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Learning Health Care System

Posted on March 27, 2015 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 a recent post by Andy Oram on EMR and EHR titles “Exploring the Role of Clinical Documentation: a Step Toward EHRs for Learning” he introduced me to the idea of what he called a Learning Health Care System. Here’s his description:

Currently a popular buzzword, a learning health care system collects data from clinicians, patients, and the general population to look for evidence and correlations that can improve the delivery of health care. The learning system can determine the prevalence of health disorders in an area, pick out which people are most at risk, find out how well treatments work, etc. It is often called a “closed loop system” because it can draw on information generated from within the system to change course quickly.

I really love the concept and description of a learning healthcare system. Unfortunately, I see so very little of this in our current EHR technology and that’s a travesty. However, it’s absolutely the way we need to head. Andy add this insight into why we don’t yet have a learning health care system:

“Vendors need to improve the ability of systems to capture and manage structured data.” We need structured data for our learning health care system, and we can’t wait for natural language processing to evolve to the point where it can reliably extract the necessary elements of a document.

While I agree that managed structured data would be helpful in reaching the vision of a learning healthcare system, I don’t think we have to wait for that to happen. We can already use the data that’s available to make our EHRs smarter than they are today. Certainly we can’t do everything that we’d like to do with them, but we can do something. We shouldn’t do nothing just because we can’t do everything.

Plus, I’ve written about this a number of times before, but we need to create a means for the healthcare system to learn and for healthcare systems to be able to easily share that learning. This might be a different definition of leaning than what Andy described. I think he was referencing a learning system that learns about the patient. I’m taking it one step further and we need a healthcare system that learns something about technology or data to be able to easily share that learning with other outside healthcare systems. That would be powerful.

What are your thoughts on what Andy calls a popular buzzword: A Learning Health Care System? Are we heading that direction? What’s holding us back?

Finding Simple Healthcare IT Solutions to Annoying Problems

Posted on March 23, 2015 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 my recent video interview with Lindy Benton, CEO of MEA|NEA, I came away with the feeling that there are a wide variety of simple healthcare IT solutions for many of the problems that annoy us in healthcare. In Lindy’s case, they work on solving the secure document transfer problem in healthcare. They work mostly with claims remediation and other billing related documentation, but the secure document transfer applies to a lot of areas of healthcare.

As a tech person, I was interested in how rather simple technology can solve such an important problem. However, Lindy and I talk about why many organizations still haven’t adopted these technologies in their office (Spoiler: The divide between billing organizations and IT). We also talk about why EHR vendors aren’t just providing these types of secure document transfer solutions.

You can watch my full video interview with Lindy Benton below:

Healthcare Applies Innovation from Other Industries for Big Impact – Breakaway Thinking

Posted on March 18, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron

Healthcare is applying innovations from other industries to make advancements in the study of disease, surgery, and research. If you’re fascinated by new ways to use everyday tools and at the same time make life easier, also known as lifehacks, you can appreciate the same concept in healthcare.

3D imaging, cellphone camera technology, and sonograms like those used in underwater navigation are all being used in healthcare. Let’s begin with a look at cellphone technology and one way it is being applied to healthcare.

UCLA researchers developed a lens-free microscope that, through a series of steps, allows tissue samples to be formed into a 3D image using a microchip that is the same type found in your cellphone camera. The image shows contrast so the researcher can see tissue depth. This lens-free microscope also offers a broader, clearer view than conventional microscopes. The result is that “the pathologist’s diagnosis using the lens-free microscopic images proved accurate 99% of the time”, according to a recent study.   In order to apply this same concept to disease, imagine that a researcher could isolate a section of diseased tissue, remove it from its environment, color code the tissue to easily spot abnormalities, and have the ability to study it from all angles.

Techradar.com reminds us that lasers, used in missile defense, in the world’s fastest camera (which takes 6.1 million pictures per second), in entertainment devices such as Blu-ray players, and in grocery check-out lines, are also used in surgery and diagnoses. Lasers can decrease the diagnosis time and cause less disruption to a patient’s comfort. Zero-dilation Scanning Laser Opthmalogy (cSLO), a new imaging technique, can diagnose a patient with diabetic retinopathy, which causes progressive damage to the retina, in as little as 3 minutes.

Technology is not only impacting the patient experience, but how caregivers are brought up to speed on new technologies. In fact, the founder of The Breakaway Group based the company’s electronic health record (EHR) learning concept on flight simulation. Flight simulators train pilots how to maneuver in extreme circumstances, situations that would be difficult to create in real life. At The Breakaway Group, we use simulation technology to increase adoption of EHRs by training providers, nurses, and healthcare professionals.

