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Carely – Helping Family Caregivers Partner with Providers

Posted on November 30, 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 met many entrepreneurs who are or have created an app designed to help families better coordinate the care of loved ones. These apps all have similar features:

  • A Facebook-like interface that allows multiple family members to post medical/care updates and add comments
  • A calendar feature for important appointments and for coordinating care coverage by family members
  • An iMessage/Whatsapp-like messaging tool to communicate one-on-one with members of the family

Caring for a loved one and trying to coordinate family members is a daunting task so I applaud all of these efforts to make it easier.

However, I must admit that I come away after meeting these enthusiastic entrepreneurs a little disappointed. Their apps, while impressive, are stand-alone and are isolated from the rest of the healthcare ecosystem. For example, manual entry is often the only way to incorporate medical information from a provider and any communication with a healthcare organization needs to be rekeyed into the app.

Because of this, I was very excited when I ran into Michael Eidsaune, Founder and CEO of Carely at a recent conference. His company is taking a unique approach – instead of just focusing on family caregivers, his company is trying to bring caregivers and healthcare providers closer together so that BOTH benefit.

Below is a summary of our conversation.

What makes Carely different than other family caregiving apps?

With Carely, we didn’t stop at just trying to make things easier for families to care for a loved one. What we want to do is recruit families to be an active part of the care team alongside the healthcare provider. We don’t want families to be passive observers waiting for the next bit of news or have to log into those terrible “family portals” that don’t really give you any useful information or allow you to communicate effectively with the healthcare organization. We all hate using portals, it’s so one-sided.

For us it’s ultimately about getting the best care for your loved one not just about making things easy. In order to do this you need to get providers involved and not just families.

So why would a healthcare provider adopt Carely? What’s in it for them?

The provider-side of Carely is something we call Carely Community. This is something we built specifically for healthcare providers. It allows them to interact with families of the loved ones they are caring for. They can share information like when appointments are, what activities their loved one has been involved in and get feedback on those things from family members.

Long-Term and Post-Acute Care providers in particular have found that listening to family feedback can help them deliver better care. Through Carely they can get messages like “Mom seemed to have a little less appetite than usual today” or “Uncle Joe seemed a bit more confused than normal and had trouble getting to the toilet”. When the provider sees these messages in combination with the medical record, they can quickly make a determination as to whether this was something expected or something they need to look into. Having observations from family members over a period of time, helps to paint a better picture for everyone. A better picture equals better care.

The reverse is also true. If the provider can share updates with families, they can help reduce the number of phone calls they get. Imagine how relieved you would feel if the long-term care facility let you know that “Aunt Mary took part in the garden walk today” or “Dad ate everything at dinner tonight”. Those simple updates can help take worries away.

Is that what families get out of Carely? Less worry?

Carely Family is the app side of our business. That’s where all the tools are for families to coordinate and track their loved one’s care. Here you can see upcoming appointments, who will be visiting, etc. But the real power comes when the healthcare provider gets added to family’s care circle. Now the entire family can get updates on what’s happening and they can make better decisions together.

Take for example, Home Care. Typically Home Care is needed as a result of an unexpected event – maybe a fall or a minor accident. Arranging for Home Care puts a lot of stress on families and they all have to come together to make decisions. Without coordination there would be a lot of phone calls and texts flying around. If it were me I wouldn’t want to be getting 5 phone calls a day from people asking me how I was doing. So by bringing everyone together onto a single platform, including the Home Care provider, now all the information is up-to-date and the family can make the best decision possible.

Let’s talk about integration for a moment. Have you integrated with any EHR or other healthcare system?

We are currently working with PointClickCare. They have an API interface that will allow us to pull updates from their system and feed it through Community and onto Family. This makes everything seamless for the healthcare organization – they just continue to use PointClickCare and families get updated behind the scenes. Down the road we will look at how we can push information or notifications into PointClickCare. As well, we plan to begin integrating with the many other systems that exist in healthcare today.

