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mHealth and Where It’s Heading with Alan Portela

Posted on May 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of my favorite healthcare IT people to interview is Alan Portela, CEO of AirStrip. Having been in the healthcare IT industry and seen it from so many angles, he always has some interesting insight into what’s happening in the industry. It’s hard to understand the value that having attended HIMSS almost as many years I’ve been alive (Ok, not quite, but not too far off either) provides.

With this as a preface, I think you’ll really enjoy this interview I did with Alan. We talk about how to build a successful mHealth application, the changing EHR market, and the impact of FDA regulation. He provides some really great insights into the market.

Population Health Management (PHM) – The New Health IT Buzzword

Posted on May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 some reason in healthcare IT we like to go through a series of buzzwords. They rotate through the years, but usually have a very similar meaning. The best example is EMR and EHR. You could nuance a difference between the two terms, but in practice they both are used interchangeably and we all know what it means.

With this in mind, I was intrigued by an excerpt from Cora Sharma’s post on Financial Analytics Bleeding into Population Health Management:

It appears that “population health management” (PHM) just has a better ring to it than “accountable care” or “HMO 2.0”. Increasingly, PHM is becoming an umbrella term for all of the operational and analytical HIT tools needed for the transition to value-based reimbursement (VBR), including EHR, HIE, Analytics, Care Management, revenue cycle management (RCM), Supply Chain, Cost Accounting, … .

On the other hand, HIT vendors continue to define PHM according to their core competencies: claims-based analytics vendors see PHM in terms of risk management; care management vendors are assuming that PHM is their next re-branded marketing term; clinical enterprise data warehouse (EDW) and business intelligence (BI) vendors argue that a single source of truth is needed for PHM; HIE and EHR vendors talk about PHM in the same breath as care coordination, leakage alerts and clinical quality measures (CQM); and so on.

Cora is right. Population Health Management does seem to be the latest buzzword and for some reason feels better to people than accountable care. I guess it makes sense. People don’t want to be held accountable for anything. However, they love to help a population be healthy.

Coming out of 30+ meetings with vendors at HIMSS this year I was asking myself a similar question. What’s the difference between an HIE, healthcare analytics, business intelligence, data warehouses (EDW) and even many of the financial RCM products? I see them all coming together into one platform. I guess it will be called population health management.

To Cora’s broader point in the post, there is a real coming together that’s happening between clinical and financial data in healthcare. All I can think is that it’s about time. The division of the data never really made sense to me. The data should be one and available to whatever system needs the data. ACOs are going to drive this to become a reality.

Healthcare CIO Mindmap

Posted on April 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

During HIMSS, Citius Tech put out this great image they called the Healthcare CIO Mindmap. It’s a beautiful display of everything that’s happening in healthcare IT. Although, it’s also an illustration of the challenge we and hospital CIOs face. Is it any wonder that so many hospital CIOs feel overwhelmed?

Enjoy the Healthcare CIO Mindmap in all its glory below (Hint: Click on the image to see the full graphic):
Healthcare CIO Mindmap

I think that image is enough for anyone to chew on for one day. I’d love to hear your thoughts on it.

My Reverse Interview at HIMSS & #DoMoreHIT Healthcare Think Tank Live Stream

Posted on March 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My HIMSS 2014 Interview
At HIMSS 2014 I did well over 20 scheduled interviews with people and had too many evening events to count. Needless to say, I got a chance to talk to a lot of different people and hear their story. Well, the good people at The Doctor Weighs In and Health Innovation Media turned the tables on me and asked if they could do a short interview with me at HIMSS. It sounded fun and so Patricia Salber interviewed me about my blogging history and the upcoming Health IT Marketing and PR Conference. You can see the video interview below:

I have to admit that it was a lot of fun being asked the questions instead of asking the questions. Plus, Pat does a really great job with the interviews. Although, I still cringe that she calls me a blogger extraordinaire.

Dell Healthcare Think Tank Event
In other news, I’ll be on camera again on Tuesday, March 18th for the Dell Healthcare Think Tank Event. However, this time I’ll be discussing more of the healthcare IT nitty gritty. We’re planning to discuss topics like: The Connected World, Aligning the Players, and Analytics to Drive Change. You can watch the livestream of the event at the link above and/or join in (or lurk if you prefer) using the #DoMoreHIT hashtag. I’ll be tweeting from the event using the @techguy and @ehrandhit accounts like usual.

I participated in the event last year and really enjoyed the conversations that happened at the event and online. Dell does a great job hosting the event. We’ll do what we can to keep the conversation honest and lively. While the live version is ideal because then you can participate in the conversation on Twitter in parallel with the event, they’re recording the whole event so you should be able to watch it after the fact.

This Geek Girl’s Singing: HIMSS 14 Social Media Finale

Posted on March 14, 2014 I Written By

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

As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

Can Healthcare IT Abolish a Disease?

