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A Justin Bieber Opioid Ballad from ZDoggMD

Posted on September 28, 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 a casual work Friday here at Healthcare Scene, so we like to take off from our regularly scheduled programming for something a little more casual. The latest parody video from ZDoggMD is about the Opioid Crisis and might be his best work yet. The messages he shares in the video are really spot on. I can imagine many of the legitimate chronic pain suffers might not like some of the ways it characterizes those who use opioids, but I thought ZDoggMD covers that in his comments about the impact the opioid crisis has had on chronic pain patients.

Check out the video below:

Have a great weekend and let’s all do what we can to help those around us impacted by opioids.

Healthcare AI Could Generate $150B In Savings By 2025

Posted on September 27, 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.

Is the buzz around healthcare AI solutions largely hype, or can they deliver measurable benefits? Lest you think it’s too soon to tell, check out the following.

According to a new report from market analyst firm Frost & Sullivan, AI and cognitive computing will generate $150 billion in savings for the healthcare business by 2025.  Frost researchers expect the total AI market to grow to $6.16 billion between 2018 and 2022.

The analyst firm estimates that at present, only 15% to 20% of payers, providers and pharmaceutical companies have been using AI actively to change healthcare delivery. However, its researchers seem to think that this will change rapidly over the next few years.

One of the most interesting applications for healthcare AI that Frost cites is the use of AI in precision medicine, an area which clearly has a tremendous upside potential for both patients and institutions.

In this scenario, the AI integrates a patient’s genomic, clinical, financial and behavioral data, then cross-references the data with the latest academic research evidence and regulatory guidelines. Ultimately, the AI would create personalized treatment pathways for high-risk, high-cost patient populations, according to Koustav Chatterjee, an industry analyst focused on transformational health.

In addition, researchers could use AI to expedite the process of clinical trial eligibility assessment and generate prophylaxis plans that suggest evidence-based drugs, Chatterjee suggests.

The report also lists several other AI-enabled solutions that might be worth implementing, including automated disease prediction, intuitive claims management and real-time supply chain management.

Frost predicts that the following will be particularly hot AI markets:

  • Using AI in imaging to drive differential diagnosis
  • Combining patient-generated data with academic research to generate personalized treatment possibilities
  • Performing clinical documentation improvement to reduce clinician and coder stress and reduce claims denials
  • Using AI-powered revenue cycle management platforms that auto-adjust claims content based on payer’s coding and reimbursement criteria

Now, it’s worth noting that it may be a while before any of these potential applications become practical.

As we’ve noted elsewhere, getting rolling with an AI solution is likely to be tougher than it sounds for a number of reasons.

For example, integrating AI-based functions with providers’ clinical processes could be tricky, and what’s more, clinicians certainly won’t be happy if such integration disrupts the EHR workflow already in existence.

Another problem is that you can’t deploy an AI-based solution without ”training” it on a cache of existing data. While this shouldn’t be an issue, in theory, the reality is that much of the data providers generate is still difficult to filter and mine.

Not only that, while AI might generate interesting and effective solutions to clinical problems, it may not be clear how it arrived at the solution. Physicians are unlikely to trust clinical ideas that come from a black box, e.g. an opaque system that doesn’t explain itself.

Don’t get me wrong, I’m a huge fan of healthcare AI and excited by its power. One can argue over which solutions are the most practical, and whether AI is the best possible tool to solve a given problem, but most health IT pros seem to believe that there’s a lot of potential here.

However, it’s still far from clear how healthcare AI applications will evolve. Let’s see where they turn up next and how that works out.

2018 Thrival Festival. Are We Asking the Right Questions?

Posted on September 26, 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.

Presentations in a botanical garden. Workshops in an actual work shop. Disco in a museum. The 2018 Thrival Festival eschewed tradition and challenged attendees to ponder: Are we asking the right questions when it comes to humanity + technology + art?

The annual Thrival Festival held in Pittsburgh PA is truly unique. It combines art, technology, philosophy, music, and yes, even healthcare, into an event that is part science fair and part theatre. Instead of holding the event in a traditional auditorium or hotel, the organizers chose the beautiful Phipps Conservatory and Botanical Gardens as the setting for this year’s event.

Rising like a glass armadillo out of lush grass splashed here and there with colorful flowers, the Conservatory welcomed attendees with a warm scent of green leaves and rich earth. It was immediately apparent we were in for something different as we passed through the mammoth glass entryway and wound our way through the maze of monarchs and waterfalls to reach the main session room.