What’s next for Carely?

I wish we could still be operating in stealth mode, but we’ve had such great feedback and interest in our product that we’re operating out in the open now.

We are continuing to iterate our product based on feedback from families and healthcare providers. We’re really making an effort to incorporate their requests. People want to use tools that they love to use. No one wants to use a tool that makes their life harder or that’s confusing. That’s why we’re spending so much time iterating our product. On one side it’s got to fit into the daily lives of families and on the other it’s got to fit into the workflow of the healthcare provider.

At the end of the day, our mission and vision is to drastically improve the caregiver experience and it’s our core belief that in order to do that we have to create an industry-wide solution, eliminate silos, get rid of useless “family portals”, and continue to innovate. This NEEDS to be done and I’m confident we’ll be the ones to successfully do it.

Has Amazon Brought Something New To Healthcare Data Analytics?

Posted on November 29, 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.

Amazon’s announcement that it was getting into healthcare data analytics didn’t come as a major surprise. It was just a matter of time.

After all, the retail giant has been making noises about its health IT ambitions for a while now, and its super-sneaky 1492 team’s healthcare feints have become common knowledge.

Now, news has broken that its massive hosting division, Amazon Web Services, is offering its Comprehend Medical platform to the healthcare world. And at the risk of being a bit too flip, my reaction is “so?” I think we should all take a breath before we look at this in apocalyptic terms.

First, what does Amazon say we’re looking at here?

Like similar products targeting niches like travel booking and supply-chain management, the company reports, Comprehend Medical uses natural language processing and machine learning to pull together relevant information from unstructured text.

Amazon says Comprehend Medical can pull needed information from physician notes, patient health records and clinical trial reports, tapping into data on patient conditions and medication dosage, strength and frequency.

The e-retailer says that users can access the platform through a straightforward API call, accessing Amazon’s machine learning expertise without having to do their own development or train models of their own. Use cases it suggests include medical cohort analysis, clinical decision support and improving medical coding to tighten up revenue cycle management.

Comprehend Medical customers will be charged a fee each month based on the amount of text they process each month, either $0.01 per 100-character unit for the NERe API, which extracts entities, entity relationships, entity traits and PHI, or $0.0014 per unit if they use its PHId API, which only supports identifying PHI for data protection.

All good. All fine. Making machine learning capabilities available in a one-off hosting deal — with a vendor many providers already use — can’t be wrong.

Now, let’s look coldly at what Amazon can realistically deliver.

Make no mistake, I understand why people are excited about this announcement. As with Microsoft, Google, Apple and other top tech influencers, Amazon is potentially in the position to change the way things work in the health IT sector. It has all-star brainpower, the experience with diving into new industries and enough capital to buy a second planet for its headquarters. In other words, it could in theory change the healthcare world.

On the other hand, there’s a reason why even IBM’s Watson Health stumbled when it attempted to solve the data analytics puzzle for oncologist. Remember, we’re talking IBM here, the last bastion of corporate power. Also, bear in mind that other insanely well-capitalized, globally-recognized Silicon Valley firms are still biding their time when it comes to this stuff.

Finally, consider that many researchers think NLP is only just beginning to find its place in healthcare, and an uncertain one at that, and that machine learning models are still in their early stages, and you see where I’m headed.

Bottom line, if Google or Microsoft or Epic or Salesforce or Cerner haven’t been able to pull this off yet, I’m skeptical that Amazon has somehow pole-vaulted to the front of the line when it comes to NLP-based mining of medical text. My guess is that this product launch announcement is genuine, but was really issued more as a stake in the ground. Definitely something I would do if I worked there.

Let’s Keep Genetic Information an Individual Affair

Posted on November 28, 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.

These times train us to seek continually for more data and more transparency, always assuming that more is better. But some types of data and transparency bring risks, because “A little learning is a dangerous thing.” In particular, sharing genetic information with family members raises daunting ethical issues, along with the need for a mature understanding of consequences, as illustrated by a court case from the UK recently reported in The Guardian.

