Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

eCW (eClinicalWorks) Settles Whistleblower Lawsuit for $155 Million

Posted on May 31, 2017 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.

In many of my press panels and other discussions at the Healthcare IT Marketing and PR Conference, I’ve argued that there’s very little “Breaking News” when it comes to healthcare IT. Today is an example where this is not true. The news just broke that EHR vendor, eCW (eClinicalWorks), has settled a whistleblower lawsuit against them for $155 million.

The suit was filed by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement, by his law firm Phillips & Cohen LLP against eClinicalWorks. eClinicalWworks and three of its founders (Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani) are jointly liable for the payment of $154.92 million. Separately, Developer Jagan Vaithilingam will pay $50,000, and Project Managers Bryan Sequeira, and Robert Lynes will each pay $15,000. As a whistleblower, Delaney stands to receive $30 million of the settlement.

Here’s the summary of the complaints against eCW from the Justice Department’s press release about the settlement:

In its complaint-in-intervention, the government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification. For example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.

Most people are writing about how eCW didn’t fully integrate the RxNorm codes, but instead hard coded the 16 codes that the certification process used. That’s embarrassing so it’s not a surprise that so many people are sharing that part of the story. However, I think the bigger part of the violation is probably around the data portability requirements. I bet a lot of EHR vendors are sweating right now as they look at the way they implemented those requirements. Not to mention the EHR audit logs which are poor in many EHR. Plus, the scariest claim is eClinicalWork’s inability to reliably record diagnostic imagine orders or perform drug interaction checks. Those are patient safety issues and exist in many EHR software.

If you want to dig into the weeds like I did, then you can see the government complaint against eClinicalWorks that was filed May 12, 2017 and the final settlement agreement with eClinicalWorks. Even more insightful was looking at the original complaint from Delaney against eClinicalWorks. Comparing the original whistleblower complaint to the government complaint against eClinicalWorks is very interesting. You’ll see that the government didn’t grab on to everything that was originally filed by Delaney. I imagine that’s a standard legal practice to file as many areas as possible and see what the government decides to use. It seems like Phillips & Cohen have represented a number of whistleblowers so I’m sure they were expert at this.

Girish Navani, CEO and Co-Founder or eClinicalWorks, offered this statement about the settlement:

“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency. We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”

Looking at the bigger picture, I’m certain that every EHR vendor is going through their EHR certification process and looking at all the statements they’ve made to make sure they’re not going to be in a similar situation. Not to mention the anti-kick back laws that were mentioned in the settlement. I’m sure there are other EHR vendors that are in violation of both of these items just as much as eCW.

Former ONC National Coordinator, Farrzad Mostashari seems to agree with me. Farzad tweeted, “Wow!! I hope this changes the attitude of the EHR vendor space more broadly.” Then, he later tweeted, “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who flouted certification /misled customers
Other vendors better clean up.”

Farzad then nailed it when he tweeted “There are a LOT of doctor’s office staff looking at their EHR today and wondering if there’s $30M worth of false promises hidden there”

I do wonder if Farzad Mostashari feels a little guilty of the role he played in this process since he oversaw such a porous EHR certification process. I’ve been against EHR certification for a long time because I thought it provided so little value to providers. The fact that it can be gamed by 16 codes being hard coded is a perfect example of why EHR Certification is a waste. Although, one could argue that without EHR certification, this suit would have never happened and maybe eClinicalWorks could still be selling the same product today.

I do find this quote from the US Attorney’s Office for the District of Vermont press release a little over the top (which I think is common on these things):

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or puts patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

Another topic I haven’t seen anyone else cover is the impact that this settlement will have on eCW’s customers that used eCW to attest to meaningful use. Technically it shows that eCW wasn’t appropriately certified, so that means that they weren’t using a certified EHR and therefore shouldn’t have been eligible for meaningful use incentives. I asked one friend about this and he suggested that CMS had previously said that it would not hold eligible providers and eligible hospitals responsible for EHRs that calculated the meaningful use measures the wrong way. So, we’ll probably see this same approach with eCW users that got EHR incentive money on what we now know was not appropriately certified.

