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Rolling Over Mountains – An Interview with Niko Skievaski, CEO of Redox

Posted on October 16, 2018 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 speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their CEO, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.

Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.

The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.

Skievaski and I had a wide-ranging conversation. I hope you enjoy it.

You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.

You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.

I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?

I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.

All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.

You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.

There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?

We do things fundamentally differently than existing vendors in the integration space.

In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.

Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.

Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.

I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.

One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?

We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.

Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.

The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.

Is there an ideal type of HealthIT company that Redox likes to work with?

With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.

Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.

Can you give me an example of an advantage Redox enjoys because you are cloud-based?

By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.

Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.

For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.

This level of integration is just not possible without being in the cloud.

One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?

I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.

I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.

The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.

When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.

I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.

Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?

Neither. It’s a business model problem.

There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.

Interoperability is the right thing to do, but it’s a hard thing to do.

What do you wish you could do with an EHR company that you cannot do today?

The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.

I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.

For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?

What’s next for Redox?

We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.

“I Don’t Want to Share What I Ate on Social Media” – Dispelling Common Healthcare IT Myths

Posted on October 15, 2018 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 wanted to start a new series of posts I’m calling the Dispelling Common Healthcare IT Myths series. There are a lot of these to cover. In many ways, this series of blog posts is going to cover some of the most common questions I get asked by healthcare providers, CIOs, nurses, practice managers, HIM professionals, etc as I travel all over the country talking to hundreds of people.

The first common myth I want to dispel is that Social Media is for sharing everything you do. This is often illustrated when I talk with someone about social media and then they reply, “I Don’t Want to Share What I Ate on Social Media.” *shakes head*

Social media is SOOOOOO much more than just sharing everything you do throughout the day including what you ate. This is particularly true in the healthcare social media community. Just so I’m clear. Social media can be used to share every meal you ever eat and a few people do in fact share every meal. That said, the majority of people don’t use social media in this way.

It’s easy to see why this perception came about. Many of the initial social media platforms like Facebook said things like “What did you do today?” In fact, I just checked Facebook now and it still says “What’s on your mind, John?” Many initially interpreted it to mean that they needed to share everything they do (including every meal). This idea has shifted and now people are sharing everything imaginable on social media (and even some unimaginable things).

The point being, social media is not really about what you did or what you’ve done or what other people have done. It is more about learning something new, connecting with people, and sharing your unique perspectives and insights on a topic. And you can have some fun on there too.

These ideas are particularly true for social media platforms like Twitter and LinkedIn which have a lot of professionals involved. Sure, those same professionals are on Facebook as well and there are some fantastic Facebook groups where this can happen, but more people use Facebook for personal things and Twitter and LinkedIn for professional things.

Here is some of the value people find from taking part in healthcare social media:

Learning – If you’re following the right people, your Twitter feed can be an incredible source of the latest news, research, and learnings for your industry. The key here is making sure you follow the right people. To see this value, you probably need to follow about 25 extremely active Twitter accounts or 50-100 less active Twitter accounts. Once you do this, your feed will be full of amazing content that stretches your mind and gets you access to information that will help you in your job.

Connecting – One of the powers of Twitter is that you can connect and message with almost anyone on the platform. If you’ve never tried it, you’ll be surprised how accessible and interactive people will be on Twitter. Want a conversation with a CIO on Twitter? That’s easy. Want to interact with someone at CMS? Not a problem. Those are specific use cases, but some of the best connections happen serendipitously. To see what I mean, take part in a Twitter chat. We’re partial to the #HITsm chat we host each week, but there are hundreds of others you can choose from to find your proverbial “tribe” on Twitter. Find your tribe and start engaging with the people tweeting with that hashtag. This is particularly true at many healthcare IT conferences which have a well used Twitter hashtag. You’ll be surprised how quickly you’ll connect with amazing people that can help you and your career. Plus, you’ll benefit from the joy of helping other people as well.

