clinical decision support | Meaningful HIT News

Answering the mail

I have to admit I’m shamefully behind on blogging this week. Between the AMA House of Delegates meeting, deadlines for FierceMobileHealthcare Tuesday and FierceEMR Thursday, plus a dentist’s appointment thrown in for good measure, I’ve been too busy or too tired to post here. I also submitted an entry for the BNET Healthcare blog, but it hasn’t been posted yet.

Meantime, I’ve left some people hanging.

While I was on the air with news anchor Andrea Darlas of WGN-AM 720 in Chicago to discuss President Obama’s speech to the AMA, I promised this link to a story about a high-schooler in Washington state who correctly diagnosed herself in science class with Crohn’s disease after doctors were stumped for years. Folks, this is why we need clinical decision support.

Fellow blogger Lodewijk Bos of the Im-Patient blog commented that he would like to see examples of the paranoia I observed at the AMA meeting. OK, but I have to link you to commentaries I wrote elsewhere, for FierceMobileHealthcare and FierceEMR. I humbly offer my “The audacity of ‘nope'” headline from the latter commentary for the Headline Hall of Fame.

Tonight, “Anonymous,” my biggest fan, left a comment asking where the proposed definition of meaningful use is. It’s right here, my friend. Actually, that page contains instructions on how to comment on the proposal. Scroll down for links to the preamble, a matrix of the proposed requirements and the CMS backgrounder on Medicare and Medicaid health IT provisions in the American Recovery and Reinvestment Act.

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June 18, 2009 I Written By Neil Versel

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Tags:AMA

Another take on clinical decision support

I’ve been on a mini kick for clinical decision support since last fall’s AMIA annual conference. If you recall, I said medical informatics needed a rock star to spread the word about the link between CDS and proper implementation of electronic health records.

Today, while attempting to catch up on a massive backlog of e-mail, I came across a Jan. 26 post from Steve Beller, Ph.D., on the Trusted.MD blog network. Beller writes about including consumer-centric cognitive support in the next generation of CDS systems, and he has started to put together a PowerPoint presentation on defining his goal and thoughts on how to achieve it.

I’d love to hear your thoughts.

It’s officially an epidemic

From Urban Dictionary:

academic bulemia [sic]

The process of learning or memorizing by rote, subsequently followed by the regurgitation of that knowledge onto an exam answer sheet. Just as with the serious eating disorder, this form of bulemia [sic] results in no real retention of substance.

This term is frequently applied to describe a common practice of young medical students.

I can’t remember anything that I learned last night. It’s like I grabbed the answer sheet, puked out all the answers and forgot everything immediately. I’d say that’s academic bulemia [sic].

As of this writing, the “score” for this definition was 6757 up and 833 down, so I’d say it’s pretty well accepted, even if the spelling of “bulimia” is wrong.

Anyone care to guess now why there are so many medical errors in teaching hospitals that don’t have adequate clinical decision support systems? Anyone? Anyone?

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January 16, 2009 I Written By Neil Versel

Filed Under: clinical decision support

Tags:education patient safety

‘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.

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.

AMDIS notes

OJAI, Calif.—I’m at the Physician-Computer Connection, the annual symposium of the Association of Medical Directors of Information Systems (AMDIS), a high-level meeting of chief medical information officers and other leading medical informatics specialists. I’ll have a bunch on a couple of surveys on the attitudes, job functions and salary ranges of CMIOs and physician executives in IT, most likely in Digital HealthCare & Productivity in the next couple of weeks. (I need to pay for this trip, after all, and the recent run-ups in airfares, car rental costs and, of course, gasoline, are not helping my cause. But I digress.) Let’s just say a need for leadership skills is prominent.

I have plenty of other news and notes that are worthy of posting here, however.

For one, look out this fall for “Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-step Guide,” an update to the 2005 “Improving Outcomes with Clinical Decision Support: An Implementer’s Guide.” According to lead author Jerry Osheroff, M.D., chief clinical informatics officer of Thomson Reuters Healthcare (formerly Micromedex), this one defines CDS as “providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care.” The guide will follow a modified set of the “five rights” for safe healthcare: The right information to the right person in the right intervention format through the right channel at the right point in the workflow, Osheroff says.