I was also intrigued by the Corporate Integrity Agreement (CIA) that eClinicalWorks entered into with HHS-OIG. There are a lot of details and oversight that eCW will get from OIG, but it also required eClinicalWorks to “allow customers to obtain updated versions of their software free of charge and to give customers the option to have ECW transfer their data to another EHR software provider without penalties or service charges. [emphasis added]”

Free updates is pretty clear and ironic since not wanting to update all their clients is one possible hypothesis for why they didn’t really push the proper upgrades. Hopefully all eCW users will do it now or they might be facing their own violations for using outdated software that has known clinical issues. However, the kicker in the CIA detail above is that eClinicalWorks has to give customers the option to have eClinicalWorks transfer their data to another EHR without penalty or service charges. I wonder how many will take them up on this requirement and what the details will be. I still wish this was required of all EHR vendors, but that’s a story for another day.

How many EHR vendor marketing groups are putting together their eClinicalWorks Rescue Plan to take in the downtrodden eCW users? I’m not sure these will be as successful as other EHR switching marketing efforts like those we see when an EHR is being shut down.

I’m sorry to say that I think this is likely only the beginning of such lawsuits. In fact, it’s probably already woken up a lot of potential whistle blowers. Hopefully it’s woken up a lot of EHR vendors as well.

Patient Stories, Not Just for Story Time Anymore – #HITsm Chat Topic

Posted on May 30, 2017 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 6/2 at Noon ET (9 AM PT). This week’s chat will be hosted by Susannah Meadows (@susannahmeadows) and the #WTFix Community on the topic of “Patient Stories, Not Just for Story Time Anymore.”

There’s a new conference happening Wednesday June 14th that’s focused fully around the patient and the problems that exist in health care as we know it. The conference is called What’s the Fix? or #WTFix for short.

The great part about the conference is that it costs nothing to attend and they’re making it available for free in person and virtually. Plus, I love their focus on the patient. Knowing that this conference was just around the corner, I reached out to Burt Rosen and his team who are organizing the event and asked if they had someone from their conference that could host the #HITsm chat talking about the patient perspective.

We’re blessed that Susannah Meadows (@susannahmeadows) was willing to host this week’s #HITsm chat. Susannah just published her book “The Other Side of Impossible” which was featured in this New York Times article. Thanks Susannah for sharing your story and hopefully during the #HITsm chat she can inspire others to share theirs. I don’t think we can ever get enough patient perspectives.

We can’t wait to talk patient stories in this week’s #HITsm chat. Here are the questions we’ll be discussing.

T1: Why are patient stories important (and you are a patient too)? #HITsm

T2: Where do you hear patient stories? Do you ever ask your friends or neighbors? #HITsm

T3: What’s the most impactful story you’ve heard #HITsm

T4: What Have you changed as a result of what you’ve heard? #HITsm

T5: How do you create an environment that’s safe for story sharing and doesn’t feel exploitative? #HITsm

Bonus: What are the best and worst conferences for hearing patient stories? #HITsm

Upcoming #HITsm Chat Schedule
6/9 – Health Plan Innovation, Change and Growth During Uncertain Times
Hosted by @HCExecGroup, @_GWConnect and @_GuideWell as part of #AHIPInstitute

6/16 – TBD
Hosted by Danielle Siarri (@innonurse)

6/23 – Clinical Intelligence
Hosted by Megan Janas (@TextraHealth)

6/30 – EHR Optimization
Hosted by Max Stroud (@MMaxwellStroud), Justin Campbell (@tjustincampbell), and Julie Champagne (@JulieEChampagne)

We look forward to learning from the #HITsm community! As always let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Memorial Day

Posted on May 29, 2017 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.

On this holiday, we hope that many of you are enjoying time with your family. For those in healthcare that are still working on this holiday, we salute you as well.

Health IT Usability Comic and a Little Rant – Fun Friday

Posted on May 26, 2017 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.

This comic reminds me of healthcare IT and EHR government regulations lately. See if you can relate to this great Dilbert comic.

For healthcare I might change the wording to say…

“Your certification and regulation requirements include four hundred features.”

“Do you realize that no doctor is able to use a product with that level of complexity?”

“Good point. How can I certify “Easy to use?””

I’m reminded of the keynote I saw the US CIO give. He said that one of the biggest challenges is taking regulation off the books. I’d love to see HHS and ONC see how many regulations they could remove as opposed to continuing to create new regulations.

If they’re not sure where to start, let me give them an idea. If you’ve required the collection of data which you haven’t ever used, that regulation is gone. That should do away with 3/4 of the healthcare regulations.

P.S. Sorry to take a Fun Friday and make it not so fun. I couldn’t help myself.

