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One Doctor’s Perspectives on the Evolution of Health Care

Posted on October 15, 2015 I Written By

I had a great exchange with a physician reader recently about HIPAA and it led to this doctor sharing his story with me. He covered a lot of ground including reimbursement challenges and history, conversations about death, integrative medicine, time spent with patients, medical education and much more.

I love first hand, off the cuff perspectives on the history of medicine and how we got where we are today. No doubt there’s always more to the story, but I think perspectives from doctors like the one that follows helps those of us who work in healthcare IT. It wasn’t intended to published, but that’s what I love about it. I hope you enjoy it as well.

I am originally from Manhattan but have lived in the DC area since 78. Ironically, I have never eaten at the government trough. I have a friend I met during my residency in Baltimore. He retired one year short because the overtime was killing him. He has since worked for Uncle Sam in a number of capacities. When he does retire, he will receive three checks…ah, if I had it to do all over again…when in Rome….

In private practice though, having worked in a number of different situations, I have had patients from every 3 letter agency that you can think of. The public has no real idea how crazy our government bureaucracy really is. The amount of waste is inconceivable. I remember laughing the first time I heard the term “beltway bandit.” Now, banditry has stretched far beyond the beltway.

What concerns me most about American Medicine is the fact that it is a business and big business at that. The problem is that it was doomed from its inception, an unholy alliance or marriage between Flexner, who condemned naturally, holistic remedies, and Rockefeller owner of Standard Oil…think organic chemical manipulation….gave birth to a child named Big Pharma and the genesis of the allopathic (against symptom) approach which has brought us to where we are today.

Add to this the change which occurred when slick surgeons forever tilted reimbursement rates to favor procedures rather than cognition. It was simple, a statistical analysis of the then existing ills that had a surgical solution. Realize that since patients would not be paying out of pocket, drive up the reimbursement for the surgeon performing the procedure. The hospitals followed in turn eventually adding cost shifting to the mix. Eventually, the malignancy spread and cognitive physicians came on board only to see their real income drop because of inflation and the procedural slant to reimbursement.

Let me demonstrate this from my own experience. Let me first digress and explain how I evolved to where I am today. My original training was in Infernal Medicine. I did my residency from 86 to 89 at the beginning of the AIDS crisis. When I started there were no patients. The first was a 7-ish year old guy who died from kidney failure who happened to be demented.

this boy’s diagnosis was AIDS dementia. Hmmm…he was not homosexual. He did however have a transfusion as did what became a deluge of patients, often with strange presentations, like the woman who came in complaining that she had difficulty walking. She had a collection of golf sized balls of lymphoma in her brain which developed because HIV destroyed her immune system, again the result of a transfusion. By the time I left, the place had become a war zone. My job became shepherding people during the transition from life to death.

Eventually, this and other experiences led to my becoming a champion of death. We spend more money on medical care in the last six months of our lives than during the entire time prior to that! Of course medicine should strive to preserve life. However, there comes a time when we have to die and prolonging it I think is a crime.

During my residency I developed a routine when an elderly patient came in who was obviously at the end of his or her life. Yet, some family members would demand that “everything be done.” I would escort the entourage to the ICU where I could always point to at least one poor soul intubated with numerous tubes either going in or out of body orifices or cavities. I would tell the group that ultimately, this is what you will make me do to your loved one. As a result, I almost always was able to get permission for a DNR or do not resuscitate order.

Yes, we live longer. However, what is the point if our final years are compromised by chronic degenerative illnesses: diabetes, Alzheimer’s, and arthritis to name a few. Contributing factors are poisoned air, soil mineral depletion resulting in food that is less nutritious, and the countless FDA approved poisons that we ingest with every bite…yes, those names you cannot pronounce.

Sorry for the digression. After residency, I fell into a Medical Directorship of a substance abuse program. Seeing the mess of Addiction Medicine, the eclectic, empiricist that I am, led me in 1990 to the South Bronx where I spent a few weeks with Dr. Michael Smith of Haight Ashbury fame, learning auricular acupuncture to treat addiction.

This turned into a year long course in Acupuncture. Thus began a journey that took me from conventional western medicine modalities to biofeedback, audio-visual entertainment, cranio electrical stimulation, nutrition, hypnosis, herbal medicine, chiropractic, off label use of pharmaceuticals, a stint as Medical Services Director for the Life Extension Foundation, stuff now under the rubric of complimentary or integrative medicine.

