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Podcast: Scot Silverstein talks health IT safety risks

In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn’t available for an interview in time for that report, but he was last week, so I got him for a new podcast.

Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. “Suboptimal system design could lead even careful users to make mistakes,” Silverstein said in this interview.

During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity and Responsibility in Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.

Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.

1:10 How this interest came about
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR’s role in Texas Health Presbyterian Hospital’s initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 “Postmarket surveillance” of “medical meta-devices”
18:50 EHRs now more like “command and control” systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 “Critical thinking always, or your patient’s dead”
25:05 Lack of health/medical experience among “disruptors”
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of “experimental” technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT “bubble”
36:10 Good health IT vs. bad health IT

 

October 20, 2014 I Written By

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.

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 fast $5000 loans-cash.net with bad credit, 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 2011 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 fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

California HealthCare Foundation CEO Smith stepping down

This comes in late on a Friday, though not as late on the West Coast, where it happened: The California HealthCare Foundation announced that founding President and CEO Mark D. Smith, M.D., will be leaving the influential organization later this year. Over the years, Smith has been a vocal advocate for quality improvement via, among other things, health IT.

I’ve had the pleasure of hearing Smith speak and interviewing him several times over the years, notably at the 2009 American Medical Informatics Association conference and at the 2011 Health 2.0 conference. (Coincidentally or not, both took place at the San Francisco Hilton.) At AMIA 2009, I distinctly remember Smith asking why there wasn’t an Open Table-like service for getting last-minute doctor’s appointments. Not long after that, ZocDoc came along.

Here’s the text of CHCF’s press release:

California HealthCare Foundation President Mark Smith to Step Down

Founding leader of Oakland philanthropy will depart in late 2013

Dr. Mark D. Smith, who has led the California HealthCare Foundation (CHCF) since its founding, plans to step down as president and CEO at the end of year, the foundation announced today.

“It has been a great honor to lead the California HealthCare Foundation in its mission to improve the quality of health care for all Californians,” Smith said. “I leave the foundation knowing it is well positioned to continue this important work.”

During his tenure, Smith focused CHCF on catalyzing efforts to improve health care quality, promote greater access, and reduce the cost of care for the state’s most vulnerable and underserved residents. The Oakland-based philanthropy makes grants totaling approximately $37 million annually from a fund of $700 million. CHCF has granted over $500 million since Smith became the founding president and CEO in 1996.

“Mark Smith’s remarkable leadership over the last 16 years has focused the California HealthCare Foundation on a vision to improve the health care system where it matters most: in the clinics, the hospitals, doctors’ offices, and wherever Californians go to find care,” said Ian Morrison, PhD, chair of the CHCF Board of Directors. “While he recognized that the problems in health care are huge, Mark and his team were smart and innovative in targeting the foundation’s resources where they could most make a difference.”

Smith, 61, a physician and expert on state and national health policy, will continue his work as a member of the clinical faculty at the University of California, San Francisco, and as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital, where he has practiced since 1992, including during his tenure at CHCF.

Under Smith’s leadership, CHCF focused on improving the way health care is delivered and financed in California through a number of initiatives, including:

Promoting research and policy analysis. From its founding, CHCF has supported sound decisionmaking using evidenced-based research and nonpartisan policy analysis. CHCF has become a prolific publisher on issues of quality, access, and the financing of care covering both the commercial and public sectors.

Promoting transparency. The foundation has made significant investments in supporting transparency in health care delivery through publicly reporting quality data on hospitals, nursing homes, and long term care facilities, and building public websites that allow consumers to compare local facilities and provide health care leaders with benchmarks for improvement.

Improving clinical care. Smith focused attention on innovative ways to improve care delivery, including being an early proponent of using information technology at the point of care, challenging providers to deliver high-quality and cost-effective care, and promoting disruptive innovations like retail clinics and process redesign. He has also championed redefining the scope of work among clinical team members, to help ameliorate the need to train more doctors to do work that lower-cost members of the clinical team can deliver safely and effectively.

Training new leaders. The foundation initiated the CHCF Health Care Leadership Program at UC San Francisco in 2001. The two-year, part-time fellowship has trained 355 clinicians in management and leadership skills required to lead the state’s health care institutions in a rapidly changing and challenging environment. The program’s alumni now occupy leading positions in hospitals, clinics, medical groups, and government throughout the state.