Both US And International Doctors Unimpressed With Govt Telehealth Adoption

Posted on May 25, 2017 I Written By

Anne Zieger 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.

A new survey by physician social network SERMO has concluded that both US and foreign physicians aren’t impressed with national and local telehealth efforts by governments.

The US portion of the survey, which had 1,651 physician respondents, found that few US doctors were pleased with the telehealth adoption efforts in their state. Forty-one percent said they felt their state had done a “fair” job in adopting telehealth, which 44 percent said the state’s programs were either “poor” or “very poor.” Just 15 percent of US physicians rated their state’s telehealth leaders as doing either “well” or “very well” with such efforts.

Among the various states, Ohio’s programs got the best ratings, with 22 percent of doctors saying the state’s telehealth programs were doing “well” or “very well.” California came in in second place, with 20 percent of physician-respondents describing their state’s efforts as doing “well” or “very well.”

On the flip side, 59 percent of New Jersey doctors said the state’s telehealth efforts were “poor” or “very poor.” New York also got low ratings, with 51 percent of doctors deeming the state’s programs were “poor” or “very poor.”

Interestingly, physicians based outside the US had comparable – though slightly more positive — impressions of their countries’ telehealth efforts. Thirty-eight percent of the 1,831 non-US doctors responding to the survey rated their country as having done a “fair” job with telehealth adoption, a stronger middle ground than in the US. That being said, 43 percent said their country has done a “poor” or “very poor” job with adopting telehealth programs, while just 19 percent rated their countries’ efforts as going “well” or “very well.”

As with state-by-state impressions in the US, physicians’ impressions of how well their country was doing with telehealth adoption varied significantly.  Spain got the best rating, with 26 percent of physicians saying efforts there were going “well” or “very well.” Meanwhile, the United Kingdom got the worst ratings, with 62 percent of doctors describing telehealth efforts there as “poor” or “very poor.”

Of course, all of this begs the question of what doctors were taking into account when they rated their country or state’s telehealth-related initiatives.

What makes doctors feel one telehealth adoption program is effective and another not effective? What kind of support are physicians looking for from their state or country? Are there barriers to implementation that a government entity is better equipped to address than private industry? Do they want officials to support the advancement of telehealth technology?  I’d prefer to know the answers to these questions before leaping to any conclusions about the significance of SERMO’s data.

That being said, it does seem that doctors see some role for government in promoting the growth of telehealth use, if for no other reason than that that they’re paying enough attention to know whether such efforts are working or not. That surprises me a bit, given that the biggest obstacles to physician telehealth adoption are generally getting paid for such services and handling the technology aspects of telemedicine delivery.

But if the study is any indication, doctors want more support from public entities. I’ll be interested to see whether Ohio and California keep leading the pack in this country — and what they’re doing right.

Seven Factors That Will Make 2018 A Challenging Year For EMR Vendors

Posted on May 24, 2017 I Written By

Anne Zieger 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.

Unless they’re monumentally important, I generally don’t regurgitate the theories researchers develop about health IT. But this time I’m changing strategies. While their analysis may not fit in the “earth shattering” category, I thought their list of factors that will shape 2018’s EMR market was dead on, so here it is.

According to a report created by analyst firm Kalorama Research, a number of trends are brewing which could make next year a particularly, well, interesting one for EMR vendors. (By the by, the allegedly Chinese curse, “May you live in interesting times” probably wasn’t Chinese in origin — it seems to have been minted in the 19th century by a British politician named Joseph Chamberlain. But I digress.)

According to Kalorama publisher Bruce Carlton, many forces are converging, including:

  • Frustrated physicians: Physician rage over clunky EMRs may boil over next year. No one vendor seems positioned to scoop up their business, but of course many will try.
  • Hospital EMR switches: While hospitals have been switching out EMRs for quite some time, defections may climb to new levels. Their main objective: Improve workflows.
  • Emerging technologies: Trendy approaches like dashboarding, blockchain and advanced big data analytics will begin to be integrated with existing EMR technologies. Or as the report notes, “the Old EMR doesn’t cut it anymore.”
  • IT staff shortages: It takes a pretty seasoned IT pro to run an EMR, but they’re hard to find, especially if you want them to have a lot of relevant experience. But without their expertise, provider organizations may not get the most out of their systems. This may spell opportunity for vendors offering better service, the report says.
  • Breach of the day: With each cybersecurity breach, EMRs get negative coverage, and the effects of this bad PR are accreting. Tales of ransomware, a particularly lurid form of cybercrime, are only making things worse.
  • Many EMR vendors remain: Despite a barrage of M&A activity in the sector, there are still over 1,000 vendors in the EMR space, Kalorama notes. In other words, competition for EMR customers will still be brisk, particularly given that no one vendor – even giants like Cerner and Epic – owns more than one-fifth of the market (This assertion comes from firm’s own market estimates.)
  • New Administration, new goals: To date the White House hasn’t proposed specific changes to health IT policy, but one clue comes from the appointment of an HHS Secretary who dislikes the meaningful use program. Anything could happen here.