​Now to that point regarding cognitive/procedural differences. I spent almost three years working in an undeserved area in rural TN. ​I had already broadened my skills by working in Urgent Care Centers. In addition to the diagnostic skills of an internist, I was now doing family medicine including pediatrics, gynecology, as well as many Urgent Care procedures. However, to better serve my patients I needed to do more. I added more cardiology service by doing my own stress tests and echocardiograms. (This required training.) An opportunity arose where I could learn to do upper and lower endoscopies. These procedures are generally done by GI docs. I could never get privileges to do these procedures in a major metropolitan area because there are so many specialists. However, in an undeserved area it is a different story. Of course initially, just as I would have done had I trained in GI, I initially did my cases with the assistance and guidance of a GI doc.

Here is the point regarding reimbursement. In my TN private practice I spent at least an hour with all my new older patients. (Eventually, my initial visits would become three hours.) Medicare would reimburse me around $90. With a 50 percent overhead, I was making $50 an hour. However, when you consider all the time that I spent on paperwork, phone calls to or about patients for which I was not reimbursed, it is even less, far less.

However, when I did a colonoscopy and removed a polyp, while I don’t remember exactly how much Medicare and other carriers reimbursed me because it has changed so much over time, but for around a half hour’s worth of work, I received on average between 3 and 5 hundred dollars. The point is that reimbursement has always favored procedural over cognitive medicine. The problem is that everything is backwards. The word doctor comes from the Latin, docere, to teach. That is exactly how I came to see a large part of my role as a physician. The idea is to prevent disease, essentially to put myself out of business which seems counter intuitive. During my time studying acupuncture I had heard, although I was never able to find references to support it, that Chinese physicians at one time were paid only when the patient was well.

When Stark II was passed, all my alternative colleagues who were doing certain things for which insurance would not reimburse, found that they had to drop out of Medicare and other insurance carriers. Combined with the fact that I was seeing very complicated patients and holistic approach, I found that I needed around 3 hours to do an initial history and exam. This was 1995 when I was a beta site for a DOS based EMR which was pretty sophisticated. Personally, I think any less time constitutes malpractice.

I also realized that the American Business model does not select for the right people to become physicians. The truth of the matter is that the best physicians I have known and with whom I share this; that we are all a little bit nuts and that we never cared about money. Our staff were always pushing us to hurry up and stop gabbing with our patients.

You simply cannot practice medicine in an 8 minute encounter. It just does not work. Look at an old Oxford or a Webster’s dictionary and you will find that there are only three professionals, the Clergy, Law, and Medicine. Why? Because they are “callings.” You truly, from the bottom of your heart and in the depths of your soul, care about people. It is impossible for you to see them as your pay check. My patients always had my home number and could call me at anytime. They never abused this. They were always welcome to bring me articles. I had absolutely no problem telling them that I did not know something or that they told me something that I did not know. That is why it is the practice of medicine.

So, the truth is, you have to be a little bit crazy but that is the passion, the essence of a calling, or at least the way I believe it is supposed to be. The American Medical Business model is antithetical with respect to this concept and as such I believe dangerous to your health. So, in my world view, HIPPA is a costly infringement on my ability to care for my patients and as such, potentially harmful to their health.

Ashley Madison Data Breach – A Lesson for Health IT

Posted on July 28, 2015 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

The recent hack of the Ashley Madison, Cougar Life and Established Men infidelity/hookup websites has been front page news. Overnight the lives of 50 million site members (pun intended) were potentially stolen by a hacker group calling itself “The Impact Team”. The Washington Post and CNBC have great articles on the details of the hack.

As the story unfolded I became more and more fascinated, not because of the scandalous nature of the data, but because I believe this hack is a lesson for all of us that work in #HealthIT.

The value of the data that is held in EHRs and other health apps is somewhat debatable. There have been claims that a single health record is worth 10-200 times more than credit card data on the black market. The higher value is due to the potential access to prescription medications and/or the potential to use health data to commit Medicare fraud. A recent NPR post indicates that the value of a single patient’s record is approximately $470 but there is not a lot of strong evidence to support this valuation (see John Lynn’s post on this topic here).

While $470 may seem like a lot, I believe that for many patients, the reputational value of their health data is far higher. Suppose, for example you were a patient at a behavioral health clinic. You have kept your treatment secret. No one in your family or your employer know about it. Now suppose that your clinic’s EHR was breached and a hacker asked you for $470 to keep your data from being posted to the Internet. I think many would seriously consider forking over the cash.