Speed to proficiency, one of four key adoption elements of The Breakaway Method, provides learners with real-life situations in a safe environment.  Learners can quickly experience many different circumstances, fail, and learn to complete tasks correctly, all without affecting patient outcomes. In addition, The Breakaway Group can cut classroom time in half on average by using simulations.

Healthcare is reaching into other industries to become more efficient and effective. Whenever information is shared and innovations are repurposed to make a process better, we all benefit.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Top Ten Reasons for EHR’s to Use Middleware for Connectivity

Posted on March 10, 2015 I Written By

The following is a guest blog post by Thanh Tran, CEO, Zoeticx, Inc.
Thanh Tran, CEO, Zoeticx
Where should CIOs and IT professionals look to address EHR interoperability?  Middleware!

A middleware architecture has been shown to be the best technological solution for addressing the problem of EHR interoperability. The middleware platform facilitates the transparent, yet secure, access of patient health data, directly from the various databases where it is stored. A server-based middleware framework supporting access to the various patient health data stores allows for a scalable, unified and standardized platform for applications to be developed upon. The middleware architectural design has been successfully used to link data from multiple databases, irrespective to the database platform or where the database is located.

Don’t take my word for it.  Here are ten good reasons to consider middleware.

  • Application Developers Can Focus on Healthcare Apps—Enables medical record app developers to focus on their healthcare solution by freeing them from dealing with a diverse, complex EHR infrastructure.
  • Inspires the Next Generation of Healthcare Innovative Solutions—These solutions are inspired by expanding the market for the next generation of healthcare applications rather than being tied down to a stack approach, depending on the particular EHR vendor.
  • Improves Patient Care OutcomesPatients will receive better healthcare outcomes when application developers can inspire more Patients will also benefit from the next generation of applications as they will address providers’ specific needs in diverse operational care environments.
  • Saves Healthcare IT Dollars—Focuses the healthcare IT budget on addressing providers’ needs instead of building and re-building the patient record infrastructure.
  • Proven Technology—A proven technology used for decades in many industries such as financial, retail, manufacturing and other markets.
  • Easy Integration—Enables healthcare integration with diverse, deployed legacy systems, including EHR systems. It addresses EHR interoperability as part of overall integration challenges.
  • Passive to Active Healthcare IT Environment—It turns passive healthcare IT environments into active ones to enhance communication and collaboration among care providers.
  • Avoids Data Duplication—Cost efficient, simplified administration. Offers a better privacy protection solution than HIEs by addressing EHR interoperability while fulfilling the demand to support the patient care continuum in an operational care environment.
  • Eliminates Wastefulness—Addressing healthcare IT integration is much more cost efficient than the “Rip-and-Replace” approach.
  • Extends EHR Usefulness—Protects and extends healthcare IT investments in EHR and EMR systems.

About Thanh Tran
Thanh Tran is CEO of Zoeticx, Inc., a medical software company located in San Jose, CA. He is a 20 year veteran of Silicon Valley’s IT industry and has held executive positions at many leading software companies.

My Prediction for the Epic App Store

Posted on March 5, 2015 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.

Today I was talking with a healthcare IT vendor which really needs to integrate deeply with an EHR to be valuable. Without that integration the product is not nearly as useful for doctors. Therefore we started talking about their current EHR integration and the potential for future EHR integrations. At that point he asked me what I thought about the coming Epic App Store (officially called the Epic App Exchange).

In case you missed it, I wrote about the Epic App Store over on Hospital EMR and EHR. I cover what’s been said about the Epic App Store (not much from Epic itself) and make some predictions. However, today’s conversation solidified my predictions.

Epic has always been open to working with their customers and a tech partner to integrate something with Epic. Basically, the customer is king and so if the customer wants the integration, Epic will provide the SDK that’s needed for the integration and make it possible for the customer to do what they need. Everyone’s known that if you want to integrate with Epic, then you need to work through a customer.

With this in mind, I believe the Epic app store is a way for Epic to allow for distribution of these apps that have been created by their customers (often with a tech partner) to other Epic customers.

Basically, this is in line with Judy’s focus on the customer. Some might say that this focus is great. Hard to argue with Epic’s success. However, this approach misses out on the opportunity of the Epic app store facilitating entrepreneurial innovators to build something on top of Epic that their customers didn’t even know they wanted yet.

Epics current strategy is more in line with staying the entrenched incumbent. Real transformation comes when you provide a platform for innovation that goes beyond yourself and your customers. I hope one day Epic sees this vision and really roles out an open app store. Until then, the Epic connected customer applications are going to have a bit of a monopoly selling their add on services to Epic customers.

“Please Choose One” – A Short Story

Posted on February 25, 2015 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.