Sharing – While you don’t need to share everything about your life, social media can be a great way for you to share your knowledge and insights with peers. We all have experiences and insights that others will find useful. If you’re not sure what to share, that’s fine. However, as you see other people sharing, engage them in a conversation and you’ll be surprised how you likely have many experiences and insights you can share with others. It’s an amazing feeling when you share something that makes another person’s life better. Don’t think it’s possible? Well, then you probably haven’t shared much on social media. I’ve experienced it hundreds of times and it never gets old.

I could go on and on about this topic, but these are 3 high-level benefits of social media that everyone can enjoy. If you’re involved in social media, please hop in the comments and share other benefits you’ve seen from social media. Of course, if you’re new to Twitter, you can start by following @techguy and @healthcarescene on Twitter and a few hundred others here.

Of course, if you do love food, you can find that on social media like Twitter as well. There’s nothing wrong with mixing work and play if you’re thoughtful about it. In fact, there’s something amazing about reading some healthcare IT tweets, some food tweets, some inspirational tweets, some sports tweets, and then some health policy tweets. That’s the beauty of Twitter. You can follow and customize your feed to the things that interest you.

Long Story Short: Social Media is for so much more than what I ate.

Physician Burnout Humor – Fun Friday

Posted on October 12, 2018 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.

It’s been a busy week for us here at Healthcare Scene. We were on the road in Seattle at the SHSMD conference which Colin covered really well over on Hospital EMR and EHR and on HITMC.com. Next week we’re off to Boston for the MEDITECH Physician and CIO Forum and the Connected Health Conference, but you already new that if you track our list of healthcare IT conferences. Lots of exciting things ahead which we’ll be sure to share here and on social media.

That said, it’s time for us to prepare for the weekend with our latest edition of Fun Friday. This week’s entry comes from @DocAroundThClok.

[Hospital boardroom]

CEO: I hear the medical staff & residents are burnt out and in significant debt from grad school. Is there anything we can do to help?

CFO: How about a monthly email asking them to donate to the hospital?

CEO: Gee, I don-

CFO: Weekly email?

CEO: Perfect

Burn out is a real thing and while healthcare administrators aren’t the root of all the burnout, they can certainly contribute to more or less burnout. Hopefully a little laughter on a Friday will contribute to less burnout.

When Disasters Hit – A Business Continuity Amazon Order List

Posted on October 11, 2018 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.

My good friend, Mike Semel from Semel Consulting, has put together an amazing business continuity resource for healthcare organizations. Of course, a lot of this applies personally as well as professionally. You should download the full Semel Consulting Disaster Checklist to see how prepared you and your business are for disaster. This resource seemed appropriate as we watch Florida get hit with more tropical storms and hurricanes, wildfires happening in California and disaster after disaster happening around the world with no signs that they’ll be stopping.

Along with the checklist linked above, Mike also included a list of emergency items you can easily order on Amazon (see the list below with links) to make sure you and your healthcare organization are prepared in case of disaster. This is important since the time to prepare for a disaster is now. Once the disaster happens, stores sell out and you can’t get the things you’ll need to ride out the disaster. As an illustration of this, Mike shared his experience during SuperStorm Sandy:

The generator at my NY home burns 7 gallons per day. Before SuperStorm Sandy I bought the last two 5-gallon cans from my local Lowes, to add to the 5 I already had, so I could store 5 days of fuel. I was in line with about 50 people buying generators. I asked them how many gas cans they had at home and how much fuel they could store. Everyone said they had one can – the biggest was 5 gallons – not even enough to fill the generator once! They all wanted to pay me double or triple what the cans I was buying were worth. I didn’t sell.

Note: These are all Prime-Eligible for quick delivery. Click on the link to order.

Now for the list of emergency items on Amazon that Mike suggests you consider as part of your business continuity efforts.

Radio – weather channel, hand-crank, solar charger, flashlight

Batteries – AAA, AA, C-cell, D-Cell (for lanterns and radios), 9 volt, 2032 lithium

Lantern

Solar charger

External cell phone battery

115-hour candle – make sure you have matches

Water Jug

LifeStraw – for when the water supply isn’t safe to drink

Water Purification Tablets – for when the water supply isn’t safe to drink

Emergency Sleeping Bag

Emergency 2-person 3-day kit

Emergency Food – 18 400-calorie bars – during a disaster you need strength – eat calories!