In addition to the factors cited by Kalorama, I’d suggest one other trend to consider. As I’ve noted above, Kalorama argues that customers will demand EMRs that incorporate sexy new technologies, perhaps more so than in the past. I’d go further with this projection. From what I’m hearing, a consensus is emerging that EMR architectures must be completely deconstructed and rethought for today’s data.

With important data flows emerging from wearables, apps, remote monitoring devices and the like, it may not makes sense to put a big database at the center of the EMR platform anymore. After all, what’s the point of setting up an enterprise EMR as the ultimate source of truth if so much important data is being generated by mobile devices at the network edge?

Anyway, that’s my two cents, along with Kalorama’s predictions. What do you think 2018 will look like for EMR vendors, and why?

How Will APIs Change Health IT? – #HITsm Chat Topic

Posted on May 23, 2017 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 5/26 at Noon ET (9 AM PT). This week’s chat will be hosted by Chad Johnson (@OchoTex) on the topic of “How Will APIs Change Health IT?.”

First, let’s define API: An application programming interface (API) is a set of standards that enable communication between multiple sources, most typically software applications. More specifically, an API is a set of routines, protocols, and data standards defined by a software vendor (an EHR for example) that specify how other vendor applications can contribute to or remove data from their database.

Other industries have profited from modern API integration, driven by the boost of internet technologies such as cloud applications and smart phones. Almost every consumer-facing technology runs on modern APIs – facebook, Twitter, Waze, Mint, etc. Facebook’s internal API, for example, pulls in data from all your friends’ FB feeds and displays it onto your feed. FB’s external API allows you to post items to your facebook feed using other applications, such as Instagram or Twitter.

Can you think of a popular/widespread/well known example of APIs in healthcare? No? Not surprisingly, healthcare has some catching up to do with APIs.

The good news for healthcare is that providers and vendors are realizing the potential impact modern APIs have on workflows, patient care, and… profits. The HL7 FHIR healthcare standard, along with Meaningful Use Stage 3 API requirements, have solidified the hype and marked API and cloud integration almost essential to understand.

Let’s discuss that in this week’s #HITsm chat.

T1: What barriers do you see for API adoption in hospitals? #HITsm

T2: Will EHRs eventually allow two-way API connectivity (read & write)? #HITsm

T3: Can API connectivity change perceptions about ‘siloed’ EHR patient databases? #HITsm

T4: Will APIs motivate hospitals to store their patient data in the cloud? #HITsm

T5: Will APIs open up the door to other vendors and applications? Or just broaden current EHR footprint? #HITsm

Bonus: What innovative solutions do you predict creative IT teams can employ for patients and caregivers? #HITsm

Upcoming #HITsm Chat Schedule
6/2 – Patient Stories, Not Just for Story Time Anymore
Hosted by the #WTFix Community

6/9 – TBD
Hosted by TBD

6/16 – TBD
Hosted by Danielle Siarri (@innonurse)

6/16 – TBD
Hosted by Megan Janas (@TextraHealth)

We look forward to learning from the #HITsm community! As always let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Big Data and the Social Good: The Value for Healthcare Organizations

Posted on May 22, 2017 I Written By

The following is a guest blog post by Mike Serrano from NETSCOUT.

It’s a well-known fact that Facebook, Google, and our phone companies collect a lot of information about each of us. This has been the case for a long time, and more often than not it’s to improve the user experience of the services we rely on. If data is shared outside the organization, it’s anonymized to prevent the usage of any one individual from being identified. But it’s understandable while this practice has still sparked a passionate and longstanding debate about privacy and ‘big brother’-style snooping.

What is often forgotten, however, or more likely drowned out by the inevitably growing chorus of privacy concerns, is the opportunity within the big data community for this valuable information to be used for social good. The potential is already there. The question, though, is how different organizations, and particularly the healthcare sector, can take advantage of anonymized user data to benefit society and improve the human condition.