Posted on March 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

A week after the craziness that is HIMSS (there’s a reason the #HIMSSanity hashtag has done so well), I’m kicking around an idea that came to my mind on my flight home from HIMSS. Overwhelmed by the 5 days of in depth discussions, I closed out my HIMSS talking about healthcare IT with the lovely lady sitting next to me. It just so happened that she was a HIE coordinator at a hospital in California and was heading home from HIMSS as well.

We had a far reaching discussion on the 5 or so hour flight home from Orlando. At one point we started the discussion of personalized medicine. I think I freaked her out a little bit when I mentioned the concept of every organ having an IP address.

Our discussion prompted to me to consider this really interesting an important question:

Can we abolish a disease because we’re so good at predicting that disease that we prevent it from ever happening?

When I considered this idea, it reminded me of Bill Gates (and many others) efforts to literally eradicate Polio from off the face of the earth. They’re doing so using vaccines and I can’t remember the exact timeline, but they’re only a few years out from this goal. It’s so empowering to think about eradicating a disease. Could health IT have a similar impact?

I haven’t thought through all the diseases and all the technology that could benefit from this concept, but I’m quite certain this is the real future of healthcare IT. How wonderful would it be to work on a project that determined the cause of diabetes early enough that we no longer had diabetics? What if we no longer had coughs and colds because we could identify the warning signs early enough that we could stop them from ever happening? We just need to get past the beauracracy and regulation and on to solving these major problems. No doubt this will take an enormous effort and resources and people beyond the traditional health IT.

This is a lofty concept indeed. However, I don’t think these ideas are that far away. What do you think? Could healthcare IT be used to abolish a disease?

Solving the Hospital Readmissions Problem

Posted on March 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the most interesting things I wrote about thanks to the HIMSS conference was what I called the real cause of hospital readmissions. I’m still interested in working with more hospitals to verify the data that’s presented in that blog post, but I’ll be surprised if it doesn’t play out as an important finding when it comes to reducing hospital readmissions.

In the post, I probably was a little aggressive in my statements about how the hospital can reduce readmissions through their own actions versus depending on home health, primary care doctors, or post-acute care providers. The good news is that my great readers always hold me accountable when I step too far over the line. In this case, Richard D. Tomlinson, RN, BSME, CMUP and Founder & CEO of Nuclei Health Consultancy, offered up a deeper perspective on the complexities associated with solving the hospital readmission problem.

I would like to take a moment to provide some perspective relative to your blog post today.

Hospital readmissions are, of course, clinically complex at times. In actuality, the risk for readmission can be influenced/increased due to lack of or missed opportunity for interventions prior to patient discharge. Effective quality measures, and robust analytics, with effective data feedback and clinical governance, can be deployed as components to an overall readmission reduction strategy; more on that later.

When we discuss readmissions we must consider the fact every case is unique; the circumstances, follow up care, coordination with 3rd party caregivers/providers (e.g. home health), level of transitional intervention, cultural influences, income levels, environment, stress levels. These factors are difficult to quantify, yet I do believe there is a way to translate these factors into reasonable algorithms.

I mentioned readmission as a strategy. Hospital readmission with most health systems I have worked with do not view it in strategic terms, and they must in my opinion in order to be effective (it could be argued Very often, initiatives are tactile in their core and therefore do not have a genesis of the strategic perspective when planning/implementing. As such, critical components such as clinical governance and workflow changes within the readmioften fall by the wayside or are missed completely. Add to that BI tools in the market today are not addressing predictive analysis for readmission risk as a dynamic in the overall care plan. A future-state, effective, model in my opinion would incorporate all the aforementioned factors, and in real-time track these factors and provide the care team with dynamic risk for readmission. That, combined with robust strategic tools and models in place, would have in my view significant outcomes.

Readmission engineering must be redesigned and retooled before any ROI level discussion can take place. Thank you for your fine Site and information exchange. All the Best, RDT.

I agree completely that the hospital readmission problem is not a simple problem. However, I still think a lot of people are looking in the wrong place. I look forward to digging into this problem a lot more. Reducing hospital readmissions is great for everyone involved.

Eyes Wide Shut: Meaningful Use Stage 2 Incentive Program Hardships

Posted on March 5, 2014 I Written By

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

In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.

Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?

Quick update on my IDN’s progress towards Stage 2 attestation, with $MM in target incentive dollars at stake. We must meet ALL measures; there is no opportunity to defer one. The Transition of Care (both populating it appropriately, and transmitting it via Direct) is the primary point of concern.

The hospital EHR is ready to generate and transmit both Inpatient Summary and Transition of Care C-CDAs. The workflow to populate the ToC required data elements adds more than 4 minutes to the depart process, which will cause operational impacts. None of the ambulatory providers in the IDN have Direct, yet; there is no one available to receive an electronic ToC. Skilled resources to implement Direct with the EHR upgrades are not available until 6-12 weeks after each upgrade is complete.

None of the 3 remaining in-scope ambulatory EHRs have successfully completed their 2014 software upgrades. 2 of the 3 haven’t started their upgrades. 1 has not provided a DATE for the upgrade.