Emergency Food – 12 meals – 3 days

Emergency Food – 30 days – good for businesses; preparation for sheltering-in-place

Toilet Paper – you won’t laugh when you are the only one in the shelter who thought ahead!

Gas Cans – Generators use 7 gallons per day if run continuously. Most people have less than 5 gallons for their mower.

Along with the stuff you should buy above, be sure to check out the full Disaster Checklist that covers a number of other things you should do to prepare for a disaster.

What have you done in your practice to prepare for emergencies? Are there other things you’d suggest that aren’t on this list? Let us know in the comments or on social media with @healthcarescene.

How to Build an Effective Rural Virtual Care and Telehealth Strategy

Posted on October 10, 2018 I Written By

The following is a guest blog post by Lee Horner, CEO of Synzi.

Rural healthcare organizations are increasingly interested in implementing virtual care and telehealth solutions in order to better meet the needs of their facilities, staff, and patient population. In danger of closing their doors, rural hospitals are struggling to survive and thrive in a healthcare environment with razor-thin margins.

iVantage’s 2017 Rural Relevance Study reports that 41 percent of rural hospitals operate at a negative margin. Poor financial performance is impacting these hospitals’ ability to keep their doors open and serve rural communities. In fact, the National Rural Health Association (NRHA) reported that the number of rural hospital closures has risen to 87 in the last 8 years.

A rural hospital closure has significant impact to its community. These facilities provide fundamental healthcare services to nearly 57 million people across the country and are often an integral part of the local economy, providing jobs and a tax base for the community. John Henderson, CEO of the Texas Organization of Rural and Community Hospitals (TORCH) stated that hospitals are a critical element of a town’s survival: “Hospitals, schools, churches. It’s the three-legged stool. If one of those falls down, you don’t have a town.”

Virtual care technology can be a viable delivery option for healthcare facilities and residents in rural communities. To best build an effective virtual care strategy, rural healthcare organizations should short-list solutions which solve for limited bandwidth in rural areas, patient preference for mobile devices and communications, an organization’s current infrastructure and workflow, and security concerns.

Addressing Bandwidth Issues: Rural healthcare organizations may initially think that limited Wi-Fi and broadband availability will restrict telehealth adoption by a facility, a medical practice and/or the patients themselves. However, rural healthcare organizations can identify and implement solutions which work across any level of connectivity (whether cellular or Wi-Fi) to ensure that the providers and the patients can use the solution without issues. Various entities are actively pushing for continued investment in our nation’s broadband infrastructure and rural communities are a priority for future build-out.

Reflecting Patient Preferences: Patients are already using many devices – including smartphones, tablets, and/or computers – which also provide them with more convenient access to healthcare without requiring significant travel time and costs. Moving forward, rural healthcare organizations should prioritize solutions which are device-agnostic and should also ensure their patient communications work across any type of modality. Providers and patients already own many of these devices; a flexible virtual care platform will help organizations and individuals reap more benefits out of the investments they have already made in technology.

Optimizing Current Workflows: Healthcare organizations have ongoing clinical workflows, and may be wary of technology’s role in automating these processes. However, rural healthcare organizations’ existing workflows can be optimized by using a virtual care platform which ensures that the virtual care protocols are consistent with in-person protocols in terms of engaging at-home patients and/or reaching offsite specialists for a needed consult. The ideal solution should be intuitive and easy to use; providers will then be able to quickly incorporate virtual care into their practices.

Addressing Security Concerns: When exploring new technology, most healthcare organizations will initially question if a net-new solution meets safety and privacy standards. Rural healthcare organizations should prioritize solutions which are HIPAA-compliant and HITRUST-certified to ensure security, privacy and compliance. Although rural health providers will immediately understand the need to adopt a virtual care platform, IT departments and champions will also need to realize that the adoption of this new technology will benefit providers, patients, and ultimately, the sustainability of the healthcare organization. Virtual care technology is essential to rural healthcare as it helps close the time and distance gap in terms of providing patients with the care they need, when they need it – regardless of where the patients or the providers are located.

