accelerating pace of change
41:10     Entrepreneurs, free markets and the economics of healthcare
43:25     Informed, empowered patients and consumer outreach
46:30     Fundamental change in care delivery

March 1, 2013 I Written By

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

Maybe Topol and Agus are rock stars after all?

I saw this advertisement on bus shelter near my home in Chicago Tuesday night:

 

Topol-Agus

Yes, that’s Dr. Eric Topol, director of the Scripps Translational Science Institute, and Dr. David Agus, co-founder of Navigenics, flanking pop star Seal, in an ad for fashion house Geoffrey Beene’s Rock Stars of Science program. (The www.rockstarsofscience.org URL currently redirects to Geoffrey Beene’s home page, but the Facebook page still works.) The photo actually is from a GQ shoot in 2009, as readers of MobiHealthNews might recall, but I’ve only noticed the outdoor ads recently. I guess the band must be on hiatus right now.

FWIW, Topol is keynoting Tuesday morning at HIMSS13 in New Orleans.

February 26, 2013 I Written By

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

New Media Meetup at HIMSS13

Next week at HIMSS13, John Lynn, el queso grande of the Healthcare Scene blog network, of which I am a member, is hosting his fourth annual New Media Meetup, and readers of this and all affiliated blogs are invited. It’s Tuesday, March 5 at 6 p.m. at Mulate’s Party Hall, right by the Morial Convention Center in New Orleans. Click here for details and to register. I should be there for at least a little while. Deadlines beckon, but I’ve got to have a little bit of fun in the Big Easy, right? Laissez les bons temps rouler! (That’s three languages in one paragraph. What do I win?)

I Written By

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

My HIMSS will be all about quality and patient safety

As regular readers might already know, 2012 was a transformative year in my life, and mostly not in a good way. I ended the year on a high note, taking a character-building six-day, 400-mile bike tour through the mountains, desert and coastline of Southern California that brought rain, mud, cold, more climbing than my poor legs could ever hope to endure in the Midwest, some harrowing descents and even a hail storm. But the final leg from Oceanside to San Diego felt triumphant, like I was cruising down the Champs-Élysées during the last stage of the Tour de France, save the stop at the original Rubio’s fish taco stand about five miles from the finish.

But the months before that were difficult. My grandmother passed away at the end of November at the ripe old age of 93, but at least she lived a long, full life and got to see all of her grandchildren grow up. The worst part of 2012 was in April and May, when my father endured needless suffering in a poorly run hospital during his last month of life as he lost his courageous but futile battle with an insidious neurodegenerative disorder called multiple system atrophy, or MSA. (On a personal note, March is MSA Awareness Month, and I am raising funds for the newly renamed Multiple System Atrophy Coalition.)

That ordeal changed my whole perspective, as you may have noticed in my writing since then. No longer do I care about the financial machinations of healthcare such as electronic transactions, revenue-cycle management, the new HIPAA omnibus rule or reasons why healthcare facilities aren’t ready to switch to ICD-10 coding. Nor am I much interested in those who believe it’s more worthwhile to take the Medicare penalties starting in 2015 for not achieving “meaningful use” than to put the time and money into adopting electronic health records. I’m not interested in lists of “best hospitals” or “best doctors” based solely on reputation. I am sick of the excuses for why healthcare can’t fix its broken processes.

And don’t get me started on those opposed to reform because they somehow believe that the U.S. has the “best healthcare in the world.” We don’t. We simply have the most expensive, least efficient healthcare in the world, and it’s really dangerous in many cases.

No, I am dedicated to bringing news about efforts to improve patient safety and reduce medical errors. Yes, we need to bring costs down and increase access to care, too, but we can make a big dent on those fronts by creating incentives to do the right thing instead of doing the easy thing. Accountable care and bundled payments seem like they’re steps in the right direction, though the jury remains out. All the recent questioning about whether meaningful use has had its intended effect and even whether current EHR systems are safe also makes me optimistic that people are starting to care about quality.