Fostering innovation. The $10 million CHCF Health Innovation Fund helps accelerate innovation in care delivery by investing in new and emerging companies focused on lowering costs and improving access to care. While supporting improvements to the health delivery system, CHCF also has focused on the rise of alternative care delivery models such as retail clinics and the adoption and effective use of information technology.

Modernizing enrollment. CHCF has been a leader in promoting more efficient and consumer-friendly ways for eligible Californians to enroll in public programs. In 1999 the foundation supported the development of the first web-based eligibility and enrollment application in the United States, which it licensed at no cost to the State of California. More recently CHCF led the successful national public-private development of a first-class user experience design to streamline enrollment under the Affordable Care Act (ACA). The foundation has also recently focused on supporting the implementation of the ACA in California, and continues to monitor and report on its progress.

Supporting health care reporting. Recognizing the important role that the media has in promoting improvements in health care, CHCF has devoted significant resources to supporting health care journalism. Since 1998, the foundation has produced California Healthline, a daily digest of news, analysis, and opinion on the state’s health care system. In 2009, the foundation established the CHCF Center for Health Reporting at the USC Annenberg School of Communication and Journalism, which collaborates with media across the state on in-depth, explanatory journalism on critical health care issues.

“Mark has built a strong staff that is set on a steady course, focusing on the medical delivery and financing systems in California, with an emphasis on quality improvement, increasing both access and efficiency, and addressing the unsustainable cost of care to individuals and society,” Morrison said. “The board expects the foundation to continue building on its successes in these areas.”

“There is still a lot of work to be done. While I will assist the board and staff in making a smooth transition to a new leader, I will also continue to look for ways to make our health care system work better for the people of California,” Smith said.

A native of New York City, Smith earned his bachelor’s degree in Afro-American studies at Harvard (1979), his medical doctorate from the University of North Carolina at Chapel Hill (1983), and a master’s in business administration with a concentration in health care administration from the Wharton School at the University of Pennsylvania (1989).

Prior to joining CHCF, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Service and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine.

He was elected to the Institute of Medicine (IOM) of the National Academy of Sciences in 2001 and recently completed service as the chair of an IOM committee on “The Learning Health Care System in America,” which issued its report Best Care at Lower Cost in September 2012.

Smith will continue serving as CHCF’s president and CEO until a new leader is in place, which is expected by the end of 2013. The search for Smith’s successor will be conducted by the foundation’s board of directors. Inquiries should be directed to Carol Emmott of Russell Reynolds Associates at cemmott@russellreynolds.com or 415-352-3363.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

 

CHCF also released a statement from Board Chair Ian Morrison, Ph.D.:

The Philanthropic Leadership of Dr. Mark D. Smith

Ian Morrison, PhD, MA, Chair of the CHCF Board of Directors

The CHCF board of directors conveys its pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and reinforces its commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

 

January 11, 2013

The board of directors of the California HealthCare Foundation has asked me to communicate our pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and to reinforce our commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

We recognize and anticipate that our next leader will bring fresh ideas and energy that will take us in new directions. We are also firm in our belief that the California HealthCare Foundation will continue to play a central role at the intersection of the health care delivery system and the policy world that Dr. Smith carved out during his tenure.

We take great pride in the fact that CHCF is a respected resource for objective research, information, data, and analysis on a broad range of health care issues in California; a trusted convener; and a creative helping hand, spurring on innovation in the market and the policy community to benefit the health of all Californians. In reflecting on Dr. Smith’s extraordinary leadership, the board has identified 10 areas where the foundation has had particular impact.

All of these efforts have been shepherded by the foundation’s most powerful asset: its staff. Each board member will attest to the quality of people who work for CHCF: their energy, enthusiasm, expertise, and professionalism are truly impressive.

The consistently high standards of the foundation’s staff, grantees, and partners have resulted in a remarkable body of work that has made important contributions to improving quality, access, and affordability of health care services in California and the nation. This list samples from the many and various ways CHCF has made a difference. Dr. Smith’s leadership signature is evident in all of them and together they reflect the enduring DNA of this organization that we believe will carry on under his successor.