With sunshine and mother nature as a backdrop, Thrival kicked off with a keynote from John Battelle @johnbattelle, CEO and Editor-in-Chief of WIRED. Battelle wasted no time in setting the tone for the day. Early in his presentation he put up the following picture from National Geographic with the caption: What makes us human?

© Martin Schoeller/National Geographic

The image was from National Geographic’s October 125th anniversary issue (2013) where they photographed the new faces of America – a reflection of the blurring of traditional racial and ethnic lines. Battelle used the slide to highlight that society will soon be challenged to define humanity more broadly than before – as we manipulate our genes, embed technology into our bodies and program human-like qualities into robots.

Later in the morning, the issue of do-it-yourself implantable devices and pseudo-scientific injectable cocktails was discussed by a panel of experts. Dr. Rasu Shrestha @RasuShrestha was asked: Is biohacking the future of medicine? With a smile and wink, he deftly answered the question by putting forward the notion that the original healers and physicians were themselves the biohackers of their day. Instead of nanobots they used herbs and crude instruments to try and cure our pre-industrial ancestors.

*Yes, Rasu did use “OG” in his answer, to the delight of the audience.

The panel also featured Rich Lee @lovetron9000 the controversial sex technologist who not only installed a vibrating implant in himself but also recently self-injected a gene therapy that he hopes will cure him of his color blindness. Vilified by authorities, Lee was decidedly normal both on and off the stage answering questions about his motivations.

Over lunch I had the opportunity to chat with Laura Montoya, Founder of Accel:AI and Director of Women Who Code. Montoya teaches development teams to consider the ethical issues relating to AI algorithms. She posed the most interesting question of the day: Would you get into a self-driving car if you knew the algorithm governing it would choose to save the life of a pedestrian over you the passenger?

“Think of it this way,” explained Montoya. “When you sign up for a ride-sharing service, you have to agree to the company’s terms of use. Buried in that agreement is a waiver of liability. Essentially you as an individual are opting into the fact that you are okay with being driven around by a computer rather than an actual driver. The liability of the company for you is therefore limited. Now think about the pedestrian. They have not opted into the company’s self-driving car. They have not agreed that a self-driving car should be in their neighborhood. Therefore, the pedestrian represents a potentially high financial liability – being an innocent bystander. So if the car is faced with the choice of crashing into the pedestrian vs crashing into a tree, would the difference in the degree of liability influence it’s decision. And if it did, would you have knowingly gotten into the vehicle in the first place.”

*Note to self, uncheck the self-driving option from my Uber app.

My Thrival afternoon began with a short viewing of GAPPED – a documentary from Molten Media Group. The excerpt contained powerful and moving interviews of Pittsburgh residents who were in danger of being left behind by the innovation boom that the city is currently enjoying. After the screening, the producers of the film shared that they were seeking to answer a single question: Will Pittsburgh and its people have the chance to rise together or will those unwilling to adapt be left behind?

To me the film asks a much broader question: What happens when innovation wealth is unequally distributed within an ecosystem? And I don’t mean the spoils of innovation like money, equity stakes and fancy offices. What happens when public and private programs inadvertently leave out a portion of the local population? Is it fair that 95% of the innovation seed funding goes to middle-class college graduates while innovators living under the poverty line struggle to keep afloat? I can’t wait to see the entire film when it is released later this year.

I decided to end my Thrival day by attending the Moonshot Workshop led by the XPRIZE Foundation – the people behind the space competition that spawned Virgin Galactic and SpaceX. The workshop started with a short presentation by Amir Banifatemi, AI Lead at XPRIZE. Banifatemi explained the process they go through to curate, refine and define the incentive competitions that “entice the world to take action”. It turns out that it takes the team at XPRIZE over nine months to clearly define one of their challenges.

“If we define the challenge too broadly, teams become overwhelmed with where to start.” Said Banifatemi. “Problems need to be specific enough to spark the imagination but not so blue-sky that people get lost in the possibilities. If we make our challenges too difficult, we may discourage people from entering. It turns out that coming up with the right question, the right challenge is almost as hard as solving it. But if you get the question right, magic happens.

Banifatemi’s statement was the perfect bow on my day at Thrival Festival. Before innovation can happen, a problem or challenge must first exist. Once we understand that problem, our collective imaginations can be unleashed. Better definition of the problem leads to better innovation. The question of: “How can we look inside the human body?” begat X-ray machines. The more refined question of: “How can we look inside the human body without causing harm to the person and with sufficient detail to see tissue?” begat MRI machines (okay maybe a bit of a stretch, but you get the idea).

As the high-energy techno anthems from Veserium washed over me at the Thrival evening event, I found myself thinking about all the questions we are asking in healthcare. Perhaps we need to take a moment and ask ourselves if we are really asking the right ones.

