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Driving Innovation in Healthcare Forward Requires New Ways of Thinking – #HITsm Chat Topic

Posted on January 9, 2018 I Written By

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

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 1/12 at Noon ET (9 AM PT). This week’s chat will be hosted by Constance Sjoquist (@CASjoquist), Chief Content Officer at HLTH.co on the topic of “Driving Innovation in Healthcare Forward Requires New Ways of Thinking.”

Traditional channels for ideating, learning, and sharing ideas, products and services that can improve healthcare outcomes, lower costs and make it easier on everyone involved are changing. Health plan members, budding consumers, both new and long-time patients, sponsor payers, employers, providers, medical device companies, pharma companies and start-ups and investors all have a vested interest. Not to mention the various federal and state-level government agencies that regulate all of these constituents.

So how can all of us – ALL OF US – work together to improve healthcare outcomes and lower costs – all while making it easier on all of us?

This chat raises and explores some ideas to help drive innovation in healthcare forward. We need new ways of thinking. Gigantic conferences and one-sided media movements are not cutting it.

Come join this exchange on how we can ALL participate and contribute in the drive to make healthcare more innovative.

Topics for This Week’s #HITsm Chat:
T1: What are the primary reasons why the transformation of healthcare in the United States in 2018 and beyond is so difficult and challenging? #HITsm

T2: How can plan members, budding healthcare consumers, new & long-time patients, their sponsor payers, employers, providers, medical device companies, pharma companies & start-ups – help to reduce healthcare costs while improving quality of care? #HITsm

T3: In what ways can healthcare conferences, forums and media – traditional and digital – help to drive innovation in the health industry? And help to reduce healthcare costs while improving quality of care? #HITsm

T4: In what specific ways can disruptive technologies like #AI, #BigData, #MachineLearning, AR/VR, #3DPrinting, #PrecisionMedicine, Mobile & #IoT drive & support transformation of #healthcare? #HITsm (How’s that for too many hashtags!)

T5: Where can plan members, #healthcare consumers, new & long-time patients, their sponsor payers, employers, providers, medical device companies, pharma companies & start-ups look for examples of successful industry transformation? #HITsm

Bonus: What‘s one thing #healthcare conference organizers, the media that promote #healthcare & those that attend & support conferences help to move healthcare forward? What are they currently not doing? #HITsm

Upcoming #HITsm Chat Schedule
1/19 – How is society’s drive for everything “on demand” changing healthcare?
Hosted by Darin Vander Well (@DarinVanderWell) from @docutap

1/26 – Patient Portals and Chronic Disease Management
Hosted by Monica Stout (@MI_turnaround) from Medicasoft

2/2 – TBD

2/9 – TBD

2/16 – TBD

2/23 – TBD

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

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

Is A Cerner Installation A “Downgrade” From Epic? Ask This Guy

Posted on January 8, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t know if I’ve ever quoted a letter to the editor in a column for this publication, but I have to this time. I thought it had an interesting story to tell.

The letter, written by a patient at the Banner University of Arizona Medical Center in Tucson, offers a scathing critique what he sees “degradation of services” taking place after the institution switched from an Epic to a Cerner EHR, a change he refers to as a downgrade throughout the letter.

Since the “downgrade,” said the patient, John Kimbell, appointments take much longer. “Three weeks after the downgrade, my 30-minute appointment took three hours and 40 minutes,” he complains.

His other concerns include:

  • Data exchange problems: “My local doctor has TWICE sent results of a scan to my oncologist, and they never arrived.”
  • Privacy issues: With the automated paging system gone, “nurses call out names in the waiting areas in each clinic,” Kimbell notes.
  • Useless information: After Kimbell’s most recent appointment, he says, he was “handed out a 13-page printout that gave 12 pages information I didn’t need.” Before the Epic to Cerner switch, he reports, he was able to access this information online.
  • Communication issues: Kimbell says he never gets telephone call reminders of appointments anymore.

As Kimbell sees it, the quality of care has slipped significantly since Epic was switched out for a Cerner system. “All the cancer patients I have known while a patient there are in need of better care than Banner now provides,” he writes.

It’s important to note here that the Epic-to-Cerner switch-off took place in October last year, which means that the tech and administrative staff haven’t had much time to work out problems with the new installation. It may be the case that the concerns Kimbell had in late December won’t be an issue in a couple of months.

On the other hand, I do think it’s possible that as the letter implies, UMC owner Banner Health may have had reasons to push the Cerner install into the facility, most particularly if all of its other properties already operate using Cerner.

Regardless, if everything is as Kimbell describes, let’s hope it all gets back in order soon.  From the looks of things, UMC seems to offer a renowned cancer treatment program. Let’s hope that a quality program isn’t undermined by IT concerns.

Cerner $10 Billion VA Contract Comes To Screeching Halt

Posted on January 5, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

After Cerner captured the massive multi billion dollar contract to roll out its EMR for the Department of Defense, everyone was a bit stunned, as many thought Epic was a lock for the job.

Cerner seems to have been conducting the rollout as promised, so there’s that. But when it comes to its performance in meeting the requirements of its $10 billion contract with the VA, things aren’t looking as good. Apparently, Cerner’s DoD implementation isn’t sharing data well with Cerner’s VA systems. Oops.

According to Politico, the Cerner contract with the VA is running into serious questions about its capacity for fluid data sharing. The VA’s Cerner rollout has been held up by questions about its ability to interoperate with the DoD system.

VA Secretary David Shulkin, who’s perhaps the biggest critic of Cerner’s efforts, had his agency issue a request for information looking for examples of data-sharing solutions. Shulkin is proposing that the VA conduct tests of the system’s capacity for interoperability, in which the department would send patients through the VA system and see whether it can share useful data with the VA along the way. If the test has a bad outcome, it’s likely to ramp up the tension considerably.