To me this hypothetical healthcare situation is analogous to what happened with Ashley Madison. The membership data itself likely has little intrinsic value (even credit card data is only worth a few dollars). HOWEVER, the reputational value of this data is extremely high. The disruption and damage to the lives of Ashley Madison customers is enormous (though some say well deserved).

The fall-out for the company behind Ashley Madison (Avid Life Media – a Canadian company) will also be severe. They have completely lost the trust of their customers and I do not believe that any amount of market spin or heart-felt apology will be enough to save them from financial ruin.

I believe what Avid Life Media is going through is what most small-medium sized clinics and #HealthIT vendors would face if all their patient data was exposed. Patients would utterly lose faith and take their business elsewhere (though admittedly that might be a little harder if other clinic choices were not covered by your insurance). Even if the organization could afford the HHS Office for Civil Rights fines for the data breach, the impact of lost patients and lost trust would be more devastating.

With the number of health data breaches increasing, how long before healthcare has its own version of Ashley Madison? We need to do more to protect patient data, it can no longer be an after-thought. Data security and privacy need to be part of the design process of software and of healthcare organizations.

Life’s short. Secure your data!

Emerging Health Apps Pose Major Security Risk

Posted on May 18, 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.

As new technologies like fitness bands, telemedicine and smartphone apps have become more important to healthcare, the issue of how to protect the privacy of the data they generate has become more important, too.

After all, all of these devices use the public Internet to broadcast data, at least at some point in the transmission. Typically, telemedicine involves a direct connection via an unsecured Internet connection with a remote server (Although, they are offering doing some sort of encryption of the data that’s being sent on the unsecured connection).  If they’re being used clinically, monitoring technologies such as fitness bands use hop from the band across wireless spectrum to a smartphone, which also uses the public Internet to communicate data to clinicians. Plus, using the public internet is just the pathway that leads to a myriad of ways that hackers could get access to this health data.

My hunch is that this exposure of data to potential thieves hasn’t generated a lot of discussion because the technology isn’t mature. And what’s more, few doctors actually work with wearables data or offer telemedicine services as a routine part of their practice.

But it won’t be long before these emerging channels for tracking and caring for patients become a standard part of medical practice.  For example, the use of wearable fitness bands is exploding, and middleware like Apple’s HealthKit is increasingly making it possible to collect and mine the data that they produce. (And the fact that Apple is working with Epic on HealthKit has lured a hefty percentage of the nation’s leading hospitals to give it a try.)

Telemedicine is growing at a monster pace as well.  One study from last year by Deloitte concluded that the market for virtual consults in 2014 would hit 70 million, and that the market for overall telemedical visits could climb to 300 million over time.

Given that the data generated by these technologies is medical, private and presumably protected by HIPAA, where’s the hue and cry over protecting this form of patient data?

After all, though a patient’s HIV or mental health status won’t be revealed by a health band’s activity status, telemedicine consults certainly can betray those concerns. And while a telemedicine consult won’t provide data on a patient’s current cardiovascular health, wearables can, and that data that might be of interest to payers or even life insurers.

I admit that when the data being broadcast isn’t clear text summaries of a patient’s condition, possibly with their personal identity, credit card and health plan information, it doesn’t seem as likely that patients’ well-being can be compromised by medical data theft.

But all you have to do is look at human nature to see the flaw in this logic. I’d argue that if medical information can be intercepted and stolen, someone can find a way to make money at it. It’d be a good idea to prepare for this eventuality before a patient’s privacy is betrayed.

Government Surveillance and Privacy of Personal Data

Posted on April 6, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Dr. Deborah Peel from Patient Privacy Rights always keeps me updated on some of the latest news coverage around privacy and government surveillance. Obviously, it’s a big challenge in healthcare and she’s the leading advocate for patient privacy.

Today she sent me a link to this John Oliver interview with Snowden. The video is pretty NSFW with quite a bit of vulgarity in it (It’s John Oliver on HBO, so you’ve been warned). However, much like Stephen Colbert and John Stewart, they talk about some really important topics in a funny way. Plus, the part where he’s waiting to see if Snowden is going to actually show for the interview is hilarious.

The humor aside, about 10 minutes in John Oliver makes this incredibly insightful observation:

There are no easy answers here. We all naturally want perfect privacy and perfect safety, but those two things cannot coexist.