Keep that in mind as you pitch me for the upcoming HIMSS conference. Also keep in mind that I have two distinct audiences: CIOs read InformationWeek Healthcare, while a broad mix of innovators, consultants and healthcare and IT professionals keep up with my work at MobiHealthNews. For the latter, I’m interested in mobile tools for doctors and on the consumerization of health IT.

I’m not doing a whole lot of feature writing at the moment, so I’d like to see and hear things I can relate in a 500-word story. Contract wins don’t really interest me since there are far too many of them to report on. Mergers and acquisitions as well as venture investments matter to MobiHealthNews but not so much to InformationWeek. And remember, I see through the hype. I want substance. Policy insights are good. Case studies are better, as long as we’re talking about quality and safety. Think care coordination and health information exchange for example, but not necessarily the technical workings behind the scenes.

And, as always, I tend to find a lot more interesting things happening in the educational sessions than in that zoo known as the exhibit hall. I’m there for the conference, not the “show.”

Many of you already have sent your pitches. I expect to get to them no later than this weekend, and I’ll respond in the order I’ve received them. Thank you kindly for your patience.

February 13, 2013 I Written By

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

Hotels open up for HIMSS13

Here’s a quick travel update for those of you still making plans for HIMSS13 in New Orleans next month. Today, OnPeak, the travel service that HIMSS has contracted with, seems to have released a number of hotel rooms for the week of the conference.

I had been waiting to book for a few weeks since I first heard that rooms would open on Jan. 30 or so after vendors, which apparently claimed big blocks of rooms months ago, had to give their final numbers. That didn’t happen, and I was starting to sweat a bit. But I made my reservation today, and am near enough to the Morial Convention Center that I don’t have to worry if I miss the last shuttle of the evening, which I’ve done plenty of times in past years. I feel bad for anyone staying out by the airport in Metairie or Kenner, because that’s a good 10-13 miles away. From my experience in other HIMSS cities, those bus trips can easily take 45 minutes to an hour during rush hour, and the buses don’t run all that frequently. HIMSS won’t be going back to San Diego anytime soon because so many people had to stay out by La Jolla the last time the conference was there in 2006, and that is closer to the San Diego Convention Center than the airport hotels are in New Orleans.

Back then,  seven years ago, attendance had swelled to a then-record 25,000, and stayed in that range for a couple of years. But then came the HITECH Act and meaningful use in 2009, and interest in health IT has soared. Last year, more than 37,000 people came to HIMSS12 in Las Vegas, where hotels are plentiful. The Big Easy might not be as big a draw as Sin City, but it might be for some people who prefer authentic culture to the manufactured kind. (For the record, I like both places.) I’ve heard registration was slower this year than last, but I didn’t get that directly from HIMSS.

If you do find yourself stuck, I did notice in the last couple of weeks that there are a good number of hotels with vacancies across the Mississippi River in Gretna and Marrero and points east, such as Chalmette and New Orleans East. But there is no HIMSS shuttle to those places, and good luck finding a car to rent unless you’re willing to spend $90 a day. Go ahead, search for a car rental with airport pickup and try to find one for less during the week of March 3. (You can get one from an off-airport location for about $31 a day if you’re willing to take a taxi into town first to pick it up.)

This leads me to wonder if this might be the last time for a while that HIMSS meets in New Orleans. I think a couple of extra shuttle routes could fix the problem. And if attendance does level off or even drop a bit since we’ve probably passed the peak of the Gartner Hype Cycle, then it’s all good. Given some of the recent pushback against the direction of meaningful use and the efficacy of current EHR technology, I think it’s safe to say we are in or headed to the trough of disillusionment this year.

I’ll have more later this week about HIMSS, including what I’m trying to get from the conference. Vendors, please pay attention. I’m finally about to start working on my schedule, but I will have specific objectives.

 

February 11, 2013 I Written By

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