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Deep Thoughts from Einstein Applied to Health IT

Posted on May 13, 2015 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.


Ok, to be honest, I don’t really want to fact check if Einstein really said this or not. You might know how quotes from famous people were often not said by said famous person. However, that doesn’t really matter to me since the above quote was too interesting not to share.

I really like the idea that the key to solving really challenging problems is to stay with the problems longer. The biggest challenge I think we face in healthcare IT is that far too many people are running around like chickens with their head cut off. I understand completely why it’s happening. The regulations and stimulus have created this maniacal set of requirements that require a bit of running around like crazy people.

I don’t think the major problems of healthcare can be solved through a maniacal chasing of incentives and regulations that we see in healthcare today.

If we want to really go after and solve major problems, then we have to stay with the problems a little longer and not head off to the next problem too quickly or even ignore a problem that seems challenging or even impossible. I realize that this is much easier said than done. We easily let the fires of today prevent us from preventing the fires that will come tomorrow, next month, and next year. It’s natural to do.

The thing that gives me most hope is the amazing people working in healthcare. The majority are great people trying to make a difference for good. Now we just need those good people working in healthcare IT can take a bit more time and stay with the problems of healthcare a little longer before they move on to put out the next fire.

Things Your EMR Will Never Do

Posted on August 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMRs can be powerful tools for building practice efficiency.

But they can’t do it all.

Ruth Sara Hart-Schneider, sales and marketing director for Cincinnati-based Salix, says health care providers are still paying too many people to move too much paper. Her firm helps them to fill the gaps left after even the most successful EMR implementation.
Ruth Sara Hart-Schneider is sales and marketing director for Salix
Salix specializes in workflow automation, business process outsourcing and litigation support. Health care makes up about 30 percent of its workload.

Hart-Schneider works with physician practices, hospitals and a variety of other health care clients, such as durable medical equipment firms and clinical research organizations. She deals with 26 EMR systems.

Note: If you catch her hanging out by your fax machine, don’t be alarmed. It’s part of her job.

Here’s what Hart-Schneider had to say:

Can you explain more about what your company does in health care IT?

We support health care companies in leveraging the electronic data they already have. We help them to avoid having redundant systems or people hand-filling forms or electronic systems generating paper systems. We work around the electronic systems in an office, like EMRs and practice management systems. Usually an office will have both, but there are all these other functions that have been left on the table.

What are some examples?

Most EMRs we deal with are not set up for prior authorization requests. And every state has its own forms for different programs — Medicaid HMOs, workers’ compensation. Particularly for practices dealing across state lines, it becomes cumbersome for the staff. EMR companies don’t want to program all these forms for all the states, and they change constantly anyway. That’s a sweet spot for us. Prescription monitoring is another one if the practice is giving many narcotics. Also, EMRs don’t interface with many of the tools the carriers have out there for eligibility, benefits and claims status. Some other areas are disability, return-to-work forms, immunization logs for pediatrics and certificates of medical necessity for things like wheelchairs and oxygen.

When practices invest in EMRs, do they realize how much they’ll still need to do on paper?

They’re trying to meet meaningful use. When they choose a system, they know what it will do. It’s not a tool to manage your office. Still, people get frustrated with how many repetitive tasks their employees have to do even after all this money has been spent. For example, a group had a pulmonary function testing machine that wouldn’t talk to the EMR. They would print the report and then walk over and scan it into the EMR. A lot of equipment is like that.

How do you identify the inefficiencies in a practice?

If you stand by the fax for 10 minutes and watch what comes through, you’ll have a pretty good idea. You can also look around at the stacks of paper. You can ask people what they’re behind on.

How do you help?

Salix will work with an organization to help them identify their biggest pain points and then customize a solution that will free up staff time and save them money. We look for the best tools for each application. We like FileBound, which has an ASP model product that meets all the HIPAA security requirements, has a very reasonable price point and allows unlimited users without user fees.

Among our services: We can help with the auto-population of forms, we can provide data-entry services for labs and test results that are faxed in and we can help provide interface solutions for equipment that’s not hooked to the EMR. For a surgery practice, as one example, we can help design and implement systems so that the manager can look at tomorrow’s schedule and ensure that all pre-certs have been completed.

How important is it to address these areas?

Most often, there are higher-level tasks that aren’t getting done because staff is bogged down in some very menial, basic and repetitive tasks. You don’t need your nurse spending time on data entry or filling out school forms.

Is it realistic for a practice to go completely paperless?

Yes, but not in the near future. You couldn’t do it yourself. Vendors and everyone else that you deal with would have to be paperless, too, and that’s not happening. Many of the nursing home and hospice operators I talk to say they’re not going electronic because they don’t have the money. I think some things will always come in on paper.

Interoperability: The High Jump and The Long Jump with ONC’s Doug Fridsma

Posted on March 5, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I’ll admit, I was incredibly nervous about interviewing Dr. Doug Fridsma, the Chief Science Officer for the Office of the National Coordinator and the face of both the Standards and Interoperability (S&I) Framework and the Federal Health Architecture initiative. Not only do I consider him a key luminary, but his overarching responsibility for the future of interoperability and standards-based programs is incredibly alluring. I swoon over those who have the power and desire to effect meaningful, positive change on a grand scale. I wasn’t disappointed.

Doug explained his philosophy towards fulfilling the promise of interoperability with a sports metaphor: the high jump and the long jump.

“I don’t like high jumps,” he said. “High jumps, if you knock down the bar, you’re done and you get no points. Long jumps, you get points for each increment. The high jump for interoperability is ubiquitous data liquidity. The long jump is Meaningful Use.”