When it comes to healthcare, data from mobile networks holds the biggest opportunity for the patient experience to be dramatically improved. To truly understand how real-time traffic and big data, in the form of historical network usage and traffic patterns, can be used for social good, let’s look at a few possible scenarios – two of which can be accomplished without needing to disclose individual user information at all.

Public health – Getting ahead of an outbreak

What a decade ago would have seemed impossible is very much a reality today. The pervasiveness of the smartphone and how people are using it has fundamentally changed our ability to leverage real-time communications data to the benefit of our society. For many people, smartphones have replaced computers as the primary device to search for information. This has value in itself, as when people use a smartphone it’s possible to place them in context of their community and travel patterns.

Zika is a recent example of a parasite spread by mosquitos that produces flu-like symptoms and can have grave consequences on a developing fetus, causing microcephaly. To control the mosquito population, local vector control agencies place field traps to capture mosquitos and periodically test the mosquitos they collect. This approach has value, but it’s slow and reactive.

What we have learned from flu epidemics is there’s typically an increase in Google searches of “flu symptoms” that emerge just before or at the same time as an outbreak of influenza. Since Zika is a mosquito-born pathogen, it will occur outside of times of the normal spread of influenza, but the initial symptoms are very similar to the common flu.

By monitoring mobile searches for any of a number of unique search terms, it is possible to quickly identify real-time locations where outbreaks may be occurring; thus allowing for a more targeted response by both vector control and public health agencies. In addition, it’s then possible to identify the extent to which migration through the area has occurred, and to where that population has traveled.

When merged with environmental data such as wind patterns, temperature, and precipitation, public health agencies can be extremely targeted about where to deploy resources and the nature of those resources to deploy. Such a targeted and immediate response is only available through the use of real-time network traffic data.

Public safety and medical deployments – disaster response

Recent earthquakes have emphasized the potential death and destruction that natural disasters can create. When buildings collapse first responders’ rush in to look for survivors, putting themselves in harms way as a series of aftershocks could cause additional damage to already weakened structures. But it’s a calculated risk. The search for life must happen quickly, which often means first responders are operating with no knowledge of the potential number of causalities within a building.

To ensure the appropriate allocation of response teams, public safety agencies working in tandem with healthcare organizations could leverage mobile network data. When a mobile phone is turned on, it automatically registers to the mobile network. At this point, the operator knows the number of devices in a certain area based on the placement of the cell tower and the parameters of that tower.

By comparing the last known number of registrants against historical network usage, the operator could guide public safety and relief agencies by understanding the number of known mobile phones in an impacted area. If needed, the operator could also assist in the identification of precisely who may still be in a damaged structure, should that level of detail be required.

Pandemic control – removing the guesswork

All major health organizations understand the next major pandemic is only a plane ride away from arriving on their doorstep. For example, when an international flight lands from a country that’s had a recent outbreak of flu or disease, there could potentially be hundreds of infected passengers on board. Those passengers will exit the plane, grab their luggage, and quickly head into the community – travelling far from the airport and growing the transmission radius significantly.

In a situation such as this, the challenge of containing or managing an outbreak is intrinsically tied to knowing where those passengers end up. How far have they travelled, how did they diffuse into the existing population, and how many circles of control need to be established in order to mitigate the risk?

Big data can address this issue. By working with mobile network operators the local healthcare community can quickly react, taking advantage of big data to deploy public health resources more effectively than they could otherwise. Operators already have access to this information, including where subscribers join the network and their current location, and this data is tremendously valuable when placed in the hands of healthcare professionals looking to stem a viral outbreak. The airline involved could also assist by providing any the phone numbers of passengers once the risk was identified.

The future of big data analysis for healthcare

Understanding human movement and social activity, powered by big data pulled from mobile networks, will have a fundamental role to play in more efficient healthcare response in the future. National, state, and local public health officials should all look to implement initiatives based on the use of big data for social good.

When you compare the use of big data against the current approach – where patient zero arrives at hospital and the local healthcare body has to try and identify who else is at risk based on the patient’s travel patterns and limited information they can provide – the benefits of this new approach are obvious.

