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Health Data: Little White Lie Detector

Posted on December 31, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As we bring 2012 to a close and ponder the new year ahead, many of us make resolutions to change something in our lives, and frequently, that something is our health. According to the University of Scranton Journal of Psychology, 47% of Americans make New Years Resolutions. Of those, the #1 New Years Resolution for 2012 is to lose weight. Staying fit and healthy and quitting smoking also appear in the top 10. Each of these health-related resolutions translates into quantifiable healthcare data that is, or can be, captured and measured to assist the resolution-makers in achieving their goals. Our calorie consumption and burn can be calculated, our blood oxygen level monitored, our ratio of fat:lean muscle mass tracked over time. If only we were all a bit more like George Washington, and couldn’t tell a lie, the success rate for annual resolutions would be higher than 8%.

The inclination to tell little white lies to protect ourselves from inconvenient, uncomfortable truths exists in all of us. “Do these jeans make my butt look fat,” meets, “Of course not,” rather than, “Yes, your butt DOES look fat in those jeans – but it’s not the jeans’ fault.” “Can Timmy come play,” warrants, “We already have plans – let’s rain check,” in lieu of, “Your child is a brat who cannot enter my home because I prefer to keep all my hair rooted in my scalp.”

Many, if not most, of us extend these white lies to ourselves. The dress that fit last month but doesn’t today “shrunk at the dry cleaner”. Cigarettes only smoked during cocktail hour don’t really count as “smoking”. You count the time you spend standing to give office presentations as “exercise”. You “usually” eat healthy, except for the tell-tale McDonald’s bags in your garbage showing a once-a-day burger and fries habit.

What if there were a way to identify and hold you accountable for these self-delusions – a health data lie detector? Would you change your behavior? Could you achieve your healthy resolution? And might it have a quantifiable impact on healthcare cost if you did?

I had a partial thyroidectomy a few years ago. A year after my surgery, I found I had gained 7 pounds in 11 days, was feeling lethargic and was having difficulty sleeping. As a very active adult who meticulously maintained body weight for a decade, I was disturbed, and convinced that my symptoms were a result of my remaining thyroid tissue failing. I went to my primary care physician to request a hormone test.

The nurse and doctor both agreed that, in 90% of cases, the root cause of weight gain is diet, and they asked myriad questions, capturing all my answers in the clinical notes of their EMR: had I been eating differently, had I altered my exercise routine, had I been traveling. I was adamant that nothing had drastically changed. Given my fitness and history, they agreed to order the hormone test, and a blood vitamin test, as well.

All lab work came back normal. BETTER than normal. So I retraced every detail of my routine over those 11 days. And I discovered the culprit: office candy.

A bad meeting one day led to grabbing a handful of chocolates from one co-workers bowl, which became grabbing a handful of chocolates from each bowl I encountered on my department’s floor…several times a day. Did you know there are 35 calories in a single Hershey’s kiss? 220 calories in a handful of peanut M&Ms? 96 calories in a mini-Butterfinger bar? Turns out, I was eating between 500-700 calories a day in office candy. And that wasn’t all.

Along with the chocolate snacks, I’d fallen into some poor nutrition habits at meals. I started to consume other starchy carbs regularly: the pre-dinner bread basket at restaurants, pizza, pasta, sandwich bread. I didn’t feel I ate to excess, but I also didn’t take into account the difference in nutrient density between the mass quantities of fruits and vegetables I had been eating for years, and the smaller (yet still plentiful) quantities of processed starches I was currently eating.

The changes in diet likely disturbed my sleeping pattern and led to my lethargy, which in turn made my daily workouts less intense and effective at calorie-burning.

In short, my weight gain was legit, and the two doctor visits and the lab tests could have been avoided had I been completely honest with myself. I cost each actor in the healthcare system money with my self-deluding little white lie: the office administrative staff, the LRNP, the doctor, the medical coder, the lab, the insurance company, myself. There is also a per-transaction cost associated with each HIPAA-covered request that the doctors’ office EMR and lab information system generated. Given that I have only been to the doctor three times this year, and twice was for this weight gain concern, one could accurately conclude that 66% of my annual medical costs could have been avoided in 2012.

