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$10 Finger Stick Blood Tests Illustrate New Quantified Future

Posted on July 3, 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’ve often talked about the variety of health sensors that are quantifying everything about us and how that’s going to change healthcare as we know it. As we have more information about ourselves, it’s impossible for us to keep doing the same things we’ve been doing. One of the challenges we’ve faced with this change is that we need access to the blood to really do quality testing. No one wants to do a venous blood draw to regularly monitor their health data.

This is why I’m so interested in what the quite secretive Theranos is doing with their finger stick blood tests. Yesterday, the big news hit that Theranos got their first FDA clearance for their herpes simplex 1 virus IgG test. Although, as MedCityNews notes, this is the first of 100 pre-submissions they have underway with the FDA.

This is exciting news, but this part of the MedCityNews article is even more exciting for me:

Its HSV-1 test costs $9.07 – one of 153 tests the company says it makes that cost less than $10.

This is a great price point for a lab test and we’d all benefit from this massive decrease in price. I’m still not sure Theranos should have a $9 billion valuation. They still have a long way to go with the FDA, but if they’re able to execute then maybe that valuation isn’t that crazy after all.

Regardless of how Theranos does as a business, I think we’re going to see hundreds of companies like Theranos that continue to make testing more affordable. That’s going to change how we approach healthcare.

Confusing the Consumer – Defining New Healthcare Roles

Posted on July 2, 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.

If you haven’t read Joseph Kvedar’s blog posts before, you’re missing out. I’m always intrigued by his insights into what’s happening with healthcare. His latest post, “The Tower of Babel and Consumer Confusion,” is no exception. Here’s an excerpt from the article I really enjoyed:

This reminds me of a time, about 25 years ago, when this new thing called disease management sprung up. Payers were frustrated by the cost of managing patients (members) with chronic illness. They got no help from providers, so they took matters into their own hands, hiring call centers staffed with nurses to contact patients/members with tips on how to manage their illness, and often sent generic brochures about high blood pressure and other conditions. Payers may have influenced the care of some patients/members, but no one was ever able to prove that this was an effective strategy.

There were numerous stories about patients receiving conflicting advice from these ‘disease managers’ compared to their own doctor’s advice, leaving patients confused. Doctors would get faxes from these same disease management companies and (perhaps arrogantly) throw them in the waste basket without reading them. As a result, the disease management industry collapsed in the middle to latter half of the last decade.

In the meantime, we now have workplace wellness programs, virtual visits offered by your health plan, retail clinics, virtual visits offered by pharmacies and — dare we forget — advice your doctor gives you, which should be more in tune with prevention now that providers are taking on risk.

He is totally right that the consumer is starting to get confused. It’s a messy world. Whenever my kids have some issue I literally have to sit down and take a few minutes to sort through all of the available options. I’m on a high deductible plan and so I want to be selective about when, where and how I and my family get healthcare. Making the wrong choice can be an extremely expensive option. As healthcare gets more proactively involved in keeping me healthy this could definitely get worse.

I think Joseph’s comparison to the Tower of Babel is a good one. The solution to all these new healthcare modalities is to make sure that everyone is speaking the same language. It doesn’t solve all of the problems, but it does help everyone get on the same page. I just hope that the business interests of many involved in healthcare don’t get in the way of this goal.

The Current EHR “Reality”

Posted on July 1, 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 response to my post on EMR and EHR about specialty specific EHR, we started a nice discussion about the need for specialty specific EHR vendors and all EHR vendors to create the capability to integrate with third party vendors who can extend the functionality of the EHR. This is not a new subject for Healthcare Scene, but it is an important one.

After talking about the dream framework of a middleware provider that connected third parties with every EHR, one of the readers offered their perspectives on the current EHR “reality”:

1) EHR vendors believe they are making great progress with their evolution.
2) EHR vendors believe that the next release is going to make everything right.
3) EHR vendors don’t believe that anyone can deliver a better solution then they can.
4) EHR vendors want to restrict access to “their” data. There’s money in that thar data.

He then offered a quote from this article: “we are stuck in a perpetual midpoint” along with these insights:

Procrastination is the best defense the EHR vendors can use to protect their turf.

That is where we will stay.

Unless there is some type of congressional action we will all keep wondering why interoperability keeps stalling and UCD is failing.

Those are some stinging words. The sting is stronger because I’ve seen so many cases of what he describes. I’ve seen glimpses of change on the horizon, but they are just glimpses. We’re really talking about an entire change in culture when it comes to EHRs.

I asked him this question, “Can the current crop of EHR build an app store model that would enable this vision? Is it an opportunity for a new vendor?