How Does Interoperability Affect Technology Adoption in Healthcare? – #HITsm Chat Topic

Posted on September 25, 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, 9/28 at Noon ET (9 AM PT). This week’s chat will be hosted by Niko Skievaski @niko_ski from @redox.

In her opening remarks at the 2nd ONC Interoperability Forum, Centers for Medicaid and Medicare (CMS) Administrator Seema Verma set the goal of eliminating the use of fax machines in healthcare by 2020. It’s true – fax is still the most common form of communication among providers for transmission of medical records, test results, instructions, and treatment regimens all thanks to its insusceptibility to hacking. While the rest of the world is embracing digitalization and the benefits it has brought us, healthcare seemed a bit reluctant about moving on. Fax or other paper-based records are largely inconvenient and created barriers to information exchange.

In the era of artificial intelligence and machine learning, we’re generating data in an unbelievable speed – more information to process, exchange and analyze, posing bigger challenges for snail-paced interoperability progress. Tech giants see this lack of interoperability as a perfect opportunity to enter healthcare and disrupt the “broken” industry. Apple Health is promoting open API for iOS users to own their health data; Amazon’s working with multiple healthcare organizations to build its own system; and the recent interoperability pledge by the six big companies is set to transform healthcare data infrastructure.

Coming from an outsider perspective, these companies are familiar with the user authorization approach. When you sign in to an app with your Google account, you’ll be asked to grant the app access to your information through an authentication protocol called OAuth 2.0. Ideally, this is the vision for healthcare data use in the future.

But the existing healthcare data infrastructure, in the meantime, is drastically different from the one these tech giants are familiar with. Perhaps a more realistic, pragmatic approach is to work with the established stakeholders in healthcare, particularly the big EHR vendors, instead of bringing in a whole new system to solve interoperability.

Join us for this week’s #HITsm chat to discuss interoperability’s impact on technology adoption in healthcare and share your opinions on what stakeholders need to do to improve interoperability and accelerate technology adoption.

Topics for this week’s #HITsm Chat:
T1: What are the biggest barriers to technology adoption in healthcare? #HITsm

T2: Is interoperability more challenging now with more data generated by technologies such as AI? #HITsm

T3: Will patient-authorized API access bring fundamental changes to interoperability? #HITsm

T4: How will tech giants’ move into healthcare impact interoperability? #HITsm

T5: What needs to be done by the established stakeholders in healthcare, e.g. EHR vendors, to solve interoperability? #HITsm

Bonus: What do you want as a patient when it comes to interoperability? #HITsm

Upcoming #HITsm Chat Schedule
10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

10/12 – TBD
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.

Going from Paper-Based Consents to eConsents in Healthcare

Posted on September 24, 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.

For years we’d talk about the “paperless office” that would be created by the adoption of EHR software. Years later, that paperless office still doesn’t exist. One of the big reasons this hasn’t come to fruition is because EHRs can print massive reams of paper with the click of the button. Another reason the paperless office still alludes us is paper-based consents.

For years, there wasn’t a good way to replace paper-based consents with eConsents. However, that’s not the case today. To help us move towards the paperless office and to learn about adoption of eConsents in healthcare, I interviewed Robin McKee, MS, RN, Director of Clinical Informatics Solutions at FormFast. In this interview, Robin offers a lot of great insights into consents in healthcare and the value of healthcare organizations moving towards eConsents.

What are the main reasons people are still doing paper-based consents?

I see two big reasons for this. First, it’s a case of “it’s what we’ve always done.” When EHRs were first implemented, mobile was not a part of the strategy. This meant that getting a consent in front of a patient still meant paper and a clipboard. Today, the informed consent workflow is difficult if you don’t have a mobile solution.

Another reason is the sheer magnitude of the project. Over the years, each department, even each surgeon, may have their own version of a paper form, adding up to hundreds of variations of paper consent forms stuck in drawers of offices and nurse’s stations. It is a daunting task to try and tackle the conversion, standardization, and consolidation of the plethora of paper consents without a concrete path forward.

FormFast addressed both of those issues with our mobile eConsent solution.  We digitize all of the organization’s consent forms and make them available in an online eForms library.  The forms are delivered at the point-of-care on a mobile tablet for the patient to review and sign.  Once completed, they’re automatically archived in the EHR.  It’s a much more streamlined process.

Are electronic consent forms as legally binding and effective as paper-based consents?

Yes. When you take the stylus and sign your name and submit it, an eConsent electronically dates and time stamps your signature. It also locks the content on the form to prevent it from being modified post signature.