None of the ambulatory EHRs comes with a Clinical Summary C-CDA configured out-of-the-box. 1 creates a provider-facing Transition of Care C-CDA, but does not produce the patient-facing Clinical Summary. (How did this product become CEHRT for 2014 measures?) Once the C-CDA is configured, each EHR requires its own systems integrator to develop the interface to send the clinical document to an external system.

Consultant costs continue to mount, as each new wrinkle arises. And with each wrinkle, the ability to meet the incentive program deadlines, safely, diminishes.

Playing devil’s advocate, I’d say the IDN should have negotiated its vendor contracts to include penalty clauses sufficient to cover the losses of a missed incentive program deadline – or, worst case scenario, to cover the cost of a rip-and-replace should the EHR vendor not acquire certification, or have certification revoked. The terms and conditions should have covered every nuance of the functionality required for Stage 2 measures.

But wait, CMS is still clarifying its Stage 2 measures via FAQs. Can’t expect a vendor to build software to specifications that weren’t explicitly defined, or to sign a contract that requires adherence to unknown criteria.

So, what COULD CMS and the ONC do about it? How about finalizing your requirements BEFORE issuing measures and certification criteria? Since that ship’s already sailed, change the CEHRT certification process.

1. Require vendors to submit heuristics on both initial implementation and upgrades, indicating the typical timeline from kick-off to go-live, number of internal and external resources (i.e., third-party systems integrators), and cost.
2. Require vendors to submit customer-base profile detailing known customers planning to implement and/or upgrade within calendar year. AND require implementation/upgrade planning to incorporate 3 months of QA time post-implementation/upgrade, prior to go-live with real patients.
3. Require vendors to submit human resource strategy, and hiring and training program explicitly defined to support the customer-base profile submitted, with the typical timeframes and project resource/cost profiles submitted.
4. Require vendor products to be self-contained to achieve certification – meaning, no additional third-party purchase (software or professional services) would be necessary in order to implement and/or upgrade to the certified version and have all CMS-required functionality.
5. Require vendor products to prove the CEHRT-baseline functionality is available as configurable OOTB, not only available via customization. SHOW ME THE C-CDA, with all required data elements populated via workflow in the UI, not via some developer on the back-end in a carefully-orchestrated test patient demo script.
6. Require vendor products adhere to an SLA for max number of clicks required to execute the task. It is not Meaningful Use if it’s prohibitively challenging to access and use in a clinical setting.

Finally, CMS could redefine the incentive program parameters to include scenarios like mine. Despite the heroic efforts being made across the enterprise, this IDN is not likely to make it, with the fault squarely on the CEHRT vendors’ inability to deliver fully-functional products in a timely manner with skilled resources available to support the installation, configuration, and deployment. Morale will significantly decline, next year’s budget will be short the $MM that was slated for further health IT improvements, and the likelihood that it will continue with Stage 3 becomes negligible. Vendor lawsuits may ensue, and the incentive dollar targets may be recouped, but the cost incurred by the organization, its clinicians, and its patients is irrecoverable.

Consider applying the hardship exemption deadline extension to the incentive program participants.

You might be an #HITNerd If…

Posted on March 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

You might be an #HITNerd If…

you use the term Direct Message as a double entendre.

Find all our #HITNerd references on: EMR and EHR & EMR and HIPAA.

NEW: Check out the #HITNerd store to purchase an #HITNerd t-shirt of cell phone case.

Note: Much like Jeff Foxworthy is a redneck. I’m well aware that I’m an #HITNerd.

HIMSS: Insider Threats Still Biggest Health IT Security Worry

Posted on February 27, 2014 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.

You can do whatever you like to lock down your data, but  it if they do they do it did buy a block of members of the earth is the work doesn’t go for all it takes is one insider who knows how to unlock it to create a serious security breach.

Results from the 2013 HIMSS Security Survey suggest that despite progress towards hardening security and use of analytics, healthcare organizations must still do more to mitigate the risk of insider threat, such as the inappropriate access of data via employees.

The HIMSS survey, which was supported by The Medical Group Management Association and underwritten by Experian Data Breach Resolution, surveyed 283 information technology and security professionals employed in US hospitals and physician practices. What the researchers found was that the greatest “that motivator” was that of healthcare workers potentially snooping into EMRs to find friends, neighbors, spouses or coworkers.

Given that healthcare IT leaders are particularly concerned about inappropriate use of health data by insiders, you won’t be surprised to hear that there’s been an increase use of several technologies related to access to patient data, including user access control and audit logs in each access to patient records.

But you may be surprised to learn that of the 51 percent of respondents increase the security of the past year, 49 percent of these organizations are still spending just 3 percent  or less of their overall IT budget on securing patient data.

Other findings from the HIMSS survey include that healthcare organizations are using multiple means of controlling employee access to patient information;  67 percent use at least two mechanisms, such as user base and role-based controls, for controlling access the data.