The new volume also involves many more industry stakeholders than the previous edition. It will carry the names of HIMSS, AMDIS, AMIA, the Institute for Safe Medication Practices and the Scottsdale Institute, and is sponsored by the Agency for Healthcare Research and Quality, two clinical IT vendors and two health systems. Osheroff didn’t name the vendors or health systems, but it’s a safe bet Thomson Reuters is involved.

Contrary to rumors, healthcare executive recruiter Betsy Hersher is not retiring, but she is shutting down her Hersher Associates firm and moving into consulting. At least a couple of her employees have taken jobs at Witt/Kieffer.

Earlier this week, I reported in Digital HealthCare & Productivity about the recent reorganization at Sage Software Healthcare. I since have learned that the company will be hiring a new, permanent CEO sooner rather than later. I’m guessing that means within a few weeks. I have no idea about who the candidates might be.

While I’ve been out here on the West Coast, the Medical Records Institute published a scathing critique of the national EMR strategy. That organization is working hard to market itself and stay relevant after a poorly attended TEPR conference a couple of months ago. This article certainly is an attention-grabber, listing the optimism about meeting the goal of getting interoperable EHRs to most Americans by 2014 among a number of “health informatics myths.”

If you want an impassioned defense of the national health IT strategy, check this space in the next 24 hours for my podcast with national health IT coordinator Robert Kolodner, M.D., who spoke at this conference yesterday. This might be my biggest podcast “get” to date.

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July 17, 2008 I Written By Neil Versel

Filed Under: clinical decision support

Tags:AMDIS CMIO Medical Records Institute recruiting Robert Kolodner Sage Software Healthcare Thomson Reuters

Priorities

What would my blog be without a random item from weeks ago? On Tuesday I discovered a news story from Dec. 31 about an e-health strategy in Rwanda. The U.S. Centers for Disease Control and Prevention reportedly is helping to fund the installation of Internet links between the three major hospitals in the Central African country, known in these parts mostly for its brutal, 1990s civil war.

According to the story, lack of high-speed Internet is holding back a national e-health strategy, “meant to help Rwandan medical experts exchange health information with their overseas counterparts.” Those overseas counterparts included “two U.S. universities of George Washington and New Jersey.” So George Washington University in Washington, and, I presume, the University of Medicine and Dentistry of New Jersey? (Anyone know for sure? I’m too tired to hunt down that information.)

So, basically, U.S. taxpayers are financing international interoperability testing in a country with limited health infrastructure of any kind, but we can’t find more than $100 million or so (counting various HHS offices) in a $3 trillion federal budget for health IT at home? Interesting.

Yes, President Bush did discuss electronic health records in his State of the Union again this year, and yes, Sen. Hillary Clinton did give a pretty lengthy argument in favor of EHRs during last week’s Democratic presidential debate in Los Angeles, but are we really getting more than empty election-year posturing? Prove me wrong, politicians, prove me wrong.

And while we’re pondering interoperability conundrums, here’s a good one from Tim Dotson, my editor at Inside Healthcare Computing. In the Feb. 4 issue of that newsletter, he asks: “Why can’t somebody figure out a way for hospitals to share clinical decision support rules that will work on any vendor’s system instead of letting those systems go to waste because hospitals never develop their own rules?”

Good question. I suppose that’s why Cerner sold off Zynx Health a couple of years ago, but the issue is a lot deeper than one set of rules being tied to one vendor. Collaboration sure is hard, isn’t it?

P.S. Is anyone arriving at HIMSS early? I may come in as early as the Friday, Feb. 22, just because I hate 6 a.m. flights. Drop me a line if you’ll be in Orlando before Sunday.

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February 5, 2008 I Written By Neil Versel

Filed Under: clinical decision support international

Tags:2008 campaign Africa Internet interoperability

Tasteless joke, but kind of on the mark

Since it’s Thanksgiving here in the states, you’d rather laugh than work, right? In case anyone was wondering if the Wal-Mart retail clinic idea is getting any traction, here’s a joke from an e-mail recently forwarded to me. (File this under clinical decision support.):

One day, in line at the company cafeteria, Joe says to Mike behind him, “My elbow hurts like hell. I guess I’d better see a doctor.”

“Listen, you don’t have to spend that kind of money,” Mike replies.