Superficially, this case seems to be a simple balancing act concerning how far a doctor is responsible to fulfill a family member’s right to know. But in context of our modern scientific knowledge about genetics–and the limitations of that knowledge–far greater concerns emerge.

In this case, a man in the latter stages of life was diagnosed with Huntington’s disease. His daughter was pregnant at the time. After the baby was born and the man died, his daughter sued the doctor because the doctor had failed to inform her of her father’s diagnosis. She claimed that she would have aborted the fetus had she known. She, in fact, was later diagnosed with the dreaded condition, meaning that her daughter has a 50% chance of developing the condition too.

The Guardian reports what I consider a proper and satisfactory resolution to the case–upholding the doctor’s right to suppress the information and denying the mother a victory–but the newspaper reports that the case was disturbing because it proceeded so far, leaving an opening for similar cases in the future. The details reported in the article about this case make the mother’s argument even weaker: it turns out that the doctor asked his patient whether he’d like his daughter to be notified. And the patient, knowing her intentions full well, told the doctor he wanted the baby to be born and insisted that his daughter not be told.

Huntington’s is certainly a heart-rending disease, both for the patient and the family. I can understand why a woman would want to prevent her child from suffering from Huntington’s–certainly a very difficult choice to make–but note that the fetus’s odds of getting the disease were only 50%, a facet of the discussion that will return as I examine the ethics of genetic counseling. The overweening point is that here we have a highly ethical doctor who quite properly left the decision in the hands of the patient and respected the patient’s privacy.

What are some of the subtler considerations about genetics that didn’t make it into The Guardian article?

Trouble setting thresholds

In our Huntington’s disease case, the mother declared that a 50% chance of contracting such a horrible condition would be enough to prevent her from having children, and even enough to drive her to abort the fetus she already had. But if we required doctors to report diseases to relatives, how serious should the risk be? Should they report a tendency to baldness or something else non-threatening? How threatening should the condition be? And how likely should it be? If the incidence of the disease is 1% in the general population, should they be forced to report a 2% chance? Or 20%? 50%? Such questions become even murkier when statistics are based on diagnosis of a family member instead of personal genetic testing.

Unknown variability

Many conditions are affected by other genes that individuals may or may not possess, along with lifestyle choices and other environmental factors. Statistics collected over a population of a few thousand patients may suggest that someone’s child has a 50% chance of inheriting a disease, but depending on one’s genetic make-up, the chance may be 5% for one person and 95% for another. Under such conditions, is it truthful and meaningful to tell a person he has a 50% risk?

Need for counseling

We’ve seen that it’s hard to draw meaningful conclusions from most genetic results, and even harder to chart a rational course of action. Furthermore, learning that one has heightened risk for any medical condition causes the eruption of strong emotions that must be handled in a professional setting. Suppose someone has Huntington’s disease and 50 family members are potentially affected. Does the doctor have a responsibility, not only to notify all 50 family members, but to provide counseling for them as well?

In short, we can’t drop crude regulations onto clinical staff in an environment of such ambiguity and variety. The best ethical guideline we have is the classic one: respecting the patient’s privacy. Each patient can determine whom to tell and how much to see to each person about his condition.

I think that genetic notification should be on a “pull,” not “push,” basis. A person who wants to check for genetic risks can be tested. An expectant mother can ask her parents to please let her know of any changes to their health that could have a genetic impact on her. Certain types of notification may require counseling to help a member of the general public understand her risks and options. Reasonable fees for all these things apply.

The problem of predicting risk goes way beyond genetic conditions. We know that insurers, financial institutions, and others comb through publicly available information about us in order to make major decisions affecting our lives, such as whether we can get a mortgage. Just as we need guidance to make health decisions, these institutions should be held to high standards for fairness and for respecting individual dignity. We’ve seen that a father has the right to withhold genetic information from his own daughter–how much more right do we all have to keep our sensitive conditions secret from commercial institutions. When data increasingly underlies our own decisions as well as decisions made about us by others, transparency has to vie with other ethical considerations.