The health data exists within Meaningful Use-certified EMR systems to capture and communicate both the absolute data (height, weight, lab results, etc.) and the unstructured notes data (patient comments, doctor notes, responses to questionnaires, etc.). The capability to automatically compare the absolute with the unstructured data already exists. It wouldn’t take an inordinate amount of effort to program a lie detector to call out many of the most common little white lies.

What would happen to medical cost if we stopped lying to ourselves, and to our healthcare providers? And how high a percentage of the nation’s total healthcare bill could be avoided by this type of analysis? Better still, how much would the healthcare industry change if patients not only took responsibility for their own action/inaction, but modified their behaviors accordingly?

I’ll tell you what happened to me. I dropped the candy and starchy carbs, and I lost those 7 pounds. Keeping them off will be 2013’s New Years Resolution.

Healthcare.gov, EMR Switch, and Flu and RSV Detector: Around Healthcare Scene

Posted on December 30, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

It was a quiet week around Healthcare Scene, but here are a few of the posts that did get posted. Hope everyone had a wonderful holiday, and this new year will be the best yet!

EMR and EHR

11 Reasons Why Healthcare is So Screwed Up

This list was initially created by GetReferralMD and reposted on EMR and EHR. This post doesn’t go into details about each of the reason, but it provides some interesting food for thought. Some of the reasons on the list include insurance companies, ignorance, and McDonalds. With the upcoming new year, it’s the perfect time for resolutions to be made, and some of these issues to be addressed.

Healthcare.gov

This government-run website has recently been revamped, and now offers a lot more features. It has an obvious mission — to convince everyone to back-up Obamacare, but it has neat options now like an insurance options wizard and tools to help people understand using insurance. It still leaves some things to be desired, but it’s a nice site that doesn’t have the looks of a typical government site.

Hospital EMR and EHR

2013: The Year of the EMR Switch

This coming year appears to be the one where more hospitals will be switching to EMR. This will, obviously, have a huge affect on the EMR sales process. It will include tons of EMR marketing, alternatives may have more of a chance, and market winners and losers will be named.

New Hospital Rockets To Top Of HIMSS EMR Adoption Scale

While many smaller hospitals have been behind the curve when it comes to Meaningful Use and HIMSS standards, one 50-bed Texas hospital challenges that sterotype. Texas Alliance Health has achieve stage-7 of the HIMSS Analytics EMR Adoption Model — something that only 1.9 percent of U.S. hospitals has achieved. This is quite the feat for any hospital, especially a small one like Texas Alliance. It had many factors working in its favor, particularly that it has only been open since September.

Smart Phone Healthcare

UK Company Developing a Biosensor Device to Detect Flu and RSV

Early detection of the flu and RSV can help prevent these illnesses from getting worse. However, early detection is hard to come by, and when the first stages have passed, many treatments are not affective. OJ-Bio, a UK-based company, seeks to change that. A new sensor is in the works that accurately can detect these illnesses, as well as other respiratory illnesses, quickly, early-on, and at home.

#HITsm and #hcsm Highlights Around Twitter – mHealth Lists

Posted on December 29, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The #HITsm Chat was put on hold for another week, so here are some of of my favorite tweets I found by searching #HITsm and #hcsm on Twitter. I saw a lot of lists this week, and thought these were kind of interesting.

This is a good list to review, for anyone that is hoping to find an Internet-savvy doctor. Obviously, most people aren’t going to be close enough to see these doctors, but there are a lot of interesting stats about them, and how they have embraced the Internet and Social Media in their practices. There is a good variety of doctors here, from different specialties  If you follow very many doctors on Twitter, you’ll probably recognize at least a handful of these names.