What makes all of this particularly embarrassing is that the VA awarded the contract to Cerner without conducting the usual bidding process, largely because the agency believed having its own Cerner implementation would make it easier to share data with the DoD. Good luck with that, folks.

I’m sure that key managers on the VA project are freaking out at this point.  The combined multi billion dollars the DoD and VA have entrusted Cerner with represents a massive commitment, and when a customer that size starts questioning whether they’ve made a good investment, the ground must have begun trembling under Cerner’s feet. Not to mention the consultants from Leidos, etc who are charged with delivering a massive chunk of the project.

It’s hard to imagine that Epic isn’t seeing if it can take advantage of the situation. While it may not have the ability to horn in on the contracts themselves, I’m sure that it’s making sure customers know about what’s happening, and using the news to suggest that Cerner doesn’t have its act together.

I don’t know what will happen if the VA continues to find fault with Cerner, but it can’t be pretty.

Key Articles in Health IT from 2017 (Part 2 of 2)

Posted on January 4, 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 first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.

A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.

An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.

A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.

A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.

In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.

Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.

Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.

No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.

The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:

Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.

A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.

Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.

The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.

A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.

To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.

Specific technologies

Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.

Lots of intriguing devices are being developed:

Remote monitoring and telehealth have also been in the news.

Natural language processing and voice interfaces are becoming a critical part of spreading health care:

Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.

Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.

A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.

3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.

A number of other interesting companies in digital health can be found in a Fortune article.

We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:

I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.

What’s Trending in #HealthIT in 2018? – #HITsm Chat Topic

Posted on January 3, 2018 I Written By

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

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 1/5 at Noon ET (9 AM PT). This week’s chat will be hosted by John Lynn (@techguy), Founder of Healthcare Scene, the Healthcare IT Marketing and PR Conference, and Health IT Expo, on the topic of “What’s Trending in #HealthIT in 2018?

As we start 2018, we thought it would be appropriate for the #HITsm chat to take a short look back at 2017 and then to start looking forward to 2018. What are going to be the hot topics for 2018? What should we be doing to be prepared for what’s coming? What can we do to better improve healthcare in 2018? Plus, hopefully, you’ll also share some ideas for what you’d like to see from #HITsm in 2018 as well.

Join us as we dive into this topic during this week’s #HITsm chat using the following questions.

Topics for This Week’s #HITsm Chat:

T1: What was the biggest #HealthIT announcement, change, trend, etc in 2017 and why? #HITsm

T2: Which part of #HealthIT in 2018 are you most watching because you’re scared about what will happen? And Why? #HITsm

T3: Which part of #HealthIT in 2018 gets you most excited or will be most transformative? And Why? #HITsm

T4: What are you doing to prepare for what’s coming in #HealthIT in 2018? #HITsm

T5: What are some creative ideas/hosts/etc you’d like to see happen during #HITsm chats in 2018?

Bonus: What are your personal and/or career goals for 2018? #HITsm

Upcoming #HITsm Chat Schedule
1/12 – Driving Healthcare Innovation Forward Requires New Ways of Thinking
Hosted by Constance Sjoquist (@CASjoquist), Chief Content Officer at HLTH.co

1/19 – TBD
Hosted by Darin Vander Well (@DarinVanderWell) from @docutap

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.

Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 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.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

How Many Garage Entrepreneurs Are In Healthcare?

Posted on December 29, 2017 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.

The final image this holiday week comes from a tweet shared by David Chou. In his tweet e shares an image of some incredible companies that were founded out of a garage. Hard to argue with these companies and the success they’ve garnered:

When I look at this image I try to think of any massive healthcare companies have been started out of a garage. I couldn’t think of any off hand. Then I started to wonder if that’s a good or a bad thing. Would love to hear your thoughts.

What Does EHR and Health IT Mean for You?

Posted on December 28, 2017 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 I continue sharing a thought provoking image each day this holiday week, I think this image will rub people the wrong way. I know it causes a little bit of pain for me, but I thought it was worth sharing to see what other people think of it. It comes from SD Global Tech:

If this graphic doesn’t bother you, then you probably haven’t been in the EHR and healthcare IT world very long. While I do think that we start to take technology for granted very quickly, I also think that many in healthcare have heard these promises for decades and many of them feel very hollow. It’s much better to show an organization that you can really do these things than to share it in an infographic on Twitter.

Granted, this image was shared from a company in Malaysia. I’m not as familiar with healthcare IT in Malaysia. So, maybe this graphic is totally appropriate for their market. Although, I’d be surprised. My international experience has been that every healthcare organization around the world is suffering through very similar challenges.

EHR Physician Use by Time of Day

Posted on December 27, 2017 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 continue our holiday week of sharing interesting healthcare IT and EHR images, today’s image comes from the NEJM Catalyst. This image charts the Percent of total EHR work time against the hour of the day. Plus, it also splits it out into weekday work and weekend work.

The thing I hate about this chart is that it doesn’t show when doctors use to spend time doing paper charts. I still wonder how similar those charts would be. I’m just not sure we have that data anywhere.

6 Ways Blockchain Could Disrupt Health Insurance

Posted on December 26, 2017 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.

I’m taking this week mostly off from work to enjoy the holidays with family. So, this week we’re going to keep our blog posts simple. Each day this holiday week I’m going to share an interesting image, graphic, chart, etc.

This first image comes from a tweet by Christine Boursin who looks at ways blockchain could disrupt health insurance:

What do you think of blockchain’s potential impact on health insurance?