Are there ways that electronic consents are more effective than paper-based consents?

Definitely. In addition to the benefits I mentioned in the previous question, there are several more to add.

From a maintenance standpoint, you have one form to modify and it is instantly available to all staff. Templates can be created to ensure standardized statements on all consents and provide the means to add procedure specific content. Clinicians cannot submit consent forms that have required fields left incomplete. This helps guide the process and ensure consents are completed.

Our eConsent forms also allow for links to your organization’s educational content, right on the form, so it’s easy to link out to approved content for further education while having the informed consent discussion.

What are the biggest misconceptions around electronic consents?

What I have seen most often with our customers has been the idea that the consent is not modifiable, that it is a fixed document. We provide dynamic content based on procedure selection, or editable fields, as well as areas to add content via free text or speech recognition.

Our customers appreciate having a combination of standardized, dynamic, and free text content. Every patient is unique; providers must be able to account for the specific risks, benefits, and alternatives of any procedure for each patient.

What are the costs and savings associated with implementing eConsent?

We see both direct and indirect impact on B organization’s financial landscape. The direct impact is, of course, the savings from eliminating paper. We’ve seen estimates from $3 – 6 per page due to the following factors:

  • Supplies – paper, ink, etc.
  • Materials – copiers, scanners, faxes as well as maintenance on the hardware
  • Staff – to perform printing scanning and indexing functions
  • Storage of paper records
  • Secure shredding of scanned documents

More indirect costs include the loss of productivity of procedures or operating rooms, due to the delays caused by missing or incomplete paper consent forms. A JAMA Surgery article estimated over $500K per year is lost simply on this factor. Also, while less common, malpractice claims that site a lack of informed consent comprise 2/3 of total claims, opening organizations to costly legal proceedings.

One also needs to consider the value of better forms, workflow and communication via eConsent which improves both patient and clinician satisfaction.

Many of the consents are needed in the EHR.  What’s the process for integrating eConsent into the EHR?

Electronic consent forms are superior to paper in this regard. While paper consents get lost or have to be carried around in a paper chart until they are scanned into the EHR, eConsent forms are instantly archived into the EHR. This ensures the document is archived correctly every time.  Plus it is easy to access the form in pre-op, as well as confirm in the OR during timeout. We utilize a variety of methods, including HL7 and FHIR, to integrate with any EHR or document management system.

Are eConsent forms secure and trusted?  Could a digital signature be inappropriately replicated?

There are a couple of ways we prevent signatures from being inappropriately or inaccurately added.

When a clinician chooses to digitally sign a consent form, the login user’s name is applied. Additionally, our solution provides audit logs to track who has been in the system.

We also require that the patient sign each signature field.  This helps ensure that their informed consent is accurately documented.

What are you looking at next when it comes to eConsent?

FormFast recently introduced a great feature that launches and pre-populates the right consent form for the patient by scanning the patient’s wristband.  It’s another way that we’ve tried to make the consent process more streamlined.

We continue to refine our eConsent solution based on customer feedback. No one knows better than the end users what a successful solution should look like, what it should contain, and what makes for an optimal workflow.

We look toward updates, such as enhanced notification processes, more OS compatibility, and further improving the user interface, that will continue to improve clinician and patient satisfaction.

About FormFast
With over 25 years exclusively focused on healthcare needs and 1100+ hospital clients, FormFast is recognized as the industry leader in electronic forms, eSignature, and document workflow technology. FormFast’s enterprise software platform integrates with EHRs and other core systems to automate required documents, capturing data and accelerating workflows associated with them. By using FormFast, healthcare organizations achieve new levels of standardization and operational efficiency, allowing them to focus on their core mission – delivering quality care. Learn more at formfast.com.

FormFast is a proud sponsor of Healthcare Scene.

Will The Fitbit Care Program Break New Ground?

Posted on September 21, 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.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.

 

Open Source Software and the Path to EHR Heaven (Part 2 of 2)

Posted on September 20, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous segment of this article explained the challenges faced by health care organizations and suggested two ways they could be solved through free and open source software. We’ll finish the exploration in this segment of the article.

Situational awareness would reduce alert fatigue and catch errors

Difficult EHR interfaces are probably the second most frustrating aspect of being a doctor today: the first prize goes to the EHR’s inability to understand and adapt to the clinician’s workflow and environment. This is why the workplace redounds with beeps and belches from EHRs all day, causing alert fatigue and drowning out truly serious notifications. Stupid EHRs have an even subtler and often overlooked effect: when regulators or administrators require data for quality or public health purposes, the EHR is often “upgraded” with an extra field that the doctor has to fill in manually, instead of doing what computers do best and automatically replicating data that is already in the record. When doctors complain about the time they waste in the EHR, they often blame the regulators or the interface instead of placing their finger on the true culprit, which is the lack of awareness in the EHR.

