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Health Wonk Review makes progress

The newest Health Wonk Review is riding a “Carousel of Progress” over at the Pizaazz blog. Hosting this blog carnival is Glenn Laffel, who takes us for a ride around the freak show commonly known as U.S. healthcare. IT even gets its own section.

Thanks, Glenn, for including the post about my experience at the doctor last week, and for the well wishes. I’m feeling a lot better now, though the cough is lingering. I guess that’s how bronchitis works.

April 16, 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.

Social media for physician practices?

Anne Zieger, editor of FierceHealthIT and other publications, is running a contest of sorts on LinkedIn: Design a social media marketing and communication system for a medical practice. It’s part of a LinkedIn discussion group, and it looks as if she’s doing this on her own, not as a representative of any publication.

I’m not sure of any prizes, but it sounds like there might be a business opportunity there for the right ideas.

See, just because I’m skeptical of Twitter doesn’t mean I don’t see value in social networking sites. In fact, here is my LinkedIn profile page.

April 15, 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.

More thoughts on Twitter

Though I’m still skeptical of Twitter and not ready to sign up for fear of having too many messages to read from anyone I decide to follow, I found something I might use it for. I’ve just learned that Children’s Hospital Omaha is getting ready to go live with EpicCare in orthopedics. That could have been handled in a single tweet, rather than a full blog post.

That said, I continue to fight a losing battle against e-mail. How in the world would I ever keep up with Twitter feeds?

Also, I don’t like the URL shorteners the Twitterati (did I just coin a new word?) like to use to conserve characters. With so many phishing scams out there, I’m wary of clicking on URLs that don’t make sense to me. Particularly alarming are the ones with country-specific top-level domain names. I’ve seen plenty of is.gd (Grenada) and bit.ly (Libya) and ow.ly (also Libya) links of late. With apologies to the legitimate sites out there, would you knowingly click on a cryptic URL from either an offshore tax haven or a country that formerly sponsored terrorism? What about Internet scam bases such as Russia (.ru) or Nigeria (.ng)? Just asking.

Again, Children’s Hospital Omaha is about to turn on EpicCare in orthopedics. Anyone want to tweet that for me?

UPDATE, 10:53 p.m. CDT: “Twitterati” already exists, but it’s a fairly new word. Urban Dictionary’s oldest definition related to Twitter is from Feb. 13. (There’s another, older usage that refers to Hollywood dingbats.)

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 Health and claims data

I’ve suspected for a while that one reason why personal health records haven’t taken off was because the “untethered” kind that are not tied to a specific provider organization’s electronic medical record or portal tend to be built with claims data. That is, an insurer or employer combs through billing codes to piece together records that ostensibly contain clinical records.

There are numerous problems with this, of course. First off is the workflow issue. If the doctor doesn’t have an EMR to import PHR data, then the PHR represents an extra step that the typical physician isn’t willing to take.

Then there is the reputation of managed care. Health insurers often are just slightly above oil companies, politicians and Bernie Madoff on the public’s trustworthiness scale. I imagine they’re even lower from the perspective of doctors who are asked to accept these claims-based records and use them in the practice of medicine. I’m sure there are some payer-sponsored PHRs that are fairly accurate, but they don’t ever get much of a chance because of this perception.

That said, claims-derived PHRs can never be fully accurate representation of health status because the ICD-9 (and soon, ICD-10) billing codes are completely different than CPT diagnosis codes. Don’t believe me? Ask Dave deBronkart, aka E-Patient Dave.

DeBronkart’s story is widely known among health IT types, but he was featured Monday in the Boston Globe. That article tells something I didn’t know, that there was inaccurate data in a Google Health PHR that had suggested cancer had spread to his brain or spine, as well as a few other false alarms.

The Globe quotes many of the usual suspects, notably deBronkart’s personal physician, Danny Sands, as well as Drs. Paul Tang, David Kibbe and John Halamka. While this may not be news for those in health IT, I think this story should be required reading for anyone considering a personal health record.

April 13, 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.