If you are wary about mHealth, or having your doctor be on Twitter and Facebook this list might put your mind at ease. There are so many benefits to doctors and physicians creating a more Internet-friendly practice, and many of them are listed here. I love that the doctor’s offices and hospitals that my family use have really embraced mHealth, and after reviewing this list, I am starting to recognize all the benefits that come from this.  Personally, I really love being able to connect with our doctor offices on Facebook, as well as on a patient portal — I’ve been able to get answers from nurses quickly, rather than having to actually go in to the doctor.

Some interesting insights about how medical care is getting better and better…and of course, as this tweet mentions, Health Apps is on the list. I’m not surprised by that one bit.

And finally, here’s a great list of resources for those in the healthcare industry that are wanting to make the jump into social media. There is an eBook, case studies, top blog posts, and more. This is definitely a must-have list for any pratice wanting to get more involved.

Have a happy New Year, everyone! Be sure to check back next week (over at EMR and EHR) for the #HITsm highlights.

Hilarious ICD-10 Holiday Parody Video

Posted on December 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, Nuesoft has a great video team that’s put together some great videos in the past. Most of you will remember the HL7 Interface Lady Gaga video from Nuesoft and for those who don’t know that video, go and watch it. Sometimes we take ourselves too seriously in healthcare and these are some great reminders to keep it lively.

In fact, Nuesoft’s last video was far too formal for me. So much so that I let them know in the comments of the video how disappointing it was to have a formal video when I was use to Nuesoft’s creative masterpieces. I’m happy to report that Nuesoft is back again with a great ICD-10 Holiday parody video. I was laughing through the whole thing and I think you’ll enjoy the video embedded below.

Healthcare Faces Massive Cybersecurity Risks

Posted on December 27, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When a consumer publication like The Washington Post — hardly an insider journal of computing — picks out your industry and slams it for having poor cybersecurity, you know something’s amiss.

The newspaper has just published a report, following a year-long cybersecurity investigation, arguing that healthcare is one of the most vulnerable industries in the U.S., making it a tasty target for terrorists, black-hat hackers and criminals.

It’s rather embarrassing, but it’s hard to argue with the Post’s conclusion that healthcare data security isn’t what it could be. A few data points:

* Researchers are finding that healthcare institutions routinely fail to fix known bugs in aging software, something other industries have largely overcome.

* Providers are making careless use of such public cybertools;  the paper cites the example of the University of Chicago medical center, which at one point operated an unsecured Dropbox site for new residents managing care through their iPads (with a single user name and password published online, yet!)

* According to Post research, open source system OpenEMR “has scores of security flaws that make it easy prey for hackers”

* In perhaps the scariest example, the paper notes that clinicians routinely work around cybersecurity measures to get their job done.

Another factor contributing to cybersecurity holes is confusion about the FDA’s position on security. While the agency actually wants vendors to update FDA-approved device interfaces and systems, vendors often believe that the FDA bars them from updating device software, the Post found.

That leaves devices, especially defibrillators and insulin pumps, open to attacks. Researchers have been able to find these devices, linked to the web in the clear, simply by using a specialized search engine.

As wireless medical devices and smartphones, iPads and Android devices creep into the mix, cybersecurity vulnerabilities are likely to get worse, not better.  I wonder whether we’ll need to see a cybersecurity disaster take place before the industry catches up to, say, financial services?

RACs Ordered To Analyze EMR Template Data

Posted on December 26, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

EMR templates are coming under increasing fire of late, with regulators arguing that they’re not doing a good job of justifying the reimbursement that doctors are requesting. Now, in a move that can only be described as racheting up the pressure, CMS has revised its instructions to Recovery Audit Contractors (and their brethren) to demand that they look more closely at template documentation.

According to a report in EHR Intelligence, CMS has issued new orders asking RACs and other recovery contractors to review templates, extract usable data, and use that to determine whether reimbursement requests are legit. Specifically, it’s asking contractors to focus in on limited space progress note templates and open-ended progress note templates.