Open source can ease these problems in several ways. First, the customizability outlined in the first section of this article allows savvy users to adapt it to their situations. Second, the interoperability from the previous section makes it easier to feed in information from other parts of the hospital or patient environment, and to hook in analytics that make sense of that information.

Enhancements from outside sources could be plugged in

The modularity of open source makes it easier to offer open platforms. This could lead to marketplaces for EHR enhancements, a long-time goal of the open SMART standard. Certainly, there would have to be controls for the sake of safety: an administrator, for instance, could limit downloads to carefully vetted software packages.

At best, storage and interface in an EHR would be decoupled in separate modules. Experts at storage could optimize it to improve access time and develop new options, such as new types of filtering. At the same time, developers could suggest new interfaces so that users can have any type of dashboard, alerting system, data entry forms, or other access they want.

Bugs could be fixed expeditiously

Customers of proprietary software remain at the mercy of the vendors. I worked in one computer company that depended on a very subtle feature from our supplier that turned out not to work as advertised. Our niche market, real-time computing, needed that feature to achieve the performance we promised customers, but it turned out that no other company needed it. The supplier admitted the feature was broken but told us point-blank that they had no plans to fix it. Our product failed in the marketplace, for that reason along with others.

Other software users suffer because proprietary vendors shift their market focus or for other reasons–even going out of business.

Free and open source software never ossifies, so long as users want it. Anyone can hire a developer to fix a bug. Furthermore, the company fixing it usually feeds the fix back into the core project because they want it to be propagated to future versions of the software. Thus, the fixes are tested, hardened, and offered to all users.

What free and open source tools are available?

Numerous free and open source EHRs have been developed, and some are in widespread use. Most famously is VistA, the software created at the Department of Veterans Affairs, and used also by the Indian Health Service and other government agencies, has a community chaperone and has been adopted by the country of Jordan. VistA was considered by the Department of Defense as well, but ultimately rejected because the department didn’t want to invest in adding some missing features.

Another free software EHR, OpenMRS, supports health care in Kenya, Haiti, and elsewhere. OpenEMR is also deployed internationally.

What free and open source software has accomplished in these settings is just a hint of what it can do for health care across the board. The problem holding back open source is simple neglect: as VistA’s experience with the DoD showed, institutions are unwilling to support open source, even through they will pay 10 or 100 times as much on substandard proprietary software. Open Health Tools, covered in the article I just linked to, is one of several organizations that shriveled up and disappeared for lack of support. Some organizations gladly hop on for a free ride, using the software without contributing either funds or code. Others just ignore open source software, even though that means their own death: three hospitals have recently declared bankruptcy after installing proprietary EHRs. Although the article focuses on the up-front costs of installing the EHRs, I believe the real fatal blow was the inability of the EHRs to support efficient, streamlined health care services.

We need open source EHRs not just to reduce health care costs, but to transform health. But first, we need a vision of EHR heaven. I hope this article has taken us at least into the clouds.

Open Source Software and the Path to EHR Heaven (Part 1 of 2)

Posted on September 19, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Do you feel your electronic health record (EHR) is heaven or hell? The vast majority of clinicians–and many patients, too, who interact with the EHR through a web portal–see it as the latter. In this article, I’ll describe an EHR heaven and how free and open source software can contribute to it. But first an old joke (which I have adapted slightly).

A salesman for an EHR vendor dies and goes before the Pearly Gates. Saint Peter asks him, “Would you like to go to heaven or hell?”

Surprised, the salesman says, “I didn’t know I had a choice.”

Saint Peter suggests, “How about this. We’ll show you heaven and hell, and then you can decide.”

“Sounds fair,” says the EHR salesman.

First they take him to heaven. People wearing white robes are strumming harps and singing hymns, and it goes on for a long time, till they take him away.

Next they take him to hell. And it’s really cool! People are clinking wine glasses together and chatting about amusing topics around the pool.

When the EHR salesman gets back to the Pearly Gates, he says to Saint Peter, “You know, this sounds really strange, but I choose hell.”

Immediately comes a clap of thunder. The salesman is in a fiery pit being prodded with pitchforks by dreadful demons.

“Wait!” he cries out. “This is not the hell I saw!”

One of the demons answers, “They must have shown you the demo.”