The Global Impact of Health IT – #HITsm Chat Topic

Posted on November 27, 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, 11/30 at Noon ET (9 AM PT). This week’s chat will be hosted by Vanessa Carter (@_FaceSA) on the topic of “The Global Impact of Health IT”.

Global health pandemics like antibiotic and antimicrobial resistance are among the most critical issues to tackle and in future will require robust, harmonious data surveillance systems along with mass co-operation between the animal, human and environmental health sectors across every country [1]. This is known as One Health [2]. WHO initiatives like GLASS (Global Antimicrobial Resistance Surveillance System) have been implemented to work towards these goals [3].

To help understand the topic of antibiotic resistance, let me start by saying that antibiotics treat bacterial infections whereas antimicrobials are a much broader term used to describe medicines that treat other types of microorganisms that cause infection. These other types of microorganisms include parasites (e.g. Malaria), fungi (e.g. Candida) and viruses (e.g. AIDS). All of these microbial infections are categorised as Communicable Diseases or Infectious Diseases. Antibiotics fall under the antimicrobial umbrella and they kill a microorganism known as bacteria. Antimicrobials, and particularly antibiotics are the cornerstone of modern medicine because they are used in all areas of disease treatments where the immune system is compromised including HIV/AIDS and Tuberculosis, as well as Non-Communicable Diseases like Cancer and Diabetes where acquiring an infection is common such as during Chemotherapy. Antibiotics are also used for your everyday Strep throat, Gastrointestinal Infections (e.g. “Tummy bug”) or Urinary Tract Infections. They are also prescribed daily by dentists when we have tooth infections or for routine surgeries. Unfortunately, we are overusing antibiotics and bacteria are evolving resistance fast. This means that antibiotics are no longer working to treat common bacterial infections for many of these health conditions. What is even more frightening is that there are very few antibiotics in the pipeline. Some big pharma companies having abandoned research and development due to a lack of global data which helps to report prescribing and consumption behaviours which are contributing to resistance [4].

Antibiotic resistance is caused in various ways including through the overprescribing and misuse of antibiotics in both humans and animals. Resistant bacteria can also spread through bad hygiene practice (e.g. hand washing) or food production. The continual rise of antimicrobial resistance was recognised by the United Nations in 2016 in a high-level meeting as a serious threat to global health and human development [5] because of its severity and complexity. It has further been compared to climate change by UK economic experts like Lord Jim O’Niell [6] and invested in excessively by organisations including The Bill and Melinda Gates Foundation and Wellcome Trust [7], particularly in Low-to-Middle-Income Countries (LMICs) where health systems are distressed and disease burdens are high.

This world has become increasingly more connected through trade and travel too, therefore tracking the spread of antibiotic resistance will probably remain impossible until we leverage the benefit of today’s digital technology to collect, process and analyse surveillance data at a national and global level. Whether or not and how health IT companies design solutions in the future taking this into consideration remains to be understood. For example, does it mean technology like EHRs should travel with us so that we improve our ability to capture holistic data, even when we’re out of our own country? What happens if we take a course of antibiotics and it never gets captured on our medical record, or worse, we pick up a disease and travel back afterwards with no data and that bacteria is a threat to our community. Shouldn’t we be considering these data gaps in all our systems? One thing is certain, without global surveillance, we couldn’t possibly begin to tackle this deadly pandemic that affects us all.

Join us for this week’s #HITsm chat where we talk about this global health challenge and how IT could potentially help with the problem.