The rural population has noted gaps in both access and quality. An estimated one in five Americans live and work in rural areas across the nation, yet, there are 2,157 Health Professional Shortage Areas in rural areas compared to 910 in urban areas. Moreover, the Rural Health Information Hub reports that 19.5 percent of rural adults describe their health status as fair/poor vs. 15.6 percent of their urban counterparts. Virtual care technology can help address the gap in care by providing access to additional physicians and needed specialists at the click of a button. By leveraging external and/or associated hospitals and physician groups, rural hospitals strengthen their care within the vast populations and geographies they support.

The Importance of Nurses in Healthcare – #HITsm Chat Topic

Posted on October 9, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 10/12 at Noon ET (9 AM PT). This week’s chat will be hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network (@HMNwriters) on the topic of “The Importance of Nurses in Healthcare”.

It’s time for #NursingNow. Nurses need to have a solid place at the table – from the C-Suite to Management, Entrepreneurs to Digital Health Innovators.  In collaboration with the World Health Organization and the International Council of Nurses, Nursing Now aims to raise the status and profile of nursing globally.  Nursing Now works to empower nurses to take their place at the heart of tackling 21st Century health challenges.

In this #HITMC chat, Carol Bush (@TheSocialNurse) and Janet Kennedy (@GetSocialHealth) will lead a discussion on Nurse Leadership and how every part of healthcare needs nurses to be present and actively involved.

Resources:

Topics for this week’s #HITsm Chat:
T1: Nurses have always been the backbone of healthcare. Do you think they have a large enough role in healthcare leadership? Why or why not? #HITsm

T2: Should the push to get more nurses in leadership come from nurses or other members of the healthcare team? Why do you think so? #HITsm

T3: Traditional concepts of a nurse’s role have changed over the past decade. What new career paths have you seen nurses take? #HITsm

T4: In a health system or practice setting, in what ways have nurses expanded their roles? #HITsm

T5: Nurses have been embracing entrepreneurship, both inside and outside of healthcare. What characteristics of nursing lend themselves to entrepreneurship? #HITsm

Bonus: Share your favorite nurse story. #HITsm

Upcoming #HITsm Chat Schedule
10/19 – Government Regulations for Healthcare – Where Are We At and Where Are We Headed?
Hosted by John Lynn (@techguy)

10/26 – TBD
Hosted by @bigdatadavid13

11/2 – TBD
Hosted by TBD

11/9 – TBD
Hosted by @technursejon

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

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

Is FHIR Adoption At A Turning Point, Or Is This Just More Hype?

Posted on October 8, 2018 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.

Over the last few years, healthcare industry players have continued to experiment with the use of HL7 FHIR to solve key interoperability problems.

Perhaps the most recent efforts to do so is the Da Vinci Project, which brings together a group of payers, health IT vendors, and providers dedicated to fostering value-based care with FHIR. The group has begun work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery.

This wasn’t big news, as it doesn’t seem to be doing anything that new. In fact, few if any of these projects — of which there have been many — have come close to establishing FHIR firmly established as a standard, much less fostering major change in the healthcare industry.

Now, a new analysis by the ONC suggests that we may finally be on the verge of a FHIR breakthrough.

According to ONC’s research, which looked at how health IT developers used FHIR to meet 2015 Edition certification requirements, roughly 32% of the health IT developers certified are using FHIR Release 2, and nearly 51% of health IT developers seem to be using a version of FHIR combined with OAuth 2.0.

While this may not sound very impressive (and at first glance, it didn’t to me), the certified products issued by the top 10 certified health IT developers serve about 82% of hospitals and 64% of clinicians.

Not only that, big tech companies staking out an expanded position in healthcare are leveraging FHIR 2, the ONC notes. For example, Apple is using a FHIR-based client app as part of its healthcare deployment.  Amazon, Alphabet, and Microsoft are working to establish themselves in the healthcare industry as well, and it seems likely that FHIR-based interoperability will come to play a part in their efforts.