Most hospitals and clinicians are currently in EHR hell–one they have freely chosen, and one paid for partly by government Meaningful Use reimbursements. So we all know what EHR hell look like. What would EHR heaven be? And how does free and open source software enable it? The following sections of this article list the traits I think clinicians would like to see.

Interfaces could be easily replaced and customized

The greatest achievement of the open source movement, in my opinion, has been to strike an ideal balance between “let a hundred flowers bloom” experimentation and choosing the best option to advance the field. A healthy open source project encourages branching, which lets any individual or team with the required expertise change a product to their heart’s content. Users can then try out different versions, and a central committee vets the changes to decide which version is most robust.

Furthermore, modularization on various levels (programming modules, hooks, compile-time options, configuration tools) allows multiple versions to co-exist, each user choosing the options right for their environment. Open source software tends to be modular for several reasons, notably because it is developed by many different individuals and teams who want control over their small parts of the system.

With easy customization, a hospital or clinic can mandate that certain items be highlighted and that safe workflow rules be followed when entering or retrieving data. But the institution can also offer leeway for individual clinicians and patients to arrange a dashboard, color scheme, or other aspect of the environment to their liking.

Many of the enablers for this kind of agile, user-friendly programming are technical. Modularity is built into programming languages, while branching is standard in version control systems. So why can’t proprietary vendors do what open source communities routinely do? A few actually do, but most are constrained in ways that prevent such flexibility, especially in electronic health records:

  • Most vendors are dragging out the lifetime of nearly 40-year old technology, with brittle languages and tools that put insurmountable barriers in the way of agile work styles. They are also stuck with monolithic systems instead of modular ones.
  • The vendors’ business model depends on this monolithic control. To unbundle components, allow mix-and-match installations, and allow third parties to plug in new features would challenge the prices they charge.
  • The vendors are fundamentally unprepared for empowered users. They may vet features with clinically trained consultants and do market research, but handling power over the system to users is not in their DNA.

Data could be exchanged in a standard format without complex transformations

Data sharing is the lifeblood of modern computing; you can’t get much done on a single computer anymore. Data sharing lies behind new technologies ranging from the Internet of Things to real-time ad generation (the reason you’ll see a link to an article about “Fourteen celebrities who passed out drunk in public” when you’re trying to read a serious article about health IT). But it’s so rare in health care–where it’s uniquely known as “interoperability”–that every year, reformers call it the most critical goal for health IT, and the Office of the National Coordinator has repeatedly narrowed its Meaningful Use and related criteria to emphasize interoperability.

Open source software can share data with other systems as a matter of course. Data formats are simple, often text-based, and defined in the code in easy-to-find ways. Open source programmers, freed from the pressures on proprietary developers to reinvent wheels and set themselves apart from competitors, like to copy existing data formats. As a stark example of open source’s advantages, consider the most recent version of the Open Document Format, used by LibreOffice and other office suites. It defines an entire office suite in 104 pages. How big is the standards document for the Microsoft OOXML format, offering roughly equivalent functionality? Currently, 6,755 pages–and many observers say even that is incomplete. In short, open source is consistently the right choice for data exchange.

What would the adoption of open source do to improve health care, given that it would solve the interoperability problem? Records could be stored in the cloud–hopefully under patient control–and released to any facility treating the patient. Research would blossom, and researchers could share data as allowed by patients. Analytical services could be plugged in to produce new insights about disease and treatment from the records of millions of people. Perhaps interoperability could also contribute to solving the notorious patient matching problem–but that’s a complicated issue that I have discussed elsewhere, touching on privacy issues and user control outside the scope of this article.

The next segment of this article will list three more benefits of free and open source software, along with an assessment of its current and future prospects.

Human Centered Design in Healthcare #askpatients – #HITsm Chat Topic

Posted on September 18, 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, 9/21 at Noon ET (9 AM PT). This week’s chat will be hosted by Jen Horonjeff (@jhoronjeff) from @Savvy_Coop on the topic of “Human Centered Design in Healthcare #askpatients“.

I, Jen Horonjeff, have a confession – I’m one of the dreaded “non-compliant” patients you hear about. I have been living with juvenile arthritis and other autoimmune diseases for 33 years, so I often have a complex treatment plan. One of my biggest offenses is I don’t get my blood work done every four weeks, which is the regularity for which my doctor has ordered my labs.

I don’t have a fear of needles, it’s also relatively quick to drop into the lab and do, so why don’t I do it?

Because every time I do, the system fails me. The lab inevitably sends me a bill for an exorbitant amount of money claiming my insurance won’t cover it. That’s incorrect, they will, it’s just been billed incorrectly. Yet it’s up to me as a patient to sit on the phone for hours with the lab, the insurance company, my doctor’s office, and probably a friend to vent about it…again.