Topics for this week’s #HITsm Chat:
T1: What do you think makes global health IT difficult to achieve? #HITsm

T2: What technologies do you think could collect global data for antibiotic resistance? (e.g. EHRs) #HITsm

T3: How do you think global health IT could benefit other medical conditions? #HITsm

T4: What are you seeing locally that you would like to see spread globally? #HITsm

T5: Why do you feel global health IT is important to achieve? #HITsm

Bonus: With global health barriers like culture, education & language, how do we overcome that with technology? #HITsm

Upcoming #HITsm Chat Schedule
12/7 – Healthcare Leadership
Hosted by Michelle Currie (@mshlcurrie)

12/14 – TBD
Hosted by Claire Pfarr (@clairepfarr) from @OneViewHC and the @Savvy_Coop Community

12/21 – Holiday Break

12/28 – Holiday Break

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.

Providers Tell KLAS That Existing EMRs Can’t Handle Genomic Medicine

Posted on November 26, 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.

Providers are still in the early stages of applying genomics to patient care. However, at least among providers that can afford the investment, clinical genomics programs are beginning to become far more common, and as a result, we’re beginning to get a sense of what’s involved.

Apparently, one of those things might be creating a new IT infrastructure which bypasses the provider’s existing EMR to support genomics data management.

KLAS recently spoke with a number of providers about the vendors and technologies they were using to implement precision medicine. Along the way, they were able to gather some information on the best practices of the providers which can be used to roll out their own programs.

In its report, “Precision Medicine Provider Validations 2018,”  KLAS researchers assert that while precision medicine tools have become increasingly common in oncology settings, they can be useful in many other settings.

Which vendors they should consider depends on what their organization’s precision medicine objectives are, according to one VP interviewed by the research firm. “Organizations need to consider whether they want to target a specific area or expand the solutions holistically,” the VP said. “They [also] need to consider whether they will have transactional relationships with vendors or strategic partnerships.”

Another provider executive suggests that investing in specialty technology might be a good idea. “Precision medicine should really exist outside of EMRs,” one provider president/CEO told KLAS. “We should just use software that comes organically with precision medicine and then integrated with an EMR later.”

At the same time, however, don’t expect any vendor to offer you everything you need for precision medicine, a CMO advised. “We can’t build a one-size-fits-all solution because it becomes reduced to meaninglessness,” the CMO told KLAS. “A hospital CEO thinks about different things than an oncologist.”

Be prepared for a complicated data sharing and standardization process. “We are trying to standardize the genomics data on many different people in our organization so that we can speak a common language and archive data in a common system,” another CMO noted.

At the same time, though, make sure you gather plenty of clinical data with an eye to the future, suggests one clinical researcher. “There are always new drugs and new targets, and if we can’t test patients for them now, we won’t catch things later,” the researcher said.

Finally, and this will be a big surprise, brace yourself for massive data storage demands. “Every year, I have to go back to our IT group and tell them that I need another 400 terabytes,” one LIS manager told the research firm.” When we are starting to deal with 400 terabytes here and 400 terabytes there, we’re looking at potentially petabytes of storage after a very short period of time.”

If you’re like me, the suggestion that providers need to build a separate infrastructure outside the EMR to create precision medicine program is pretty surprising, but it seems to be the consensus that this is the case. Almost three-quarters of providers interviewed by KLAS said they don’t believe that their EMR will have a primary role in the future of precision medicine, with many suggesting that the EMR vendor won’t be viable going forward as a result.

I doubt that this will be an issue in the near term, as the barriers to creating a genomics program are high, especially the capital requirements. However, if I were Epic or Cerner, I’d take this warning seriously. While I doubt that every provider will manage their own genomics program directly, precision medicine will be part of all care at some point and is already having an influence on how a growing number of conditions are treated.

Black Friday in Healthcare

Posted on November 23, 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.

As we were heading into Black Friday, I wondered if anyone in healthcare was doing something for Black Friday. It’s such a big shopping day, I had to think that someone was getting involved. Turns out, I found a few things.

The first thing I found was a Medical Uniform Boutique in Downtown Lancaster, PA. They were promoting 10% off scrubs:

This actually felt pretty reasonable. Scrubs is something that makes a lot of sense for medical professionals to buy on Black Friday. Of course, the JustScrubz account only had 1 follower, so I’m not sure that promotion did very well. I did just feature it in this post. So, your welcome citizens of Lancaster.