ICD-10 Claims Monitoring Infographic

Posted on June 30, 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’m told that there are only 92 days left for Congress to delay ICD-10 until the deadline to implement ICD-10. A few weeks ago we published a great post from Vishal Gandhi, CEO of ClinicSpectrum, that talked about a part of ICD-10 preparation that is often forgotten: Claims Monitoring.

I know this is going to be a major problem for many healthcare organizations and is going to cause some major cash flow problems if they don’t get on top of their ICD-10 claims by implementing some sort of ICD-10 claims monitoring process. ICD-10 hiccups are the perfect excuse for a payer not to pay your claims.

For those that prefer a more visual approach to this discussion, Vishal and his team have put together an infographic that shares the same message as his post. Pretty cool. What won’t be cool is if you’re stuck with a lot of unpaid claims thanks to ICD-10. Make sure you and your organization are ready to deal with it.
What Are You Doing to Monitor Your Claims

Full Disclosure: ClinicSpectrum is a sponsor of EMR and HIPAA.

2300 Blog Posts and 11 Million Pageviews Later

Posted on June 29, 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.

For those that don’t know the history of EMR and HIPAA, I wrote the first post on EMR and HIPAA back on December 11, 2005. It’s fun to read that first post. Short and sweet. I hit some high level points which amazingly still represent my desires 10 years later. “I will try to incorporate any aspects of EMR and HIPAA because I think best practices across the industry are important to know.” – I still try to incorporate any aspect of healthcare IT. Lately I’ve been writing even more about the business of medicine, but I still try and find best practices.

In my original post I invited people to participate in the conversation. I still desire this greatly, but I’ve found that much of the conversation has moved to social media versus the blog comment section. Plus, as I’ve refined my blogging skill, it avoids many comment threads. In the beginning I wasn’t as skilled and so there was a lot of opportunity to correct me which made for great comment threads.

The last line of that original post really expressed my understanding of EHR at the time: “This is my best knowledge from my research and is not guaranteed in anyway.” Pretty funny that I thought to put in a disclaimer from the start. When I started I knew so little. It’s amazing how much you can learn over 10 years. Yet, I’m still learning.

5 months into my EMR and HIPAA blogging journey I celebrated reaching 30,000 visitors to my blog. I was amazed by my achievement. Little did I know that less than 10 years later I’d be celebrating 2300 blog posts and 11 million pageviews. For some perspective, we celebrated 3 million pageviews in August 2010 and then last Valentine’s day we celebrated 9 million pageviews. I was nostalgic for those posts and still am today.

I’m really not sure how to process 2300 blog posts and 11 million pageviews for one of my Healthcare Scene blogs. I mostly feel to say: Thank you!

I never thought I’d be a full time blogger when I grew up, but I feel lucky to do so. Over the past 5 years as a full time blogger, it’s been amazing to see the blogging business model change. When I started blogging people were happy to buy links from my site (We stay far away from that now). We always have done some pay per click and display advertising and those both still do quite well for us. However, as we’ve matured, we’ve been able to offer a variety of email marketing and sponsored content options which really take healthcare IT marketing to the next level.

With that in mind, I want to take a second to thank those companies who are currently supporting the work we do here at EMR and HIPAA. Without their support, none of this would be possible.

EMR and HIPAA Email Sponsors
DrChrono
Stericycle

EMR and HIPAA Sponsored Content Series
ClinicSpectrum
The Breakaway Group

EMR and HIPAA Display Advertising
Ambir
HIPAA Secure Now
Colocation America
Accountable

What I love about each of these companies is that they are looking to promote their company, but they’re also interested in supporting the work we do here at EMR and HIPAA. Almost all of them are not only sponsors of the site, but also readers of the site as well.

If your company would like to support the work we do here at EMR and HIPAA, we’ve created a new landing page which outlines all of the various healthcare IT marketing and advertising options we offer across the Healthcare Scene network. We’d love to work with you on sharing your message. Just drop us a note on our contact us page.

We’ve got a lot of ideas on how to continue to make what we do here at EMR and HIPAA better. However, what won’t change is our efforts to provide valuable content that helps make our readers’ lives easier.

Starting with Small and Simple Changes

Posted on June 26, 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 had the chance to talk with Dr. Adam Sharp, CMO of par8o. While I’d followed at a very high level Dr. Sharp and Dr. Daniel Palestrant’s move from Founding Sermo to the launch of par8o, this was the first time I’d had a chance to really learn what they were doing in their new venture. I’d say that par8o’s core product now is managing the referral process, but they’ve built referral management on a platform that could facilitate all sorts of communication and data sharing across many parts of healthcare.