Healthcare, its systems, products and services, are supposed to improve the lives of patients and families, not create more headaches. But the problem is, until recently, no one really ever asked the patients what they were going through, what mattered to them, or their input how to fix it. Patients have been the recipients of the systems we develop, rather than the co-creators.

This is where human-centered design comes in. Human-centered design is about taking the time to #askpatients and design solutions to fit them, rather than continually have them navigate systems and tools that, at times, feel like a cruel joke. I’m not a bad patient because I don’t get my labs done. I am just exhausted by a system that did not incorporate proper human-centered design.

We all have a role to play to improve this. After a lifetime of stumbling through the healthcare system, I decided to do something about it and started Savvy Cooperative. Savvy is a patient-owned co-op that provides a marketplace for patient insights. Our goal is to make it so easy to connect and work with patients and healthcare consumers there is no excuse not to. I believe the future of healthcare is co-designed with patients.

As you go about your work or interface with the healthcare system, I hope you’ll be on the lookout for all the hoops patients jump through and think, “did anyone #askpatients about this?”

If you need examples where lack of human-centered design affects patients, check out some of our #MessedUpPtExp videos, featuring our friendly Savvy Puppets. Then, join us for this week’s #HITsm chat where we’ll discuss it in further detail.

Topics for this week’s #HITsm Chat:
Ice Breaker: We’ve got a Spotify playlist going of song titles that describe the current state of healthcare – what would you add to our #HealthcareSoundtrack? #HITsm

T1: Everyone has one, what’s one of the messed up patient experiences you’ve personally gone through or heard someone else go through that showed lack of human-centered design? #HITsm

T2: How can technology help to ease these headaches and improve the patient experience, rather than make it worse (feel free to use responses from T1 for inspiration!)? #HITsm

T3: Do you think patients can bring unique and valuable perspectives to the table that can make these technologies even better, and how so? #HITsm

T4: Let’s lay it out there, what are the reasons you have heard for why people or companies don’t work more directly with patients? #HITsm

T5: Some of the big consumer brands have mastered the user experience, but what do they need to do to truly improve the patient experience? #HITsm

Bonus: Who are some of the companies or individuals you feel are winning at human-centered design in healthcare, and what are they doing to show that? #HITsm

Upcoming #HITsm Chat Schedule
9/28 – How Does Interoperability Affect Technology Adoption in Healthcare?
Hosted by Niko Skievaski @niko_ski from @redox

10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

10/12 – TBD
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.

Applying AI Based Outlier Detection to Healthcare – Interview with Dr. Gidi Stein from MedAware

Posted on September 17, 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.

Most people who receive healthcare understand that healthcare is as much art as it is science. We don’t expect our doctors to be perfect or know everything because the human body is just too complex and there are so many factors that influence health. What’s hard for patients to understand is when obvious human errors occur. This is especially true when technology or multiple layers of humans should have caught the obvious.

This is exactly why I was excited to interview Dr. Gidi Stein, CEO and Co-founder of MedAware. As stated on their website, their goal is to eliminate prescription errors. In the interview below, you’ll learn more about what MedAware and Dr. Stein are doing to achieve this goal.

Tell us a little about yourself and MedAware.

Early in my career, I worked in the Israeli high-tech industry and served as CTO and Chief Architect of several algorithm-rich startups. However, after many years working in technology, I decided to return to school and study medicine. In 2002, I graduated from Tel Aviv University Medical School with a specialization in internal medicine, treating patients and teaching students and residents in one of Israel’s largest hospitals.

After working as a physician for several years, I heard a heartbreaking story, which ultimately served as my motivation and inspiration to found MedAware. A physician was treating a 9-year-old boy who suffered from Asthma. To treat the symptoms, the physician entered the electronic prescribing environment and selected Singulair from the drop-down menu, a standard treatment for asthma. However, unfortunately, he accidentally clicked Sintrom, an anticoagulant (blood thinner). Tragically, neither the physician, pharmacist nor parent caught this error, which resulted in the boys’ untimely death. This avoidable, medication-related complication and death was caused by a typo.

Having worked as a physician for many years, I had a difficult time understanding that with all the medical intervention and technological support we rely on, our healthcare system was not intelligent enough to prevent errors like this. This was a symptom of a greater challenge; how can we identify and prevent medication related complications before they occur? Given my combined background in technology and medicine, I knew that there must be a solution to eliminate these types of needless errors. I founded MedAware to transform patient safety and save lives.