1. The Fruits of Conversion: The Orderly Creation of Two Important Philanthropic Foundations

CHCF was originally tasked with managing the sale of Wellpoint stock following the conversion of Blue Cross of California to for-profit status and transferring 80% of the proceeds to The California Endowment (TCE), our sister foundation. The founding CHCF board and staff under Dr. Smith’s leadership managed the process smoothly and created the endowment for TCE, which today has assets of $3.2 billion and annual giving in excess of $165 million. CHCF’s 20% of the proceeds amounted to almost half a billion dollars at the time, and Dr. Smith led the process of developing a complementary strategy and grants program. The result was the creation of two important health care philanthropies in the state: The California Endowment, which focuses on community-level initiatives to improve access and public health, and the California HealthCare Foundation, which focuses on policy and practice change in health care financing and delivery.

2. A Market Savvy, Policy-Relevant, Innovative, and Trusted Philanthropy

We are proud of our position as a trusted convener of health care stakeholders from the worlds of policy and industry. We value our reputation as an organization that simultaneously understands market dynamics and the intricacies of policy at federal, state, and local levels. Dr. Smith and the staff have built the capacity to navigate through this difficult terrain, but most importantly, to identify creative ways to intervene and play a catalytic role. Our board has strongly supported the identification of unique points of leverage on market-makers and policymakers alike to help improve quality, access, and affordability of health care for all Californians.

3. Support for New Leaders

Early in CHCF’s history, in collaboration with the University of California, San Francisco, CHCF conceived of a professional development program for clinical leaders in the state, particularly those serving in safety-net institutions. The purpose was to provide young clinicians with the leadership skills they would need to head their organizations in the future. The program currently has 355 alumni across the state and the board recently announced the foundation’s support for two new classes. The program has been emulated by other foundations and institutions in California, resulting in a total of more than 2,000 graduates across the state. Any meeting of California health care leaders is likely to include graduates of these programs, and many of them have become important grantees, partners, and champions for constructive change across California’s health care system.

4. The Adoption and Effective Use of Health IT

CHCF has always been known as a pioneer in the promotion of health information technology as an important tool to improve the quality, safety, and efficiency of care delivery. Some may point to our investments in the creation of the Santa Barbara County Care Data Exchange as taking a large risk (as we explored in a self-reflective 2007 Health Affairs special section). But as a board, we have been consistent in our support for investment and improvement in the use of new information technology in health care. And indeed we firmly believe that Santa Barbara was a catalyst for the significant federal HITECH investment that has followed.

While CHCF has had a long and important interest in promoting health IT to improve clinical care, we have also made special contributions in the seemingly arcane area of enrollment modernization. Building on Mark Smith’s and Vice President of Programs Sam Karp’s combined belief, interest, and expertise in the area, CHCF created important tools, technologies, and policy processes to help automate and modernize enrollment in public programs such as Medi-Cal and Healthy Families. Health-e-App and One-e-App not only enabled thousands of Californians to secure the coverage they were eligible for, but these pioneering efforts laid critical groundwork and built expertise in online enrollment and user experience design that has informed policy and practice related to implementing the Affordable Care Act in California and nationally.

5. Technical Assistance for the Safety Net

Much of CHCF’s work has involved deep engagement with public hospitals, community health centers, and county-organized health systems to improve quality, access, and affordability, particularly for patients with chronic conditions. Through a wide range of projects and initiatives, CHCF has supported chronic disease registries, electronic health records, telehealth adoption, quality improvement activities, and measuring and improving patient experience in institutions that lack the resources, capacity, or time to invest in delivery system transformation. These programs have helped improve access to care for specialty services for the underserved and the quality of care for patients with chronic illness, as well as improve the efficiency, service level, and throughput of overstretched safety-net providers.

6. The California Health Care Almanac and Information Services

CHCF plays an active role in monitoring the functioning and improving the transparency of health care policy and practice in California. Through a wide range of sponsored studies, custom reports, and news services under the broad rubric of the California Health Care Almanac, California Healthline, and iHealthBeat, the foundation keeps health care leaders informed about what is happening, what is important, and what lies ahead. The consistent quality and timeliness of this work has created a resource base that is relied upon by managers, policymakers, consultants, and academics, in the state and across the country.