CMS isn’t asking providers to stop using templates, but it does seem fairly disapproving, particularly of limited space templates, which it regards as largely inadequate for payment purposes

“Review contractors shall remember that progress notes created with Limited Space Templates in the absence of other acceptable medical record entries do NOT constitute sufficient documentation of a face-to-face visit and medical examination,” the agency says in its contractor instructions.

The agency notes that templates using checkboxes and predefined answers to enter information generally don’t work. “Claim review experience shows that limited space templates often fail to capture sufficient detailed clinical information to demonstrate that all coverage and coding requirements are met,” the instructions note.

Well, there you have it. You’ve got an agency that’s coming down hard on the use of inadequate templates, but “does not endorse or approve any particular templates.”  Seems like a recipe for disaster.

If CMS refuses to propose a specific template design, I say it’s incumbent on the industry to do so. With so much at stake, it’s time to lay out a design that vendors and providers can live with and hand it to CMS.  Maybe that will spur the agency to take a stand.

All I Want for Christmas…

Posted on December 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My family and I are in final preparations for Christmas. It’s an exciting time for me. I love everything about the season. I don’t stress over gift giving. I wallow in the joy of getting to spend money on someone I love. I don’t mind the crowds at the mall. I love the hustle, bustle, excitement and energy with everyone running around. Add in some Christmas music that reminds me of many wonderful Christmas’ past. It’s a wonderful time to me.

As I consider Christmas, my two favorite parts of Christmas is giving someone something they’ve always wanted and dreaming of the things that I would love to get for Christmas. So, in that vain, let’s dream about what I’d want for Christmas from an EMR and Healthcare IT perspective.

1. Open EHR Systems – I wish that every healthcare IT system would embrace truly open APIs and that the healthcare data would start flowing. I can only imagine the amazing benefits to healthcare if vendors would just embrace open exchange of healthcare data. It’s the right thing to do and can also be a tremendous business opportunity.

2. Remove Healthcare’s Perverse Incentives – It always pains me to see so many perverse incentives in healthcare. I applaud the many many doctors who do the right thing regardless of the incentive. However, we’d be in a lot better position if we had more than the good nature of doctors driving things. One simple example, can we finally reimburse a doctor for their time spent on an email or video visit on a website? In a large percentage of cases that’s more than sufficient. Yet, the current healthcare incentives “force” a doctor to have you come to the office in order to get paid. That’s perverse and sad.

3. Beautiful EHR User Interfaces – I must acknowledge that we’ve made some real progress on the EHR UI. You should have seen the UI’s we were dealing with when I started blogging 7 years ago. We’re measurably ahead of where we were then. However, with 300+ EHR companies we still have a lot of room to improve the EHR user interface. EHR is the heart of a practice and the better the UI the better the heart. We all know how important a heart is to your health.

4. More Empowered and Trusted Patients – Imagine where the patient was a full participant in their healthcare. That includes being trusted and listened to by their doctor and a patient who thoughtfully considers and listens to their doctor. This is not a one sided issue. This is something that both patients and doctors can improve. There are as many belligerent patients as their are arrogant doctors. We need a good dose of humility, care and trust re infused into healthcare. I think they only way we’ll get there is for the lines of communication to open up on an unprecedented level.

Those are a few of my Christmas wishes. Whether you celebrate Christmas or some other Holiday tradition, I’d love to hear what you’d love to see happen in healthcare. And to those of you who do enjoy Christmas, Merry Christmas!

Rip & Replace EHR, 3rd Party EHR Connections, and EHR Advice from a Physician

Posted on December 23, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


It’s not good for morale, finances, or patient care. Although, it might be better than being stuck with an EHR that is worse for morale, finances and patient care. It’s not an easy decision to switch EHR, but sometimes it’s necessary. Although, this is an almost impossible decision for a hospital. See this post about the “Wrong EHR” conundrum.


I’m not sure how much of this twitter thread will embed. If it doesn’t, then here’s a link to see the full thread. I hope that we can continue to raise the call for more open systems and access to EHR by third party software! Which EHR will set themselves apart in this regard?


Great advice for every doctor when it comes to EMR. It’s a hard shift for many, but I expect Dr. Noah won’t have any issues with this advice.