As the conversation around the use of big data for healthcare purposes evolves, there will inevitably be new questions over individual privacy. While the examples outlined above do take advantage of subscriber behavior and individual insights – be that search terms of location information – the purpose is to understand populations or communities, not to identify any one subscriber. With this in mind, it is easy to mask subscriber identifiers while preserving the information about the population. Ultimately, the goal is to provide a more efficient utilization and allocation of society’s resources as we work to improve the human condition, not to undermine any one person’s right to privacy.

About Mike Serrano
Mike has over 20 years of experience in the communications industry. He is currently responsible for Service Provider Marketing at NETSCOUT. He began his career at PacBell (now part of at&t) where he designed service plans for the business market and where he was responsible for demand analysis and modeling. His career continued with Lucent technologies where he brought to market the first mobile data service technology. At Alloptic, he was responsible for marketing the industry’s first EPON access solution and bringing to market the first RFOG solution. At O3B Networks, Mike headed up marketing bringing to market the first MEO based constellation of satellites for serving internet service to the Other 3 Billion on the planet. Mike’s work continued at Cisco where he helped to define MediaNet (Videoscape) and the network technology transformation for cable operators. Mike holds a B.S. in Information Resource Management from San Jose State University and an MBA from Santa Clara University

E-Patient Update:  Changing The Patient Data Sharing Culture

Posted on May 19, 2017 I Written By

Anne Zieger 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.

I’ve been fighting for what I believe in for most of my life, and that includes getting access to my digital health information. I’ve pleaded with medical practice front-desk staff, gently threatened hospital HIT departments and gotten in the faces of doctors, none of whom ever seem to get why I need all of my data.

I guess you could say that I’m no shrinking violet, and that I don’t give up easily. But lately I’ve gotten a bit, let me say, discouraged when it comes to bringing together all of the data I generate. It doesn’t help that I have a few chronic illnesses, but it’s not easy even for patients with no major issues.

Some these health professionals know something about how EMRs work, how accurate, complete health records facilitate care and how big data analysis can improve population health. But when it comes to helping humble patients participate in this process, they seem to draw a blank.

The bias against sharing patient records with the patients seems to run deep. I once called the PR rep at a hospital EMR vendor and complained casually about my situation, in which a hospital told me that it would take three months to send me records printed from their EMR. (If I’d asked them to send me a CCD directly, the lady’s head might have exploded right there on the phone.)

Though I didn’t ask, the vendor rep got on the phone, reached a VP at the hospital and boom, I had my records. It took a week and a half, a vendor and hospital VP just to get one set of records to one patient. And for most of us it isn’t even that easy.

The methods providers have used to discourage my data requests have been varied. They include that I have to pay $X per page, when state law clearly states that (much lower) $Y is all they can charge. I’ve been told I just have to wait as long as it takes for the HIM department to get around to my request, no matter how time-sensitive the issue. I was even told once that Dr. X simply didn’t share patient records, and that’s that. (I didn’t bother to offer her a primer on state and federal medical records laws.) It gets to be kind of amusing over time, though irritating nonetheless.

Some of these skirmishes can be explained by training gaps or ignorance, certainly. What’s more, even if a provider encourages patient record requests there are still security and privacy issues to navigate. But I believe that what truly underlies provider resistance to giving patients their records is a mix of laziness and fear. In the past, few patients pushed the records issue, so hospitals and medical groups got lazy. Now, patients are getting assertive, and they fear what will happen.

Of course, we all have a right to our medical records, and if patients persist they will almost always get them. But if my experience is any guide, getting those records will remain difficult if attitudes don’t change. The default cultural setting among providers seems to be discomfort and even rebellion when they’re asked to give consumers their healthcare data. My protests won’t change a thing if people are tuning me out.

There’s many reasons for their reaction, including the rise of challenging, self-propelled patients who don’t assume the doctor knows best in all cases. Also, as in any other modern industry, data is power, and physicians in particular are already feeling almost powerless.

That being said, the healthcare industry isn’t going to meet its broad outcomes and efficiency goals unless patients are confident and comfortable with managing their health. Collecting, amassing and reviewing our health information greatly helps patients like me to stay on top of issues, so encumbering our efforts is counter-productive.

To counter such resistance, we need to transform the patient data sharing culture from resistant to supportive. Many health leaders seem to pine for the days when patients could have the data when and if they felt like it, but those days are past. Participating happily in a patient’s data collection efforts needs to become the norm.