Next up, I found a health insurance company offering a Black Friday special:


The tweet does seem to be advertising their online visits which could be a pretty valuable thing for people who might be traveling over Thanksgiving. It’s never fun to get sick while traveling, but always a pain to get care on the holidays. So, I’d say this online visit offer could be a pretty good one.

The next Black Friday deal I found for healthcare was from GE Healthcare Life Sciences. You can see the Black Friday landing page here. Looks like this is going to be a great place for you if you’re interested in Bioprocess, Genomics, Western Blotting & Imaging, Biacore chips and reagents, Purification: AKTA, columns and media, and Cell Culture. Sounds like some hot sellers to me. Who wouldn’t want to buy some genomics on Black Friday?

In case you’re interested in the GE Healthcare Life Sciences offer, they’ll be donating $10 to Seeding Labs for every purchase made during their Black Friday event. They have a goal of raising $10,000 which if my math is correct, that means they expect this Black Friday deal will be taken advantage of by at least 1000 people. Who knew that cell culture, genomics, and protein purification would be so popular on Black Friday.

I’ll admit that I’m not sure if I love or hate the use of Black Friday in healthcare. Certainly it’s a big shopping day and it makes sense for marketers to use it if they can effectively. No doubt we’ll see plenty of action from consumer health devices like 23 and Me and Fitbit. However, at some point the Black Friday tag doesn’t seem to fit.

I think my friend Grace Cordovano put it best:

I hope you’re enjoying your Black Friday and not spending too much money on Amazon. They get me every year.

Happy Thanksgiving!

Posted on November 22, 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 Thanksgiving Day. Hopefully, most of you aren’t reading this blog today, but are enjoying a great Thanksgiving feast with friends and family. We all have our own traditions and I know the holidays can be hard for some people. Especially those in healthcare who are stuck at work.

However, I saw this Thanksgiving message below and thought that regardless of my situation, I’ve always found this to be true. Even if I often don’t take enough time to look.

Happy Thanksgiving to all of you and thanks so much for being part of the Healthcare Scene community!

Cybersecurity Confidence and Cybersecurity Maturity

Posted on November 21, 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.

Cybersecurity is the number one topic on most healthcare CIOs minds. It’s the number one thing that keeps them up at night. No doubt, it’s become one of the most challenging parts of their job.

These facts were illustrated really well in this chart that CIO, David Chou, shared on CIOs self reported confidence in IT security.

There’s been a drop in security trust in almost every industry, but the drop in healthcare’s trust in IT security is dramatic. As David Chou mentions, it’s likely due to all the incidents of ransomware and malware that have been all over healthcare.

What then can an organization do to improve this situation? What’s the right approach to be able to improve your confidence in your IT security?

David Chou also offered a great response to these questions in this cybersecurity maturity chart and the key to successfully implementing what’s in this chart:


There’s little doubt that effective cybersecurity takes the entire organization being on board. It can’t just be the job of the CIO or CEO or CISO. If that’s the case, it will fail and a breach will occur.

Looking at this chart, how is your organization doing on cybersecurity? How mature are your efforts? Is there room to improve?

Healthcare Interoperability is a Joke

Posted on November 20, 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.

Did you see the big news last month about healthcare interoperability? That’s right, Carequality announced support for FHIR. Next thing you know, we’re going to get an announcement that CommonWell is going to support faxing.

Seriously, healthcare interoperability is a joke.

The reality is that no EHR vendor wants to do interoperability. And it’s not saying anything groundbreaking to say that Carequality and CommonWell are both driven by the EHR vendors. Unfortunately, I see these organizations as almost a smokescreen that allows EHR vendors to not be interoperable while allowing them to say that they’re working on interoperability.