I love the way they’re approaching healthcare IT because I’ve long believed that many healthcare IT companies are trying to bite off more than they can chew. Many healthcare IT companies have really big visions of how they’re going to solve healthcare’s problems (of which there are many). They raise a bunch of money to go after those problems and then they never really solve anything. In most cases, the healthcare establishment kicks against such massive changes and so it makes it almost impossible for a health IT company to sell such a massive solution.

One reality of life is that we all hate change. This is true even when we know that change is the right thing to do. So, it shouldn’t be any wonder when a healthcare IT company comes in and wants to massively change what we’re doing that they find resistance. I consider that a failed strategy that I’ve seen far too many healthcare IT startup companies employ.

What I heard from par8o is that they’ve taken the opposite approach. They’re focused on a small change that can provide value to a healthcare organization. In this case it’s referral management. When you hear what they’re doing to make the round trip referral and response process electronic, you ask yourself why we haven’t been using technology to do this forever.

I’ve seen over and over again in healthcare IT that these small, simple and almost obvious solutions often make the biggest impact. They make a big impact because healthcare organizations actually adopt them. Dr. Sharp told me that even the small changes they’re introducing often meet resistance from their users. They have to invest a lot of time and effort to overcome that resistance. If even small changes are resisted, you can imagine why massive changes to an organization’s process are flat out refused.

What’s most interesting about this approach is that by successfully implementing these small changes, it opens the door for a company to eventually help a healthcare organization make much larger changes. I’ve often asked healthcare IT companies, what’s your gateway drug? (ie. What feature of your product do they really want to buy that gets them started with you?). Once you get them hooked on a specific feature, then you have the relationship and trust built to be able to offer broader changes.

It seems like par8o has taken the right approach to building trust in and providing value to their customers in referral management. I’ll be interested to watch how they leverage that trust and their healthcare communication and data sharing platform (they call it a healthcare operating system) to optimize other healthcare processes. In a fee for service world many healthcare organizations profited from a lack of optimization. In a new value based care world those optimizations are going to become extremely important.

King v Burwell Decision Teaches Sad Lesson in Law Making

Posted on June 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.

In case you’re living under a hole (in the healthcare world we call that in the middle of an EHR implementation), the Supreme Court ruled on King v Burwell today. You can read the 47 page document here if you’re interested in the details of the decision. If you’ve ever read a Scalia decision or dissent, then you’ll know what to expect in his dissenting comments.

The reality is that the decision essentially made it a non-event. If they’d decided the other direction, then there would be a lot of scrambling to mitigate the damage of having all the federal health exchanges not be subsidized. That didn’t happen and so ACA (Obamacare) will continue on as before.

I won’t dive into the good and bad of ACA or the efforts to keep it around or get rid of it here. However, the one big takeaway I have from reading the SCOTUS decision is that the law making process is really awful. At one point in the decision they even reference a quote that “we need to pass the law to see what’s in it” which I’m told is a common phrase in Washington. The decision also commented on how the law was poorly crafted because it wasn’t put through the regular congressional procedures.

I understand that the US government has hundreds of years of overhead that they’re dealing with when making laws. A lot of the procedures likely play a critical role in the law making process. However, I feel that the law making process has accrued so much complexity that it makes everything a challenge.

In the tech world we call this situation “technical debt.” Over time as you’re programming a piece of software, you accrue so much technical debt that making changes on the existing code base becomes really expensive. The solution in the software world is often to recode the software from scratch. It’s almost like declaring bankruptcy and starting from scratch.

The SCOTUS decision highlights to me how much legislative debt our government has accrued in their processes. Unfortunately, they can’t declare bankruptcy and start over without the debt. That’s just not feasible or reasonable.

Since I live in the healthcare IT world, we’ve seen a lot of this “debt” impact legislation like meaningful use. We’re going to see more of it around value based reimbursement and ACOs as the healthcare payment world evolves. Government involvement is a reality in healthcare for many reasons including the government being one of the biggest healthcare “customers.” There can be a lot of benefits that come from government involvement, but there can also be a lot of challenges and loopholes that can snag you. That’s the lesson I’m taking from the King v Burwell decision.

How NOT to Do Population Health

Posted on June 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.

The famous world traveler, Dr. Nick (he’s also CMIO for Nuance Healthcare), is attending #AMDIS15 and was kind enough to share out this awesome image:
How to Not Do Population Health

This slide was shared by Coray Tate from KLAS and is a great message to consider.

I also don’t think we should come down too hard on Humana. As healthcare companies start to stretch the normal, stuff like this is going to happen. I think that’s a good thing. At least the diabetic now had a chocolate bar that they could share with someone like me. Then, they’d have a happy friend and making a friend happy is worth so much more than a chocolate bar.

Does Federal Health Data Warehouse Pose Privacy Risk?

Posted on June 23, 2015 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.