Most Expensive Purchase is Second EHR

Posted on December 21, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At an event this fall I happened upon an executive at one of the major EHR vendors. We had a brief discussion in the lobby, but he said something that I found really interesting and I think describes the strategy of many of the large ambulatory EHR vendors. Here’s what he said:

“The Most Expensive Purchase is Their Second EHR”

A popular EHR consultant was in on the conversation and he started shaking his head in agreement.

I’ve long suggested that practices usually get their second EHR selection and implementation right. It just makes common sense that a practice would use the lessons learned from their first EHR implementation and be able to do a better job selecting and implementing the second EHR implementation. Although, I have heard of cases where it took the third implementation to do it right.

What intrigued me more was that this EHR vendor executive tied the purchase price to a second EHR. He’s right that price becomes a very different discussion when you are talking to someone who is buying their second EHR. In a lot of cases, price becomes a non-issue for those implementing their second EHR. They will spend whatever amount is needed to be able to get an EHR that they like to use. This is reflected in the quote above. I expect that’s why a second EHR is the most expensive purchase.

I wonder how many EHR companies are capitalizing on this fact. I’ve heard from numerous people that there’s a lot of EHR switching that’s happening right now. So, the idea of a second EHR is not outlandish. For many, the second EHR implementation has become a major reality.

The Fiscal Cliff of Primary Care

Posted on December 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Hello Health blog has a really interesting article up discussing what they called the Primary Care Fiscal Cliff. The thing I like most about the post is the data they provide on what’s happening with primary care doctors. Take for example this list of statistics:

  • Primary care practice income rose just $500 from 2008-2011
  • Operating expenses of a practice continues to rise each year
  • Primary care physicians can spend an average of 13 hours a week of uncompensated care worth over $30,000 in lost revenue a year
  • The cost of a traditional electronic health record can easily exceed $20,000 in the first year with a 5-year projected cost approaching $50,000 per physician

I’m not sure that the US government’s fiscal cliff has much relationship to the primary care doctor fiscal cliff (except for the possible Medicare cuts), but it’s very safe to say that primary care doctors are in a real financial predicament.

In the Hello Health post they suggested from their own research that practice finances and EHR are the two issues keeping primary care physicians up at night. I’m sure these findings won’t be a surprise to any primary care doctors. Plus, it’s worth noting that the finances of a primary care practice are tied to an EHR in many ways.

I have often questioned how much influence the government EHR incentive money has had on getting doctors to adopt EHR. Whenever I do, I usually get a response from a primary care doctor saying that they wouldn’t be implementing an EHR if it weren’t for the EHR incentive money and that they were depending on the EHR incentive money to help cover the new EHR expense.

In my recently started EHR benefit series I’m hoping to expand the thinking when it comes to EHR revenue implications. There are still tens of thousands of primary care doctors that need to implement an EHR or replace their existing EMR. Understanding the financial ties to EHR will help a practice ensure a more successful EHR implementation.

At the core of the question is whether EHR software is a financial benefit or a financial loss. The cop out answer to that question is that it depends on how you implement the EHR and which EHR you implement. I wish someone would take the time to study the top 20 EHR companies and evaluate how practices have done pre-EHR implementation and post EHR implementation. Plus, they’d need to take into account the cost of an EHR. That type of study would produce a lot of interesting EHR data.

My gut feeling having participated in numerous EHR implementations and heard from thousands of other EHR implementations is that the result is usually a wash. In most EHR implementations I don’t think there’s a net financial gain or loss. There are outliers on both sides of that spectrum, but I think for most it has some pros and some cons.

With that said, I think there are long term benefits to a practice that has an EHR. While the immediate financial returns may not come, I think that the EHR in a practice is going to be essential for many of the financial gains a practice wants to achieve in the future. The most obvious example is becoming part of an ACO. Can you really get the financial benefits of being in an ACO without an EHR? I think the answer will likely be no. You need the EHR data to obtain and report on the ACO improvements your practice achieves.