Every once in a while I come across a piece of healthcare prose that I have to share, but there’s no good way to share it in pieces. I found that once in The Old Man and the Doctor Fable. It’s a must read if you haven’t read it.

I recently had another such example shared with me called “Please Choose One“. This one took me a second to really get into it, but about a quarter of the way through, I couldn’t stop reading and had to figure out how it ended. I’m sure that many physicians will feel the heartache shared in this short story. Thank you Philip Allen Green, MD for sharing. If you haven’t gone and read it, go read it…we’ll be back here once you’re done.

Obviously, the story is told in an exaggerated worst case scenario fashion. Although, to me that’s what illustrates the point so well. The lesson I took from the story is that we can’t take the human out of healthcare. Technology should help us offer more humanity to patients as opposed to less. Furthermore, we’re at risk for doing the opposite.

What’s your takeaway? I’d love to hear your thoughts on the story.

Thinking About Future EHR Switching When Purchasing EHR Software

Posted on February 24, 2015 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.

When we start purchasing our EHR, many times we don’t spend enough time thinking about what happens when we reach the end of life for the software we’re purchasing. I was particularly reminded of this when writing my post about the legacy EHR ticking time bombs. During our EHR or other healthcare IT software purchase, we don’t think about 5, 10, 15 years down the road when we might want to switch systems. What happens at the end of a system’s life is not our concern during an EHR purchase, but it should be.

A lot of people like to talk about EHR data portability. This is a very important subject when you’re looking to sunset an old system. However, if you haven’t put the right items in your EHR contract, it becomes a major issue for you to get that data out of the EHR. If you haven’t read the section on EHR contracts in my now somewhat dated EMR selection e-Book, take some time to read it over and check out your EHR contract.

When you can’t get the data out of your EHR, then you’re stuck in a situation that I described in my legacy EHR ticking time bomb post. You limp your legacy EHR system along and have issues with updates, fear the lost of the system completely, and much more. It’s just an ugly situation.

It’s nice to think that an EHR system will just work forever, but technology changes. It’s just the reality of life. I’m interested to see if the concept of an EHR vendor neutral archive will really take off. That would be one major way to combat this. However, I think many are afraid of this option because it’s tough to preserve the granular data elements in the EHR. Plus, it takes a forward thinking CIO to be able to make the investment in it. Although I’ve met some that are doing just this.

What has your organization done to prepare for the day that you’ll sunset your EHR or other healthcare IT systems? Is this a concern for you? Or are you like some CIOs who figure that it will be someone else’s problem?

What’s Your Value Based Care Strategy? What Role Does IT Play?

Posted on February 23, 2015 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.

I pretty regularly take a look at various healthcare IT whitepapers to glean insights into what’s happening in the industry and what advice vendors are offering healthcare organizations. I’ve been keeping a special eye on the changing reimbursement model and move to value based care and so I was interested in this whitepaper titled “How to Win with Value-based Care: Developing Your Practice’s EHR Strategy.”

The whitepaper starts with a dive into some of the changing care and reimbursement models that are emerging in healthcare. Then they offer this 4 step “Winning Strategy” for being ready for these changes:
Step 1: Assess your current situation
Step 2: Develop a customized VBC Plan that’s right for your practice
Step 3: Determine IT solution needs
Step 4: Implementation

In many ways, this 4 step plan could be applied to any project. Of course, the whitepaper dives into a lot more detail for each step. Although, I was struck by step 3. It takes for granted that value based reimbursement will require an IT solution. This whitepaper comes from a healthcare IT company with some value based IT product offerings so you have to question whether IT will be at the core of a practice’s value based care strategy or not.

As I think about the future of coordinated care and value based reimbursement, I think it’s more than fair to say that technology will be at the center of these initiatives. Value based care requires data to prove the quality of the care you’re providing. Certainly you could try and collect some of this data on paper, but does anyone think this is reasonable?

Try identifying all overweight patients in your patient population using paper chats. I can see in my mind’s eye an army of medical records professionals sifting through stacks of paper charts. It’s not a pretty solution and it’s fraught with error. That’s one query on an EHR system.

One of the biggest elements of value based reimbursement will be communication with patients. Can we build that real time communication on the back of snail mail? It sounds almost silly talking about it. Of course we’re going to use mobile devices, secure messages, and even secure video communication. We still have A LOT of work to do in this regard, but it’s the future.

Of course technology is going to be at the core of value based reimbursement. It’s the only way to accomplish what we’re striving to accomplish. The next question is: will the EHR make this possible or are we going to need something new and more advanced?

Are Legacy EHR Sytems the HIPAA Ticking Time Bomb?

Posted on February 20, 2015 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.