7. CHCF Center for Health Reporting

CHCF recognized with concern that the ongoing transformation in media was undermining the economic viability of quality journalism in the health care field. The foundation created the CHCF Center for Health Reporting at the USC Annenberg School for Communication and Journalism to support high-quality reporting in partnership with media outlets in the state. The results can be seen in the number of stories produced in state and local media and their impact on the policy discourse on important topics, including the performance of Denti-Cal plans, the public conversation on end-of-life issues, and variation in the quality of care delivered across the state.

8. CHCF Health Innovation Fund

CHCF has committed $10 million over three years to invest in new ventures that have the potential to reduce the cost of care or improve access for the neediest Californians. The fund is off to an exciting start with several important investments in promising start-ups that we hope will create lasting value and improvement in health care delivery in areas such as telehealth access to specialists, better asthma management, and more efficient pharmacy services for rural and safety-net institutions. The fund is at an early stage, but we are excited by the prospects for this program-related investment (PRI) vehicle to innovate in areas of greatest need that the market might have overlooked without our help.

9. End-of-Life Care

End-of-life care has become a focus of the foundation because of the wide gap between the way Californians say they want to spend their last days and the highly medicalized way that many of them die. The foundation has supported greater clarity in end-of-life wishes through use of POLST (Physician Orders for Life Sustaining Treatment) forms across the state. Major progress has been made in making this a standard of care. Similarly, CHCF grants and initiatives have enabled every public hospital in the state to establish palliative care programs over the last five years. CHCF remains committed to raising awareness of Californians’ wishes for the care they receive at the end of life and in supporting care choices that are consistent with those wishes.

10. Supporting Improvement in the Medi-Cal Program and the Implementation of the ACA

CHCF has joined with other foundations and has worked with policymakers and state agencies and departments to provide instrumental technical support for many dimensions of the Medi-Cal program and the implementation of the Affordable Care Act, including:

  • Informing the development of enabling legislation for the state-based health benefits exchange
  • Providing technical support on the development of Medi-Cal waivers
  • Developing performance standards for Medi-Cal beneficiaries with disabilities and monitoring and evaluating their transition into Medi-Cal managed care
  • Informing California’s implementation of coverage expansion and insurance market reform, health IT deployment, and quality improvement initiatives

This important work continues.

Over the course of the next year, there will be many opportunities to toast Mark Smith’s legacy and contributions, and also time to warmly welcome a new leader. As we embark on this journey, the CHCF board of directors is proud of CHCF’s past and confident in its future. With the board’s strong encouragement and support, Mark Smith and his team have created an important institution that will continue to serve Californians in the decades ahead, building on a rich legacy of creativity and innovation, as evidenced in these efforts we highlight today.

January 11, 2013 I Written By

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.

When you talk health reform, don’t forget quality and IT, in that order

In my previous post, I was perhaps a bit too critical of Maggie Mahar in her hosting of last week’s Health Wonk Review. I noted that there was not a word about health IT in that rundown, but that’s not her fault. A host can only include what’s submitted, and apparently nobody, myself included, who contributed to HWR bothered to submit a blog post about health IT this time around.

But I continue to be troubled by this fixation so many journalists, pundits, commentators, politicians and average citizens have on health insurance coverage, not actual care. I blame most of the former for the confusion among the populace. People within healthcare know that you can’t talk about reform without including the serious problems of quality and patient safety, and people within reform know that IT must be part of the discussion even if they don’t always say so.

I would like to draw your attention to a story of mine that appeared on InformationWeek Healthcare this morning, about a report on care integration from the esteemed Lucian Leape Institute. The report itself did not say a lot about IT, but the luminaries on the committee that produced the paper are aware of the importance.

I was lucky enough to interview retired Kaiser Permanente CEO David M. Lawrence, M.D., who told me there has been “little attention” paid to the importance of a solid IT infrastructure in improving care coordination and integration. “What you now have is too much data for the typical doctor to sift through,” Lawrence told me.

That’s exactly the message Lawrence L. Weed, M.D., has been trying to spread for half a century, as I’ve mentioned before. And that’s pretty much how longtime patient safety advocate Donald M. Berwick, M.D. — also a member of the Lucian Leape Institute committee that wrote the report — feels. Berwick hasn’t always advocated in favor of health IT in his writings and speeches, but he has told me in interviews that the recommended interventions in his 100,000 Lives Campaign and 5 Million Lives Campaign are more or less unsustainable in a paper world.