Steven Heusing, IMIA executive director, dies at 64

Canadian medical informaticist Steven Heusing, executive director of the International Medical Informatics Association, died Sunday. He was 64. Mr. Heusing had been in declining health for a number of years and reportedly had had two kidney transplants.

Mr. Heusing, a resident of Edmonton, Alberta, was founding president of COACH, Canada’s Healthcare Informatics Association and co-founder of the Canadian Healthcare Information Technology Trade Association (CHITTA), now called ITAC Health. He was editor and publisher of Healthcare Information Management & Communications Canada, the official journal of COACH and ITAC Health.

To recognize his service, COACH established the Steven Heusing Scholarship in 1999 for students in Canadian health informatics or healthcare information management programs.

Current AMIA President Dr. Reinhold Haux, director of the Peter L. Reichertz Institute for Medical Informatics at the University of Braunschweig Institute of Technology and Hannover Medical School in Germany, issued this statement:

Steven Huesing was an outstanding person and professional. As Executive Director of the International Medical Informatics Association, he has for many years provided significant and global contributions to the progress of our field. It is through his tireless work that IMIA has developed into the leading international association that it is today. Since the start of his career, in the 1960s, he has been a pioneer and ambassador to the advancement of computers and information technology in healthcare. Among the many recognitions of his contributions, he was honoured for his exceptional work with the prestigious Canadian Health Informatics Award for Lifetime Achievement.

Additionally, Michael Martineau posted his thoughts on the eHealth Musings blog.

Funeral arrangements are pending.

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: Jonathan Bush at HIMSS09

CHICAGO—It’s becoming a tradition, sitting down with athenahealth Chairman, CEO and President Jonathan Bush for a podcast during the annual HIMSS conference. If you missed the original in 2007 or the sequel in 2008, you missed a whole lot of fun. If you happened to catch either or both of those, you know you’re in for some more entertainment, and perhaps even some enlightenment. We get awfully intellectual this time.

By the way, this one is rated PG-13 for language, but the kiddies wouldn’t understand the topic anyway. Enjoy.

Podcast details: Interview with athenahealth’s Jonathan Bush at HIMSS09. MP3, stereo, 64 kbps, 16.6 MB, running time 36:11.

1:45 Thoughts on “meaningful use”
2:25 Maybe accelerate PQRI?
3:30 Why EHR implementation has failed so far
4:40 David Ricardo and physician transcription
4:35 Let primary care physicians be the disruptive force
5:30 Lessons from “House”
6:15 Rethinking medicine
6:50 Micromanagement by the government and thoughts on scope of practice
7:50 Practice models that work
9:05 Data that help manage populations
10:05 Lobbying in Washington and qualifying for stimulus money
11:15 Medicare audits
11:30 HIMSS membership and “defensive” business management
13:00 Software-enabled service vs. software vs. ASP vs. software as a service
14:30 Examples of software-enabled services
16:45 Why standalone software is dying
17:15 Uninstalls of other products
18:15 How the stimulus has affected the company
21:20 “Aggressive stance” of Medicare
21:40 Many things happening at once
22:40 Unintended consequences of government actions
24:50 Entitlement spending and end-of-life care
28:30 Potential similar problems with stimulus and a return of the <a href="
http://clinicalit.blogspot.com/2007/03/podcast-jonathan-bush.html”>”plutonium sneakers.”
29:20 Decision-makers who have never run a practice
30:00 Hopes for David Blumenthal as national coordinator
30:30 Thoughts on comparative effectiveness studies
31:20 Concerns of HIT industry: “Don’t make what I’ve been doing for years illegal.”
31:50 Different needs for different doctors
32:35 New standards on data mining and patient privacy
34:20 The example of General Motors

April 12, 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.

A health IT reality check

I canceled my last vendor meeting at HIMSS09 yesterday so I could make a last-minute doctor’s appointment at 1:15 p.m. (ah, the joys of not having to travel for a major conference). As it turned out, I slogged through most of HIMSS with bronchitis. I hope I didn’t get anyone else sick.