Healthcare IT and EHR security is a really important topic right now. Many organizations have started to spend time and resources on this problem after a series of healthcare and non-healthcare breaches. The Anthem breach being the most recent. Overall, this is a great thing for the industry since I think there’s more that could be done in every organization to shore up the privacy and security of patient health data.

In a recent conversation I had with Mike Semel, we talked about some of the challenges associated with legacy EHR and Healthcare IT systems in offices. Our conversation prompted to me to ask the question of whether these legacy EHR systems are the ticking time bombs of many healthcare organizations.

Think about what happens to many of these legacy EHR systems. They get put in some back office or under someone’s desk or in some nondescript closet where they’re largely forgotten. In many cases there are only 1-2 people who regularly use them and in many cases the word “regularly” equates to accessing it a few times a month. These few people are usually not technically savvy and know very little about IT security and privacy.

Do I need to ask the question about how good the security is on a system for which most people have forgotten?

These forgotten systems often don’t get any software updates to the application or the operating system. The former is an issue, but the later is a major problem. Remember that when updates to an operating system are issued, it’s essentially blasted out to the public that there are issues that a hacker can exploit. If you’re not updating the O/S, then these systems make for easy pickings for hackers.

Forget about great audit log tracking and other more advanced security on these legacy systems. In most cases, organizations are just trying to limp them along until they can decommission them and put them out to pasture. It makes for one massive security hole for most organizations.

Of course, this doesn’t even take into the account the fear that many organizations have that these systems will just give up the ghost and stop working all together. There’s nothing quite like security on a Windows 2000 Server box sitting under someone’s desk just waiting for it to die. Hopefully those hard drives and other mechanical elements don’t stop before the data’s end of life requirements.

These legacy systems aren’t pretty and likely present a massive HIPAA privacy and security hole in many organizations. If you don’t have a good handle on your legacy systems, now might be a good time to take a look. Better to do it now than to deal with it after a HIPAA breach or HIPAA audit.

Were Anthem, CHS Cyber Security Breaches Due to Negligence?

Posted on February 19, 2015 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.

Not long ago, health insurance giant Anthem suffered a security breach of historic proportions, one which exposed personal data on as many as 80 million current and former customers. While Anthem is taking steps to repair the public relations damage, it’s beginning to look like even its $100 million cyber security insurance policy is ludicrously inadequate to address what could be an $8B to $16B problem. (That’s assuming, as many cyber security pros do, that it costs $100 to $200 per customer exposed to restore normalcy.)

But the full extent of the healthcare industry hack may be even greater than that. As information begins to filter out about what happens, a Forbes report suggests that the cyber security intrusion at Anthem may be linked to another security breach — exposing 4.5 million records — that took place less than six months months ago at Community Health Systems:

Analysis of open source information on the cybercriminal infrastructure likely used to siphon 80 million Social Security numbers and other sensitive data from health insurance giant Anthem suggests the attackers may have first gained a foothold in April 2014, nine months before the company says it discovered the intrusion. Brian KrebsAnthem Breach May Have Started in April, 2014

Class action suits against CHS were filed last August, alleging negligence by the hospital giant. Anthem also faces class action suits alleging security negligence in Indiana, California, Alabama and Georgia. But the damage to both companies’ image has already been done, damage that can’t be repaired by even the most favorable legal outcome. (In fact, the longer these cases linger in court, the more time the public has to permanently brand the defendants as having been irresponsible.)

What makes these exploits particularly unfortunate is that they may have been quite preventable. Security experts say Anthem, along with CHS, may well have been hit by a well-known and frequently leveraged vulnerability in the OpenSSL cryptographic software library known as the Heartbleed Bug. A fix for Heartbleed, which was introduced in 2011, has been available since April of last year. Though outside experts haven’t drawn final conclusions, many have surmised that neither Anthem nor CHS made the necessary fix which would  have protected them against Heartbleed.

Both companies have released defensive statements contending that these security breaches were due to tremendously sophisticated attacks — something they’d have to do even if a third-grade script kiddie hacked their infrastructure. But the truth is, note security analysts, the attacks almost certainly succeeded because of a serious lack of internal controls.

By gaining admin credentials to the database there was nothing ‒ including encryption ‒ to stop the attack. The only thing that did stop it was a lucky administrator who happened to be paying attention at the right time. Ken Westin – Senior Security Analyst at Tripwire

As much these companies would like to convince us that the cyber security breaches weren’t really their fault — that they were victims of exotic hacker gods with otherworldly skills — the bottom line is that this doesn’t seem to be true.

If Anthem and CHS going to point fingers rather than stiffen up their cyber security protocols, I’d advise that they a) buy a lot more security breach insurance and b) hire a new PR firm.  What they’re doing obviously isn’t working.