In addition, CMS has shown faith in FHIR as well, investing in FHIR through its Blue Button 2.0,  a standards-based API allowing Medicare beneficiaries to connect their claims data to applications, services, and research programs.

That being said, after citing this progress, the agency concedes that FHIR still has a way to go, from standards development implementation, before it becomes the lingua franca of the industry. In other words, ONC’s definition of “turning point” may be a little different than yours or mine. Have I missed something here?

Look, I don’t like being “that guy,” but how encouraging is this really? By my standards at least, FHIR uptake is relatively modest for such a hot idea. For example, compare FHIR adoption of AI technology or blockchain. In some ways, interoperability may be a harder “get” than blockchain or AI in some ways, but one would think it would be further along if it were completely practical. Maybe I’m just a cynic.

Number Of Health Data Breaches Grew Steadily Over Last Several Years

Posted on October 5, 2018 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.

New research has found that while the number of patient records exposed per breach has varied widely, the number of health data breaches reported grew substantially between 2010 and 2017.

The study, which was conducted by researchers with Massachusetts General Hospital, was published in JAMA. Its aim was to look at the changes in data breach patterns as EHRs have come into wider use.

The authors analyzed 2,149 reported breaches over the previous seven years. The number of records breached for incident varied from 500 to almost 79 million patient records.

Researchers behind the study put breaches reported in three categories: those taking place at healthcare provider sites, within health plans, and at business associate locations.

One thing that stuck out from among the data points was that over that seven-year period, the number of breaches increased from 199 the first year to 344 in 2017. During that period, the only year that did not see an increase in incident volume was 2015.

Another notable if unsurprising conclusion drawn by the researchers was that while 70% of all breaches took place within provider organizations, incidents involving health plans accounted for 63% of all breached records.

Overall, the greatest number of patient records breached was due to compromised network servers or email messages. However, the top reasons for breaches have varied from year-to-year, the analysis found.

For example, the most common type of breach reported in 2010 was theft of physical records. The most commonly breached type of media that year was laptop computer data storage, followed by paper and film records.

Meanwhile, by 2017 data hacking or other information technology incidents accounted for the largest number of breaches, followed by unauthorized access to or disclosure of patient data. In addition, a large number of breaches could be attributed to compromised network servers or email messages.

The number of patient records exposed differed depending on what media was breached. For example, while the total of 510 breaches of paper and film records impact about 3.4 million patient records, 410 breaches of network servers affected nearly 140 million records.

Top 5 Ways Healthcare Applications Slow Down and What To Do About It

Posted on October 4, 2018 I Written By

The following is a guest blog post by Jeff Garbus and  Alvin Chang from Soaring Eagle Consulting.

We spend a lot of our lives tuning applications that people complain are too slow. In no particular order, here are some of our findings.

Poor indexing #1 – Unused Indexes, Missing Indexes can cause problems

While I’ve said, “in no particular order,” I do have to say this one is usually first. When applications go through Q/A / Stress test, there is often a lot more horsepower than there is data. As a result, the memory and CPU combination mask the otherwise bad performance. Once the application hits production, larger volumes of data are not managed as effectively.

On the plus side, you can almost always add an index (or indexes) without causing other application side effects.

Warning: Do NOT automatically add indexes as recommended by a DBMS’ tuning advisor; they often miss opportunities, and also often significantly over index by recommending multiple similar indexes rather than one enveloping one.

Be wary of overindexing as too many indexes can also create overhead that will cause processes to slow.

Bad queries #2 – Too much data returned by a query

Sometimes you are simply bringing too much data back from the database to the front end. I saw a search recently that brought about a half million rows of data back to the end user. I asked, “What is the user going to do with that much data?” Answer: “They are going to look at the first few rows and refine the search.”

This unnecessarily stresses the disk CPU, memory, and the network.

Easiest solution: Bring back only the data the user is going to work with. Perhaps the first few hundred rows. Save time, disk resources, and network resources.