If providers hope to meet the transformational goals they’ve set for themselves, they’ll have to help patients get their data as quickly, cheaply and easily as possible. Failing to do this will block or at least slow the progress of much-needed industry reforms, and they’re already a big stretch. Just give patients their data without a fuss – it’s the right thing to do!

Scenarios for Health Care Reform (Part 2 of 2)

Posted on May 18, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this article suggested two scenarios that could promote health care reform. We’ll finish off the scenarios in this part of the article.

Capitalism Disrupts Health Care

In the third scenario, reform is stimulated by an intrepid data science firm that takes on health care with greater success than most of its predecessors. After assembling an impressive analytics toolkit from open source software components–thus simplifying licensing–it approaches health care providers and offers them a deal they can’t refuse: analytics demonstrated to save them money and support their growth, all delivered for free. The data science firm asks in return only that they let it use deidentified data from their patients and practices to build an enhanced service that it will offer paying customers.

Some health care providers balk at the requirement to share data, but their legal and marketing teams explain that they have been doing it for years already with companies whose motives are less commendable. Increasingly, the providers are won over. The analytics service appeals particularly to small, rural, and safety-net providers. Hammered by payment cuts and growing needs among their populations, they are on the edge of going out of business and grasp the service as their last chance to stay in the black.

Participating in the program requires the extraction of data from electronic health records, and some EHR vendors try to stand in the way in order to protect their own monopoly on the data. Some even point to clauses in their licenses that prohibit the sharing. But they get a rude message in return: so valuable are the analytics that the providers are ready to jettison the vendors in a minute. The vendors ultimately go along and even compete on the basis of their ability to connect to the analytics.

Once stability and survival are established, the providers can use the analytics for more and more sophisticated benefits. Unlike the inadequate quality measures currently in use, the analytics provide a robust framework for assessing risk, stratifying populations, and determining how much a provider should be rewarded for treating each patient. Fee-for-outcome becomes standard.

Providers make deals to sign up patients for long-term relationships. Unlike the weak Medicare ACO model, which punishes a provider for things their patients do outside their relationship, the emerging system requires a commitment from the patient to stick with a provider. However, if the patient can demonstrate that she was neglected or failed to receive standard of care, she can switch to another provider and even require the misbehaving provider to cover costs. To hold up their end of this deal, providers find it necessary to reveal their practices and prices. Physician organizations develop quality-measurement platforms such as the recent PRIME registry in family medicine. A race to the top ensues.

What If Nothing Changes?

I’ll finish this upbeat article with a fourth scenario in which we muddle along as we have for years.

The ONC and Centers for Medicare & Medicaid Services continue to swat at waste in the health care system by pushing accountable care. But their ratings penalize safety-net providers, and payments fail to correlate with costs as hoped.

Fee-for-outcome flounders, so health care costs continue to rise to intolerable levels. Already, in Massachusetts, the US state that leads in universal health coverage, 40% of the state budget goes to Medicaid, where likely federal cuts will make it impossible to keep up coverage. Many other states and countries are witnessing the same pattern of rising costs.

The same pressures ride like a tidal wave through the rest of the health care system. Private insurers continue to withdraw from markets or lose money by staying. So either explicitly or through complex and inscrutable regulatory changes, the government allows insurers to cut sick people from their rolls and raise the cost burdens on patients and their employers. As patient rolls shrink, more hospitals close. Political rancor grows as the public watches employer money go into their health insurance instead of wages, and more of their own stagnant incomes go to health care costs, and government budgets tied up in health care instead of education and other social benefits.

Chronic diseases creep through the population, mocking crippled efforts at public health. Rampant obesity among children leads to more and earlier diabetes. Dementia also rises as the population ages, and climate change scatters its effects across all demographics.

Furthermore, when patients realize the costs they must take on to ask for health care, they delay doctor visits until their symptoms are unbearable. More people become disabled or perish, with negative impacts that spread through the economy. Output decline and more families become trapped in poverty. Self-medication for pain and mental illness becomes more popular, with predictable impacts on the opiate addiction crisis. Even our security is affected: the military finds it hard to recruit find healthy soldiers, and our foreign policy depends increasingly on drone strikes that kill civilians and inflame negative attitudes toward the US.

I think that, after considering this scenario, most of us would prefer one of the previous three I laid out in this article. If health care continues to be a major political issue for the next election, experts should try to direct discussion away from the current unproductive rhetoric toward advocacy for solutions. Some who read this article will hopefully feel impelled to apply themselves to one of the positive scenarios and bring it to fruition.