My regular internist is not in this particular office on Wednesdays, so I was seen by another partner in the five-physician primary care practice—the most tech-savvy one. The entire patient-physician encounter lasted the usual 10 minutes, but I got a wonderful demonstration in that short time of the issues facing so many practices.

The doctor pulled up my record on the Sage Intergy EMR that the practice has had for the last three years (a replacement for an earlier system), but couldn’t find much of a history on me. I had given my regular physician a printed list of my medications and allergies the last time I was in there for a checkup last year, but that never got into my electronic chart. No matter, this doctor took my information verbally, and typed everything in as I was talking to him. (I checked, and it was accurate.)

He examined me, entered the diagnosis into the EMR and gave me some simple, verbal instructions, since he didn’t write any prescriptions for this encounter. (Even I know that antibiotics are ineffective against viral bronchitis, so I picked up some OTC medicine for sore throat and cough at a local Walgreens.)

I was surprised my history hadn’t gotten into the record, but this doctor was not. He is what you could call an early adopter, having been convinced to go electronic a decade ago. He said he’s been fighting his partners for years to get them to use the EMR for more than just entering orders and diagnoses. He said he loves the Intergy system, which should make the folks in Tampa smile, but wishes he could persuade the other doctors to do more and make a larger investment.

This practice has spent $120,000 over the past three years on the EMR, but needs another $50,000 to integrate or upgrade the practice management system so the two sides could share demographic and insurance data, making the whole operation more efficient. Unfortunately, the other doctors don’t want to spend the extra money while primary care is under so much financial pressure. Until there is the link between practice management and EMR, the practice isn’t even able to report its activity to capture the new 2% Medicare bonus for e-prescribing, the doctor said.

All the stimulus money sounds exciting for those of us who view health IT from on high, but January 2011 might as well be an eternity from now for those on the front lines of medicine.

April 9, 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.

My BNET commentary on the Google-HIPAA issue

I’ve got a new outlet for my work, namely the BNET Healthcare Blog. My first post went up today after a couple of weeks of refining and editing—worth it only because the faster I get the hang of BNET’s style, the more I get to post on this big stage.

The subject is the denials by Google and Microsoft that their PHR offerings are not subject to the new HIPAA requirements, even though the language seems clear to me and to several experts I’ve talked to. I specifically quoted Dr. David Brailer in this post, from a conversation we had a couple of weeks ago for a story I wrote on the stimulus bill. Brailer consulted extensively with congressional staff during the legislative process.

I expect BNET to put up another post of mine on Wednesday, hopefully before HIMSS09 ends at 2:30 p.m. CDT.

April 7, 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.

Too candid?

CHICAGO—I’m sitting in a HIMSS session where reformed hacker extraordinaire Kevin Mitnick is demonstrating how bad guys exploit security vulnerabilities, and asked for a volunteer from the audience. The volunteer was Will Weider, aka the Candid CIO. Mitnick entered Weider’s name and home state (Wisconsin) into a personal-search database and came up with Weider’s Social Security number that displayed on the two giant projector screens in the meeting room.

I can’t wait to read what Will has to say about the experience.

I Written By

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

Finally, a thoughtful argument against CCHIT

CHICAGO—For all the ranting and pseudononymous posting going on of late regarding the Certification Commission for Healthcare Information Technology, there hasn’t been a real, cohesive, thoughtful argument that CCHIT critics can hang their hat on. Until now.

This morning, Will Weider, the Candid CIO, wrote a cohesive, thoughtful argument about why the American Recovery and Reinvestment Act makes the current CCHIT mechanism unworkable. “However, assuming CCHIT can determine acceptable EHR functionality is based on the flawed assumption that an EHR is a single purchase from a single commercial vendor. Organizations that have achieved EHR functionality through the use of multiple specialized applications don’t have a certified EHR in the eyes of CCHIT (and therefore in the eyes of the ARRA it appears),” Weider writes.

He makes it clear he’s a fan of CCHIT and places the real blame on the lawmakers who wrote ARRA. (Leave it to Congress to screw up the best intentions.) But this gives us a good, true starting point for a debate on certification. Semi-sane rants do not.

I Written By

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