I’d describe current interoperability efforts as a “just enough” approach to interoperability. EHR vendors want to do just enough to appease the call for interoperability by the government and other patient organizations. It’s not a real effort to be interoperable. That’s most EHR vendors. A few of them are even using interoperability as a weapon to keep vendors out and some are looking at interoperability as a new business model.

Just to be clear, I’m not necessarily blaming the EHR vendors. They’re doing what their customers are asking them to do which is their highest priority. Until their customers ask for interoperability, it’s not going to happen. And in many respects, their customers don’t want interoperability. That’s been the real problem with interoperability since the start and it’s why grand visions of interoperability are unlikely to happen. Micro interoperability, which is how I’d describe what’s happening today, will happen and is happening.

If EHR vendors really cared about being interoperable, they’d spend the time to see where interoperability would lower costs, improve care, and provide a better patient experience. That turns out to be a lot of places. Then, they’d figure out how to make that possible and still secure and safe. Instead, they don’t really do this. The EHR vendors just follow whatever industry standard is out there so they can say they’re working on interoperability. Ironically, many experts say that the industry standards aren’t standard and won’t really make a big impact on interoperability.

There are no leaders in healthcare interoperability. There are just followers of the “just enough” crowd.

Let’s just be honest about what’s really possible when it comes to EHR vendors and healthcare interoperability. There is some point to point use cases that are really valuable and happening (this feels like what FHIR is doing to me). In a large health system, we’re seeing some progress on interoperability within the organization. We’re starting to see inklings of EHR vendors opening up to third-party providers, but that still has a long ways to go. Otherwise, we’re exchanging CCDs, faxes, and lab results.

Will we see anything more beyond this from EHR vendors? I’m skeptical. Let me know what you think in the comments on on Twitter with @HealthcareScene.

Process Re-engineering Can Produce Results, Lumeon Finds

Posted on November 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.

A rigorous look at organizational processes, perhaps bolstered by new technology, can produce big savings in almost any industry. In health care, Lumeon finds that this kind of process re-engineering can improve outcomes and the patient experience too–the very Triple Aim cited as goals by health care reformers.

A bad process, according to Robbie Hughes, Founder and CEO for Lumeon, can be described as, “The wrong people have the wrong information at the wrong time.” One example is a surgery unit that Lumeon worked with on scheduling surgeries. The administrative staff scheduled the surgeries based on minimal contact with the clinicians–a common practice throughout the industry that might seem efficient. But unfortunately, people who are uninformed about the clinical aspects of the surgery make sub-optimal plans, directly leading to poorer outcomes. The administrative staff don’t use rooms and other resources effectively, and stumble over risks that the clinicians could have warned them about. Lumeon uncovered the problem during a single morning meeting with this particular hospital. By enabling the clinicians to better coordinate with the scheduling staff, the surgery unit more than doubled its presurgical screening capacity without asking for increased funding.

I recently wrote about a controversy over patient loads that erupted into a major political controversy (rarely a formula for rational process engineering). Thus, when talking to Hughes, I was sensitized toward the importance of good processes. The health care field is stuck in the kind of blindness toward process seen in the fictional medieval setting of Monty Python’s Jabberwocky, but some of the more forward-thinking institutions are doing the hard work of streamlining their processes. These include:

  • Cleveland Clinic, which reorganized their recommendations for patient behavior before and after surgery, called Enhanced Recovery After Surgery (ERAS)
  • BUPA, a major British insurer that has a formal process model
  • U.S. giant Kaiser Permanente, which uncovered enormous waste when clinicians search for supplies

The higher you rise above the scene, and the more you can think about the system rather than one silo, the more efficient you can become. The Kaiser inquiry covered the entire supply chain for each hospital. BUPA is fortunate to possess actuarial information that help it assign a predicted cost and likely outcomes to cancer cases, where the company can assign caretakers to patients as needed throughout the whole recovery process.

Another useful scope is the sequence leading from a patient’s initial contact to a successful outcome, a process or “pathway” that goes far outside the hospital’s walls and beyond the time in the doctor’s office or surgical unit.