Either you have to lose one of them or you have to accept some reasonable restrictions on both of them.

This is the challenge of privacy and security. There are risks to having data available electronically and flowing between healthcare providers. However, there are benefits as well.

I’ve found the right approach is to keenly focused on the benefits you want to achieve in using technology in your organization. Then, after you’ve focused the technology on the benefits, work through all of the risks you face. Once you have that list of risks, you work to mitigate those risks as much as possible.

As my hacker friend said, “You’ll never be 100% secure. Someone can always get in if they’re motivated enough. However, you can make it hard enough for them to breach that they’ll go somewhere else.”

Wearables And Mobile Apps Pose New Data Security Risks

Posted on December 30, 2014 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.

In the early days of mobile health apps and wearable medical devices, providers weren’t sure they could cope with yet another data stream. But as the uptake of these apps and devices has grown over the last two years, at a rate surpassing virtually everyone’s expectations, providers and payers both have had to plan for a day when wearable and smartphone app data become part of the standard dataflow. The potentially billion-dollar question is whether they can figure out when, where and how they need to secure such data.

To do that, providers are going to have to face up to new security risks that they haven’t faced before, as well as doing a good job of educating patients on when such data is HIPAA-protected and when it isn’t. While I am most assuredly not an attorney, wiser legal heads than mine have reported that once wearable/app data is used by providers, it’s protected by HIPAA safeguards, but in other situations — such as when it’s gathered by employers or payers — it may not be protected.

For an example of the gray areas that bedevil mobile health data security, consider the case of upstart health insurance provider Oscar Health, which recently offered free Misfit Flash bands to its members. The company’s leaders have promised members that use the bands that if their collected activity numbers look good, they’ll offer roughly $240 off their annual premium. And they’ve promised that the data will be used for diagnostics or any other medical purpose. This promise may be worthless, however, if they are still legally free to resell this data to say, pharmaceutical companies.

Logical and physical security

Meanwhile, even if providers, payers and employers are very cautious about violating patients’ privacy, their careful policies will be worth little if they don’t take a look at managing the logical and physical security risks inherent in passing around so much data across multiple Wi-Fi, 4G and corporate networks.

While it’s not yet clear what the real vulnerabilities are in shipping such data from place to place, it’s clear that new security holes will pop up as smartphone and wearable health devices ramp up to sharing data on massive scale. In an industry which is still struggling with BYOD security, corralling data that facilities already work with on a daily basis, it’s going to pose an even bigger challenge to protect and appropriately segregate connected health data.

After all, every time you begin to rely on a new network model which involves new data handoff patterns — in this case from wired medical device or wearable data streaming to smartphones across Wi-Fi networks, smart phones forwarding data to providers via 4G LTE cellular protocols and providers processing the data via corporate networks, there has to be a host of security issues we haven’t found yet.

Cybersecurity problems could lead to mHealth setbacks

Worst of all, hospitals’ and medical practices’ cyber security protocols are quite weak (as researcher after researcher has pointed out of late). Particularly given how valuable medical identity data has become, healthcare organizations need to work harder to protect their cyber assets and see to it that they’ve at least caught the obvious holes.

But to date, if our experiences with medical device security are any indication, not only are hospitals and practices vulnerable to standard cyber hacks on network assets, they’re also finding it difficult to protect the core medical devices needed to diagnose and treat patients, such as MRI machines, infusion pumps and even, in theory, personal gear like pacemakers and insulin pumps.  It doesn’t inspire much confidence that the Conficker worm, which attacked medical devices across the world several years ago, is still alive and kicking, and in fact, accounted for 31% the year’s top security threats.

If malevolent outsiders mount attacks on the flow of connected health data, and succeed at stealing it, not only is it a brand-new headache for healthcare IT administrators, it could create a crisis of confidence among mHealth shareholders. In other words, while patients, providers, payers, employers and even pharmaceutical companies seem comfortable with the idea of tapping digital health data, major hacks into that data could slow the progress of such solutions considerably. Let’s hope those who focus on health IT security take the threat to wearables and smartphone health app data seriously going into 2015.

Email vs Text for Healthcare Communication

Posted on April 8, 2013 I Written By

John Lynn is the Founder of the 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 and 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 idea of improving communication in healthcare is always a hot one. For fear of HIPAA and other factors, healthcare seems to lag behind when adopting the latest communication technologies. The most simple examples are email and text message. Both are simple and widely adopted communication technologies and most in healthcare are afraid to use them.