Isn’t about time more people understand that widespread health reform is impossible without attention to quality and that widespread quality and process improvements are impossible without properly implemented IT?

 

 

October 29, 2012 I Written By

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.

EHR disadvantages disappear from Wikipedia

According to the Health Care Renewal blog, which chronicles some of the myriad problems in American healthcare, editors of the Wikipedia page for “electronic health record” keep deleting or changing the section about EHR disadvantages. Drexel University medical informatics professor Scot Silverstein, M.D., who contributes to the Health Care Renewal blog, says that the following text has been removed from the Wikipedia page in the past week: Read more..

January 29, 2012 I Written By

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.

Podcast: IBM Distinguished Engineer Scott Schumacher envisions the ‘clinical hub’

In part two of my series from month’s IBM Exchange 2011, my guest is IBM Distinguished Engineer Scott Schumacher. In this lively podcast, Schumacher discusses Watson, disease management and the concept of the “clinical hub,” which envisions bringing together clinical decision support and case management.

As with my previous podcast with IBM’s Lorraine Fernandes, I set my mic too low. I boosted the level during editing, but that introduced more background noise than I’d like. Schumacher mostly comes through nice and clear, though.

Podcast details: Interview with IBM Distinguished Engineer Scott Schumacher, recorded Sept. 14, 2011, in Chicago. MP3, stereo, 128 kbps, 13.2 MB. Running time 14:25.

0:30 What the IBM Exchange is
1:38 The “clinical hub”
2:30 Population analytics and individual patient analysis
4:20 Applying Watson intelligence and other medical knowledge
5:40 Target customers for clinical hub
7:10 Technical challenges
8:15 Potential for the technology
9:00 Video/image mining
10:00 Plans for testing and deployment
11:35 Mining of clinical notes and patient history
12:30 Incorporation of genomics and predictive treatment plans

October 23, 2011 I Written By

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.

Clinical informatics certified as medical subspecialty

I just got word from AMIA that the American Board of Medical Specialties has officially accepted clinical informatics as a medical subspecialty. I’ll have more in a story for InformationWeek by tomorrow morning. I don’t have a link to the press release yet, but here’s the text:

 

FOR IMMEDIATE RELEASE

 

Clinical Informatics Becomes a Board-certified Medical Subspecialty Following ABMS Vote

AMIA to offer prep courses for clinicians who sit for Board Exam

Sept. 22, 2011, Washington, DC—Today, AMIA—the association for informatics professionals—announces the success of a multi-year initiative to elevate clinical informatics to an American Board of Medical Specialties (ABMS) subspecialty certified by an examination administered by the American Board of Preventive Medicine and available to physicians who have primary specialty certification through the American Board of Medical Specialties. Joining such subspecialties as pediatric anesthesiology, medical toxicology, sports medicine, geriatrics medicine, and cardiovascular disease, clinical informatics (CI) certification will be based on a rigorous set of core competencies, heavily influenced by publications on the subject that were developed by AMIA and its members, many of whom have pioneered the field and supported CI’s new status as an ABMS-recognized area of clinical expertise. The goal for the first board exam is to have it available in Fall 2012, with the first certificates awarded early in 2013. To prepare physicians who wish to sit for this examination, AMIA is developing preparatory materials both as online and in-person courses starting Spring 2012.

“It is entirely appropriate and timely to certify clinical informatics as a specialized area of training and expertise in an era when more and more clinicians are turning to data-driven, computer-assisted clinical decision support to provide care for their patients,” said AMIA’s Board of Directors Chair Nancy M. Lorenzi, PhD, of Vanderbilt University Medical Center. “Clinical informatics blends medical and informatics knowledge to support and optimize healthcare delivery.”