“There’s a diagnostic computer down at Wal-Mart. Just give it a urine sample and the computer will tell you what’s wrong and what to do about it.

It takes 10 seconds and costs $10 — A lot cheaper than a doctor.”

So, Joe deposits a urine sample in a small jar and takes it to Wal-Mart. He deposits $10, and the computer lights up and asks for the urine sample. He pours the sample into the slot and waits.

Ten seconds later, the computer ejects a printout:

“You have tennis elbow. Soak your arm in warm water and avoid heavy activity. It will improve in two weeks. Thank you for shopping @ Wal-Mart.”

That evening, while thinking how amazing this new technology was, Joe began wondering if the computer could be fooled.

He mixed some tap water, a stool sample from his dog, urine samples from his wife and daughter, and a sperm sample for good measure.

Joe hurries back to Wal-Mart, eager to check the results. He deposits $10, pours in his concoction, and awaits the results.

The computer prints the following:
1. Your tap water is too hard. Get a water softener. (Aisle 9)
2. Your dog has ringworm. Bathe him with anti-fungal shampoo. (Aisle 7)
3. Your daughter has a cocaine habit. Get her into rehab.
4. Your wife is pregnant. Twins. They aren’t yours. Get a lawyer.
5. If you don’t stop playing with yourself, your elbow will never get better!
Thank you for shopping @ Wal-Mart.

CDS=Cat decision support?

I’m sure the national media are jumping all over a “Perspective” essay in the July 26 New England Journal of Medicine about a cat named Oscar (at right) at Steere House Nursing and Rehabilitation Center in Providence, R.I., who has “an uncanny ability to predict when residents are about to die,” the report says.

“His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families,” writes David M. Dosa, M.D, a geriatrician at Rhode Island Hospital.

According to an Associated Press/Yahoo story, Oscar recently received a wall plaque publicly commending his “compassionate hospice care.”

I guess if you don’t have advanced information systems with full clinical decision support, you rely on the innate talents of the animal kingdom. Hey, if a method works, don’t knock it!

When doctors actually do turn to computers, it’s often for educational purposes. For what it’s worth, Manhattan Research now has a ranking of the top 10 pharmaceutical product Web sites that primary care physicians are visiting in 2007:

Januvia

Singulair

Advair

Chantix

Adderall XR

Byetta

Gardasil

Vytorin

Avandia

Concerta

In other news, URAC has a new competition to reward best practices in consumer empowerment and protection, with a related conference. The organization is taking applications through Aug. 15 at www.urac.org/bestpractices/. The awards will be presented at the first conference, set for next March in Orlando, Fla.

And finally, we come to the self-flagellation section of this post. My latest feature story on personal health records is out.

‘Isabel’ as a verb?

Will “Isabel” become a verb, much in the way “Google” has? A Fox News story from December on Isabel Healthcare, developer of a diagnostic decision support engine, suggested that it already has. The correspondent, Dr. Christine Dumas, says that clinicians in some hospitals routinely ask, “Did you Isabel this?”

Unfortunately, the 2-minute piece does not include an interview with anyone at Isabel, nor does it mention any other clinical decision support companies. (Insert “fair and balanced” joke here.) I’ll be speaking with the company at HIMSS in a couple of weeks.

A much more in-depth piece of TV reportage on healthcare quality comes from none other than Katie Couric. The CBS Evening News anchor interviewed safety guru Dr. Don Berwick in a report that aired last week. The link takes you to a print version of the story, but you’ll see the video player on the right-hand side of the screen. In the “Eye to Eye” segment, an online exclusive that follows the main story, Berwick talks about the need for computers and automation.

I talked to Berwick at his Institute for Healthcare Improvement‘s annual conference in December, shortly after Dr. Larry Weed’s stirring address, and Berwick said that the technology finally has gotten good enough for physicians to start taking seriously Weed’s call for electronic medical records and various forms of CDS. Weed, of course, has been advocating the need for computers in medicine since before I was born. I’m closing in on 37 now.

Answering the mail

Another take on clinical decision support

It’s officially an epidemic

‘Modest’ feedback

A modest proposal

AMDIS notes

Priorities

Tasteless joke, but kind of on the mark

CDS=Cat decision support?

‘Isabel’ as a verb?

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