Bad queries #3 – Overuse of temporary tables

Many applications use temporary tables incorrectly or are wasteful with them. For example, they are used

  • When the programmer wants to avoid joins (which the server is very good at!);
  • Are filled with lots of data, then rows are deleted (why load them in the first place?);
  • Or too many columns are used (why select * when the columns aren’t being used?) – this increases network bandwidth, as well as making the table unnecessarily big
  • Joining temp tables is another way developers often misuse server resources. Without indexes, this is very costly

Avoid temporary tables

Bad Queries #4 – Attempting to do it all in one Giant Query. 

Sometimes the opposite can also be true. When attempting to write a query for a process, Developers can get stuck in the mindset that a single query can solve all possible conditions of a query.  This leads to large complicated queries that in addition to being difficult to decipher. Can also generate excessive numbers of worktables as it attempts to place large subsets of data into worktables.

Large Reports #5 Combine reporting and transactional activity

It is very common to allow reporting off highly transactional databases. The problem is that reporting creates shared locks on resources, and transactions can not modify the data while the locks are held. In addition, reports are often ad hoc, so that the load on the server is unpredictable.

Easy solution: replicate production data to a reporting server. If replication or other high availability is unavailable, use dump/load to keep day old data for reporting purposes (this is often sufficient).

Allow direct downloads of data

Some companies allow “super users” (also sometimes called “analysts”) to download production data, real time, to applications like Microsoft Access. In addition to being a likely security violation, this also creates blocking issues for the online users.

Solution: Data replication, as above.

If you’d like to learn more about how to improve slow applications, sign up for our webinar “Are your Servers, Apps, and EHR systems ready for a spike in website traffic?

About Jeff Garbus and Alvin Chang
Jeff Garbus founded Soaring Eagle Consulting 20 years ago, and Alvin has been his right hand for almost 30 years now. Together they have authored or coauthored 20 books and dozens of articles on Database Management. Soaring Eagle Consulting is an On Shore HIPPA and PCI compliant remote database management company that is available for projects and consulting work on Architecture, Performance and Tuning, Scalability, application development, migrations and 24×7 full operational support. Do your DBAs need a best friend? Jeff, Alvin, and the On Shore GURU level database team are here to help you!

Soaring Eagle is a proud sponsor of Healthcare Scene.

Medication Compliance & Drug Monitoring – #HITsm Chat Topic

Posted on October 3, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 10/5 at Noon ET (9 AM PT). This week’s chat will be hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth) on the topic of “Medication Compliance & Drug Monitoring”.

One of the most effective medical interventions to significantly improve the health of patients doesn’t require the latest technology or expensive medication but simply involves helping them take their existing medication as prescribed.

It’s not a light topic, but we believe that people can benefit from more awareness about their actual risks, as opposed to sensationalized risks that make good stories for the popular media.

  • Between 41% and 59% of mentally ill patients take their medication infrequently or not at all.
  • Examples of common non-adherence behaviors include:
    • 1 in 2 people missed a dose
    • 1 in 3 forgot if they took the med
    • 1 in 4 did not get a refill on time

Medication non-adherence is an enormous problem that is still largely unaddressed by the healthcare system, but it’s not totally out of our control. Join us for this week’s #HITsm chat as we talk about medication compliance and drug monitoring.

Topics for this week’s #HITsm Chat:
T1: In what ways has medication non-compliance affected you or anyone you know? Professional or Personal. Can be acute or episodic… #HITsm

T2: Why didn’t the patient adhere? Was there a social determinant? An issue with side effects, access or money? Possible Rx abuse? #HITsm

T3: We know communication with healthcare professionals is key in patient’s adherence and that Medication Reconciliation is gaining traction with MIPS, etc., but are providers going into this level of detail (see example) to ensure patients truly understand why they need to take the meds they are prescribed? Why or why not? #HITsm

T4: Beyond condition management, what impact do you think medication non-compliance has on society as a whole? #HITsm

T5: What ideas & thoughts do you have around strategies for improving medication compliance? Have you come across any impactful strategies or workflows? #HITsm

Bonus: What technology do you think could help with these challenges? #HITsm

Upcoming #HITsm Chat Schedule
10/12 – The Importance of Nurses in Healthcare
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

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

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