Typically, Hughes says, one day is enough to find process improvements. Through interviews and through observation–because staff misunderstand and misrepresent their own processes–Lumeon can develop a process map, expressed visually like the post-operative pathway in the following figure.

Typical pathway, describing post-operative process

*Click to see Full Size – Typical pathway, describing post-operative process

The best motivation for taking a longitudinal view, of course, is risk-sharing. A doctor who will be rewarded or penalized for outcomes will be willing to invest in producing better outcomes. Similarly, an insurer such as BUPA will be motivated to reduce readmissions if it has a long-term responsibility for patients. Bundled payments are a round-about, highly diluted approach to risk-sharing.

Fee-for-service models mean having to define a deliverable that everybody can understand and achieve. A bundled payments model is far from this. UK outcome measures truly place risk on the provider. In the US, bundled payments dilute risk.

But Lumeon can find ways to improve processes even within a fee-for-service model by enabling health organizations to guide patients more successfully through their entire health journey. For instance, with the company’s Care Pathway Management solution, doctors can remind patients to come back in five years for a colonoscopy, thus potentially saving lives while ensuring the institution’s own revenue stream under fee-for-service. Other simple goals can be to make sure the patient has a complete list of tasks prior to surgery (such as not to drink water in the morning) in order to eliminate late starts or last-minute cancellations, which are very expensive as well as frustrating. Predictably, Lumeon finds a certain set of common problems over and over, regardless of medical disciplines or institutions. Hospitals sometimes optimize within each department, but not across multiple departments. Usually this change comes down to maximizing compliance with a known protocol, rather than trying to use sophisticated artificial intelligence techniques to look for new approaches that theoretically offer benefits.

Lumeon also works to minimize disruptions to existing workflows. Large institutions such as Kaiser can tell everybody to adopt a whole new way of doing things, but staff within most institutions might be more resistant. The staff can still be trained to do things like create quality standards and follow them, or call patients at certain intervals or after a procedure, but these processes need training before they become reliable and predictable. Culture and habit, not technology, turn out to be the biggest barriers to process improvement.

Software, too, must be molded to current ways of working. We all experience little tolerance in our work or everyday lives for non-intuitive computer interfaces that appear to be putting barriers in our way. For instance, I have never forgiven my phone vendor for changing the most common activity I do on the device (turning airplane mode on and off) from a three-step process to an eight-step process.

The most effective persuasion is evidence-based. If an institution can get one department or doctor to adopt a new process, and can then collect data showing that it improves outcomes and cut costs, other departments are likely to follow along. In contrast, staff are likely to be oblivious to a study from a journal with statistics from clinical trials, no matter how scientifically valid the study may be. Hughes says that resistance to change is often attributed to doctors, but he thinks that this resistance is primarily caused by change being forced on them without evidence. With proper, objective data supporting a change, doctors are often the first to lead new initiatives in the spirit of delivering better patient care.

New kinds of records are needed to keep track of outcomes and make use of the valuable data they provide. Ideally, Lumeon would integrate with electronic medical records, but the EMRs are rarely set up to hold and provide such information. Instead, Lumeon installs software on top of the EMR, calling their addition an “agility layer.”

Hughes identified two common practices that can interfere with process improvement. The first is the growing focus around “patient engagement,” which can be as superficial as sending reminders for online check-ins or as fundamental as giving patients access to data.

However, patient engagement by itself is not sufficient to deliver meaningful process improvement. Patient engagement measures can make a difference as an integral part of an effective operational process. For instance, there is no point in getting patients to fill in data online if it’s not going to be used by the clinicians.

Second, the focus on documenting compliance with standards, such as meaningful use, often becomes a documentation exercise rather than a way of improving care. Unfortunately, this is a problem that is seen all over the world by well-intentioned governments and funders who want to offer incentives for good behavior by paying for better processes. But this all too often ends in additional costs and effort to administer the care, rather than actually focusing on the basics.