In 2005, AMIA took note that demand for formal training and certification in clinical informatics (CI) was growing among physicians. Two years later, with support from the Robert Wood Johnson Foundation, AMIA launched a process to define the core content of the CI specialty and the training requirements for proposed CI fellowships (that would be accredited by the Accreditation Council of Graduate Medical Education). In 2009, the American Board of Preventive Medicine (ABPM) agreed to sponsor an application for a CI specialty examination, and a year later submitted a formal application to the American Board of Medical Specialties (ABMS) to consider the creation of a new specialty certification. Once submitted, the ABPM proposal attracted support from the American Board of Pathology, which will cosponsor the subspecialty with the ABPM.  Subsequently, several other medical boards expressed interest in joining as formal co-sponsors

The role of the clinical informatician is to use his/her knowledge of patient care in combination with an understanding of informatics concepts, methods, and tools to:

  • assess information and knowledge-based needs of healthcare professionals and patients.
  • characterize, evaluate, and refine clinical processes.
  • develop, implement, and refine clinical decision support systems, and
  • lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems, such as electronic health records and order-entry systems.

“Establishment of the clinical informatics medical subspecialty is consistent with the current emphasis on broadening and professionalizing the health information technology workforce,” said AMIA President and CEO Edward H. Shortliffe, MD, PhD. “With the need over the next decade for 50,000 informatics professionals in the health sector with various levels of expertise, this focus on physician expertise in clinical informatics is clearly a step in the right direction. The CI exam will encourage more medical schools to build informatics into their training programs and to begin addressing real-world information management needs of physicians in virtually every work environment.”

About AMIA
AMIA is the center of action for 4,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the affect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.

About ABMS

ABMS Member Boards certify physicians in more than 150 specialties and subspecialties. To see a full list of current specialty and subspecialty certificates offered by ABMS Member Boards, including the American Boards of Preventive Medicine and Pathology, visit www.abms.org/Who_We_Help/Physicians/specialties.aspx

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UPDATE, 8:50 pm CDT: Here’s the link to AMIA’s press release.

UPDATE, Sept. 23: Here’s my story for InformationWeek.

September 22, 2011 I Written By

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.

Podcast: Gartner’s Vi Shaffer on HIE, ACOs and meaningful use

Back in June, I covered the Wisconsin Technology Network’s Digital Healthcare Conference in Madison. That conference featured a panel with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner, Judy Murphy, vice president of information services at Aurora Health Care in Milwaukee, and Epic Systems CEO Judy Faulkner, based in nearby Verona, Wis.

The panel discussed the question, “Is meaningful use a floor or a ceiling?” as I reported for WTN News. The conference also featured several sessions on how business intelligence and health information exchange can support Accountable Care Organizations.

A month later, I saw Shaffer again at AMDIS Physician-Computer Connection meeting in Ojai, Calif. There, she presented preliminary data from Gartner’s annual survey of CMIOs. After the conference ended, I got a chance to sit down with Shaffer for this podcast. Since the fog and clouds finally lifted on the final day, we decided to record this outdoors at the beautiful Ojai Valley Inn, which is why you will hear some birds and other (human) creatures in the background. We don’t care, it was too nice to sit indoors.

We mostly discussed how HIE can support ACOs, but we also touched on meaningful use and health reform in this lively interview. Enjoy.

Podcast details: Interview with Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner. Recorded July 15, 2011, in Ojai, Calif. MP3, mono, 64 kbps, 7.9 MB. Running time 17:14.

1:35 ACO as a business model and a fundamental change in the needs of patients (chronic disease)

3:00 Interoperability for care coordination 3:50 Will ACO model be better than disease management as it exists today?

4:50 Nature of proposed rules

7:30 Importance of innovation because “meeting the metrics is average.”

9:05 Is meaningful use a floor or a ceiling? Is an ACO a floor or a ceiling?

10:46 Ambulatory services growing faster than hospital services

12:38 “Oligopolies” in healthcare building interoperability and continuums of care

14:40 How far can you go with interoperability in this changing healthcare climate?

15:19 Targeted panel management rather than population health

August 12, 2011 I Written By

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.

CMIOs wanted in the UK

I’m getting ready to head west for, among other things, the annual AMDIS Physician-Computer Connection in Ojai, Calif., a high-level gathering of chief medical information officers. After years of fighting for a seat at the table, CMIOs now are being held up as a model, at least overseas.

Specifically, my friends at E-Health Insider in the UK have embarked on a mission to have every NHS hospital hire a chief clinical information officer, the British equivalent of the CMIO. Read more about the British perspective on the American CMIO here.

July 10, 2011 I Written By

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.