Describe the problem with prescription-based medication errors that exists today.  What’s the cause of most of these errors?

Every year in the U.S. alone, there are 1.5 million preventable medication errors, which result in patient injury or death. In fact, medication errors are the third leading cause of death in the US, and errors related to incorrect prescription are a major part of these. Today’s prescription-related complications fall into two main categories: medication errors that occur at the point of order entry (like the example of the 9yr old boy) and errors that result from evolving adverse drug events (ADEs). Point of order entry errors are a consequence of medication reconciliation challenges, typos, incorrect dosage input and other clinical inconsistencies.

Evolving ADEs are, in fact, the bulk of the errors that occur – almost 2/3 of errors are those that happen after a medication was correctly prescribed. These are often the most catastrophic errors, as they are completely unforeseen, and don’t necessarily result from physician error. Rather, they occur when a patient’s health status has changed, and a previously safe medication becomes unsafe.

MedAware uses AI to detect outlier prescriptions.  It seems that everything is being labeled AI, so how does this work and how effective is it at detecting medication errors?

AI is best used to analyze large scale data to identify patterns and outliers to those patterns. The common theme in industries, such as aviation, cyber security and credit card fraud, is that they are rich with millions of transactions, 99.99% of which are okay. But, a small fraction of them are hazardous, and these dangers most often occur in new and unexpected ways. In these industries, AI is used to crunch millions of transactions, identify patterns, and most importantly, identify outliers to those patterns as potential hazards with high accuracy.

Medication safety is similar to these industries. Here too, millions of medications are prescribed and dispensed every day, and in 99.99% of cases, the right medication is prescribed and dispensed to the right patient. But, on rare occasions, an unexpected error or oversight may put patients at risk. MedAware analyzes millions of clinical records to identify errors and oversights as statistical outliers to the normal behavioral patterns of providers treating similar patients. Our data shows that this methodology, identifies errors and ADEs with high accuracy and clinical relevance and that most of the errors found by our system would not have been caught by any other existing system.

Are most of the errors you find obvious errors that a human could have detected but just missed or are you finding surprising errors as well?  Can you share some stories of what you’ve found?

The errors that we find are obvious errors; any physician would agree that they are indeed erroneous. These include: prescribing chemotherapy to healthy individuals, not stopping anticoagulation to a bleeding patient, birth control pills to a 70-year-old male and prescribing Viagra to a 2-year-old baby. All of these are obvious errors, so why didn’t the prescribers pick these up? The answer is simple: they are human, and humans err, especially when they are less experienced and over worked. Our software is able to mirror back to the providers the crowdsourced behavioral patterns of their peers and identify outliers to these patterns as errors.

You recently announced a partnership with Allscripts and their dbMotion interoperability solution.  How does that work and what’s the impact of this partnership?

Today’s healthcare systems have created a reality where patient health information can be scattered across multiple health systems, infrastructures and EHRs. The dbMotion health information exchange platform aggregates and harmonizes that scattered patient data, delivering the information clinicians need in a usable and actionable format at the point of care, within the provider’s native and familiar workflow. With dbMotion, all of the patient’s records are in one place. MedAware sits on top of the bdMotion interoperability platform as a layer of safety, accurately looking at the thousands of clinical inputs in the system and warning with even greater accuracy. MedAware catches various medication errors that would have been missed due to a decentralized patient health record. In addition to identifying prescription-based medication errors, MedAware can also notify physicians of patients who are at risk of opioid addiction.

This partnership will allow any institution using Allscripts’ dbMotion to easily implement MedAware’s system in a streamlined manner, with each installation being quick and effortless.

Once MedAware identifies a prescription error, how do you communicate that information back to the provider? Do you integrate your solution with the EHR vendor?

Yes, MedAware is integrated with EHR platforms. This is necessary for error detection and communication of the warning to the provider. There are two intervention scenarios: 1) Synchronous – when errors are caught at the point of order entry, a popup alert appears within the EHR user interface, without disturbing the provider’s workflow, and the provider can choose to accept or reject the alert. 2) Asynchronous – the errors/ADE is caught following a change in the patient’s clinical record (i.e. new lab result or vital sign), long after the prescription was entered. These alerts are displayed as a physician’s task, within the physician’s workflow and the EHR’s user interface.

What’s next for MedAware?  Where are you planning to take this technology?

The next steps for us are:

  1. Scale our current technology to grow to 20 million lives analyzed by 2020
  2. Create additional patient safety centered solutions to providers, such as opioid dependency risk assessment, gaps in care and trend projection analysis.
  3. Share our life-saving insights directly to those who need it most – consumers.