Not too long ago, few consumers were aware of the threat data thieves posed to their privacy, and far fewer had even an inkling of how vulnerable many large commercial databases would turn out to be.

But as consumer health data has gone digital — and average people have become more aware of the extent to which data breaches can affect their lives — they’ve grown more worried, and for good reason. As a series of spectacular data breaches within health plans has illustrated, both their medical and personal data might be at risk, with potentially devastating consequences if that data gets into the wrong hands.

Considering that these concerns are not only common, but pretty valid, federal authorities who have collected information on millions of HealthCare.gov insurance customers need to be sure that they’re above reproach. Unfortunately, this doesn’t seem to be the case.

According to an Associated Press story, the administration is storing all of the HealthCare.gov data in a perpetual central repository known as MIDAS. MIDAS data includes a lot of sensitive information, including Social Security numbers, birth dates, addresses and financial accounts.  If stolen, this data could provide a springboard for countless case of identity or even medical identity theft, both of which have emerged as perhaps the iconic crimes of 21st century life.

Both the immensity of the database and a failure to plan for destruction of old records are raising the hackles of privacy advocates. They definitely aren’t comfortable with the ten-year storage period recommended by the National Archives.

An Obama Administration rep told the AP that MIDAS meets or exceeds federal security and privacy standards, by which I assume he largely meant HIPAA regs. But it’s reasonable to wonder how long the federal government can protect its massive data store, particularly if commercial entities like Anthem — who arguably have more to lose — can’t protect their beneficiaries’ data from break-ins. True, MIDAS is also operated by a private concern, government technology contractor CACI, but the workflow has to impacted by the fact that CMS owns the data.

Meanwhile, growing privacy breach questions are driven by reasonable concerns, especially those outlined by the GAO, which noted last year that MIDAS went live without an in-depth assessment of privacy risks posed by the system.

Another key point made by the AP report (which did a very good job on this topic, by the way, somewhat to my surprise) is that MIDAS’ mission has evolved from a facility for running analytics on the data to a central clearinghouse for data sharing between CMS and health insurance companies and state Medicaid organizations. And we all know that with mission creep can come feature creep; with feature creep comes greater and greater potential for security holes that are passed over and left to be found by intruders.

Now, private healthcare organizations will still be managing the bulk of consumer medical data for the near future. And they have many vulnerabilities that are left unpatched, as recent events have emphasized. But in the near term, it seems like a good idea to hold the federal government’s feet to the fire. The last thing we need is a giant loss of consumer confidence generated by a giant government data exposure.

Downsides of Incorporating Behavioral and Social Data Into an EHR

Posted on June 19, 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 response to my post about incorporating behavioral and social data into EHR, I got the following email from one of our readers:

My worry on the collection of such behavioral and social data is that it will get used to further prescribe people with the psychiatric drugs that have such horrendous side effects to the benefit of big pharma rather than move towards diet, health education, nutrition and other non-medical remedies that can have long lasting benefits for a lifetime.

It’s a very fine point. In my previous article I didn’t spend enough time talking about the potential downsides of incorporating all that data into an EHR. The reader pointed out the potential abuse by big pharma to sell more drugs. No doubt, pharma is trying to sell more drugs. I’m sure the creative minds at pharma will try and find ways to leverage this data and sell more drugs. That’s the nature of healthcare.

However, I think pharma would try to do this whether the data was in the EHR or not. In fact, having this data in the EHR for the doctor might mean the doctor makes better choices and doesn’t always default to pharma to treat a patient. For example, if you know they’re living in a poor area, then you can ask them if they have enough food or heat in the winter in order to avoid them returning to you a few weeks later with another cold. This would actually lead to less drugs because you’re actually treating the cause of the problem as opposed to just the presenting problem.

While this example paints a pretty picture, you could also paint an awful picture where this data is used for discrimination. This could be in the office itself or by insurance companies. Some of the new ACA laws help when it comes to insurance discrimination, but many fear that the move to ACOs will cause these organization to discriminate against the unhealthy and poor. I have this fear as well. When you pay to keep people healthy, who do you want to have in your patient population? The healthy.

When you start talking about including all this new data in an EHR, there are a lot of privacy and security questions that come up as well. We’ve always known that the patient record was a treasure trove of personal information that needed to be safeguarded and protected from abuse. Social and behavioral data makes the health record even that much more desirable to nefarious groups who want to abuse the data. HIPAA along with privacy and security will become that much more important.

I’m sure I’m just touching the surface on the challenges and problems associated with all this new data. Although, the thing that scares me most is the way people could abuse the data. I don’t think these are reasons to not use this data. We need to use this data to move healthcare forward. However, it is a call to be very thoughtful about how we collect, secure, and use the data we’re collecting.