At the core of why people are afraid is because native email is not HIPAA secure and native SMS is not HIPAA secure either. Although, there are a whole suite of communication products that are working to solve the healthcare communication security challenges while still keeping the simplicity of an email or text message. In fact, both of the other companies I’ve started or advise, Physia and docBeat, are focused on the problems of secure email and secure text. Plus, there are dozens of other companies working to improve healthcare communication and hundreds of EMR, PHR, and HIE applications that are integrating these forms of communication into their systems.

As we enter this brave new world of healthcare communication, it’s worth considering some of the intricacies of email vs text. The following tweet is a good place to start.

This is really interesting to note and I can confirm those are the general statistics for most email campaigns out there today. I’m not sure of the number of texts that are open, but it’s clear that the number of text messages that are opened is very high.

The reason this is the case is because of the expectation of what’s inside a text message vs an email. When you receive a text, you can be sure that it won’t take up more than a moment of your time. You can consume it quickly and move on with your life. The same is usually not the case with email (especially email lists). Most of the emails that are sent are lengthy because they can be. We try and pack every option imaginable into an email and so people have an expectation that if they start with the email they’re going to need time. I know this is the case because my email subscribers often thank me for my emails because they know they can get something of value quickly.

I think it was Dan Munro that pointed out an exception to the email open rate. His idea was that if the email contains an action item, then open rates are much higher. This was a good insight. There’s little doubt that if an email contains something that you have to do, then more people will open it and do the action. I don’t get a bill in my email and then don’t open it. I have to open it so I can pay the bill. I’m sure this principle can be applied in a number of ways to healthcare.

As we finally bring these common communication technologies to healthcare we need to be thoughtful about which ones we use and when we use them.

Patients Want to Share Their Medical Data

Posted on March 29, 2013 I Written By

John Lynn is the Founder of the 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 and 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 the recent Dell Healthcare Think Tank which I took part in, I had an idea that I think is incredibly powerful and not talked about nearly enough. In fact, I think its reasonable to say that if we want to get healthcare costs down, then we have to learn how to do this well.

The idea revolves around how we talk about privacy of health information with patients. Far too often, patients just hear news reports that talk about all of the reasons they should fear their health information getting out in the open. Instead, they almost never hear stories about how having their health information shared with the right people will actually improve their health.

The simple fact is that if you lead with all the bad things that could possibly happen with health information in the wrong hands, then of course no patient is going to want their patient information shared. However, if they know how sharing their health information with the right people will improve their care, then patients are more than willing to share away.

Basically, what I’m saying is that sharing healthcare data has been marketed wrong. The privacy advocates are well organized and have many people fearful for what will happen with their health information. I don’t have any problem with privacy advocates, because they help us to pause to take a reasonable look at the importance of privacy. However, the need for proper privacy controls doesn’t mean that we don’t share healthcare information at all.

The beauty of all of this is that the majority of people think this is how it happens in healthcare today. They don’t realize that quite often their healthcare information isn’t traveling with them to specialists and hospitals. In fact, when patients discover that it doesn’t they’re usually quite surprised and don’t understand why it doesn’t.

I hope we can work on the data sharing message. We can share your data with the people who need it so we can improve your care. If patients hear this message, healthcare data sharing will not be feared but embraced.

Does Healthcare IT Need Stability?

Posted on February 12, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last night during one of my favorite TV shows, Charlie Rose, he interviewed a guy about the economy. One of the discussion points that came out of this interview and that I’ve heard a lot in all the discussions about the economy is having some stability to the economy. Many argue that one of the biggest things holding our economy back is all the unknowns. When there are unknowns companies get paralyzed and hold back doing things they’d do if the economy felt stable.

I wonder if we’re experiencing the same thing in healthcare IT? Could we use some stability in healthcare IT?

Think about all the various unknowns that exist in healthcare IT. Let’s start with ICD-10. The pending ICD-10 implementation date is looming, but that date has been pushed back so many times it’s still unknown if it’s really going to happen this time. That’s the opposite of stability.

I’m sure that many also wonder if the same will be the case with EHR penalties. Will the EHR penalties go into effect? What exceptions will be made for the EHR penalties? I could easily see the EHR penalties being delayed, but then again what if they’re not?

Is it hard for anyone else to keep up with what’s happening with meaningful use? I do this every day and so I have a pretty good idea, but even I’m getting confused as it gets more complex. Imagine being a doctor who rarely looks at meaningful use. So, we’re in meaningful use stage 1, but meaningful use stage 2 is coming, unless you didn’t start meaningful use stage 1 and then meaningful use stage 2 won’t come until later. Oh, and they’re making changes to meaningful use stage 2. That’s right and they’re also coming out with meaningful use stage 3. However, don’t worry too much about meaningful use stage 3 because a lot of people are calling for it to be slowed down. So, does that mean that meaningful use will be delayed? Now how does the meaningful use stages match with the EHR certifications? Which version of my EHR software does which stage of meaningful use?

I think you get the picture.

Of course, I haven’t even mentioned things like ACO’s, HIE’s, 5010, HIPAA, RAC Audits, Medicare/Medicaid cuts, or healthcare reform (ACA) to name a few others.

It’s a messy healthcare IT environment right now. We could definitely use some stability in healthcare.

Telemedicine Panel at CES Hosted by HealthSpot

Posted on January 9, 2013 I Written By

John Lynn is the Founder of the 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 and 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 had the chance to attend a Telemedicine panel today at CES that was put together by HealthSpot (see my previous post about HealthSpot at CES). They put together a good panel that included:
Peter Tippett, MD, PHD – Vice President, Connected Healthcare Solutions, Verizon
John F. Jesser – Vice President, Health Care Management, WellPoint
William Wulf, M.D. — Central Ohio Primary Care
Leslie Kelly Hall — Healthwise

The panel was an interesting discussion, but I think the underlying discussion really centered around how screwed up many parts of healthcare are right now. This showed itself in two different ways. One was that telemedicine could possibly fix some of those screwed up parts of healthcare. Second, telemedicine is actually hard to execute because of some of the screwed up parts of healthcare. It’s kind of odd to look at it that way.

I tweeted a number of the comments that struck me and so I thought I’d share them here for those who weren’t following along on Twitter.

This was a fitting comment at a “consumer” electronics show.

I think there are still some wackos;-), but I think the message they send is clear.

This would be a monumental achievement if we can embrace HIPAA and make the technology happen. I think the key message is: HIPAA should not be used as an excuse.

Such a no brainer question with an easy answer. Why is it so hard to do?

Will telemedicine become the “standard of care” so that this becomes a big issue? I hope we don’t reach the point that this is the reason we implement telemedicine, but it might take something like it to get people off the proverbial couch.

Hospitals Use EMR Data To Target Marketing Campaigns

Posted on November 14, 2012 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.

When we talk about the benefits we can derive from compiling and analyzing EMR data, most of us focus on care and efficiency improvements, and to some extent population health.  But what if hospitals used EMRs to find appropriate targets for marketing efforts?  Is that kosher?

I don’t know, but it’s clear some hospitals have decided that it is. For example, a recent article in the Columbus Dispatch tells the tale of two health systems which have been data-mining their EMRs to target mailings on health issues to patients in the community.

According to the piece, regional health system OhioHealth has been using this approach for six years, and Mount Carmel Health System has for two years. Both are non-profit systems with large presences in the areas they serve.

It seems that these health systems are largely using these mailings to address patients’ specific health concerns. For example, OhioHealth has sent messages to diabetic patients and others with heart disease. Mount Carmel, for its part, has sent out mammograms and colorectal screenings, as well as to invite patients to seminars on joint replacement and health fairs.

But OhioHealth goes a step further and targets households with higher incomes.

Of course, both parties swear on a stack that none of this violates HIPAA, because marketers never see an individual’s health information.  And maybe they’re right.

As for me, I could go either way as to whether this is an ethical use of medical data. While it may indeed be legal, it’s discomfiting to know that hospitals might be using my clinical data for non-clinical purposes.

That being said, if health education and marketing efforts are done in a tasteful way which doesn’t invade my privacy — or expose my medical situation to the mailman — I can see the benefits.  Sometimes the right reminder or piece of  education can change a patient’s behavior in a timely manner.

And the truth is, if hospitals are going to spend millions and millions on EMRs, maybe this is a way to squeeze those extra bucks out of the system that will help pay for the investment.

I don’t know. I guess it’s something of a tossup. Readers, how do you feel about this issue? Is your hospital mining EMRs for marketing purposes?