The S&I Framework project is tracking progress towards standardization and standards adoption across 5 areas of Meaningful Use and interoperability:

  1. Meaning – shared vocabularies across continuum of care
  2. Structure of messages shared across continuum of care
  3. Transport of messages
  4. Security of transport and messages
  5. Services for accessing messages

All of these categories are exemplified in the flagship project for Meaningful Use and interoperability: the Automate Blue Button Initiative, affectionately known as ABBI. For those not familiar with ABBI, do an experiment: ask your primary care provider whether you can visit a patient portal and download your medical records by clicking the “Blue Button.” If your PCP can provide you the website link to request the download, you should be able to receive your entire medical record (from that provider) in a vaguely huma-readable format (Excel, Word, PDF, etc.). The medical and clinical jargon may not make a lot of sense; however, it’s certainly an incremental hop in the long jump towards interoperability and standards adoption. The standard vocabularies, structure, transport mechanism, security protocol, and web-enabled access are foundational building blocks which enable the Blue Button program’s adoption.

Doug’s goal with the ABBI program was three-fold: get it OUT there, have providers and patients start USING it, and structure it so that it can be repeatable and scalable. Patient engagement advocates across the Twittersphere applaud the sentiment that we, patients, should have ownership of our health data, and many recognize the ONC’s efforts as instrumental in turning the tide for patient access. Several notable bloggers have covered the ABBI project in detail, analyzing its value to healthcare IT development professionals, providers, and patients, including:
Keith Boone @motorcycle_guy – the ABBI Pitch, with a quick overview of the goals for the program, and humorous insight into providers’ qualms about adoption

Greg Meyer @greg_meyer – Scalable Trust and Trust Bundles, with developer-focused details on the structure and transport categories of interoperability

For the next incremental long jump beyond ABBI and Meaningful Use Stage 2, Doug Fridsma and the ONC have several new initiatives tackling the atomic-level data governance and quality of clinical information. In order to communicate between disparate EHR systems, across multiple facilities and potentially multiple payers, it isn’t just the structure of the container and transport of the message that must be consistent: it’s the individual data elements, themselves, which comprise the meat of the message that must be standardized.

The ONC recently announced the Structured Data Capture Initiative with the goal of creating a technical infrastructure to support “structurally sound” standard data elements with support for “unique semantics”, to capture EHR and supplemental clinical data for use across the continuum of care. This effort officially kicked off the week of HIMSS 2013; its progress will be instrumental in broadening the effectiveness of interoperability and Meaningful Use.

So, as I walk the Interoperability Showcase at HIMSS13, watch the use case demonstrations, and ask the participants the tough questions like, “How are you incorporating the use case development you’re exhibiting here into consideration for your next product full release,” I’ll be taking note of those organizations that seem focused on the next incremental jump towards patient-centric, data-driven healthcare systems. And I’ll be wondering what Doug Fridsma and the ONC will do to get to the next incremental jump on the way to the nirvana of ubiquitous data liquidity.

…I’ll also be kicking myself for not taking the opportunity to get a fan photo with Doug while I had the chance.

What Would ONC’s Dr. Doug Fridsma Do? (THIS Geek Girl’s Guide to HIMSS)

Posted on March 2, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I know you’ve all been wondering how I’m planning to spend my mad crazy week at HIMSS in New Orleans. Well, maybe not ALL of you, but perhaps at least one – who is most likely my blog boss, the master John Lynn. Given the array of exciting developments in healthcare IT across the spectrum, from mobile and telehealth to wearable vital sign monitoring devices, EMR consolidation to cloud-based analytics platforms, it’s been extraordinarily difficult to keep myself from acting like Dori in “Finding Nemo”: “Oooooh! Shiny!” I’ve had to remind myself daily that I will have an opportunity to play with everything that catches my eye, but that I am only qualified to write and speak intelligently on my particular areas of expertise. And so, I’m proud to say I’ve finally solidified my agenda for the entire week, and I cannot WAIT to go ubergeek fan girl on so many industry luminaries and fascinating up-and-comers making great strides towards interoperability, deriving the “meaning” in “Meaningful Use” from clinical data, and leveraging the power of big data analytics to improve quality of patient experience and outcomes.

On Sunday, I’m setting the stage for the rest of the week with a sit-down with ONC’s Director of Standards and Interoperability and Acting Chief Scientist, Dr. Doug Fridsma. His groundbreaking work in interoperability spans multiple initiatives, including: the Nationwide Health Information Network (NwHIN) and the CONNECT project, as well as the Federal Health Architecture. For insight into his passion for transforming the healthcare system through health IT, check out his blog: From The Desk of the Chief Science Officer.

Through the rest of the week, I aspire to see the world through Dr. Fridsma’s eyes, focusing on how each of the organizations and individuals contribute to the standards-based processes and policies that form the foundation for actionable analytics – and improved health. I’ve selected interviews with key visionaries from companies large and small, who I feel are representative of positive forward movement:

Health Care DataWorks piques my interest as an up-and-comer to watch, empowering healthcare systems to improve outcomes and reduce medical costs by providing accelerated EDW design and implementation, whether on-premise or via SaaS solution. Embedded industry analytics models supporting alternative network models, population-based payment models, and value-based purchasing allow for rapid realization of positive ROI.

Emdeon, is the single largest clinical, financial, and administrative network, connecting over 400,000 providers and executing more than seven billion health exchanges annually. And if that’s not enough to attract keen attention, they recently announced a partnership with Atigeo to provide intelligent analytics solutions with Emdeon’s PETABYTES of data.

Serving an area near and dear to my heart, Clinovations provides healthcare management consulting services to stakeholders at each link in the chain, from providers to payers and supporting trading partners – in areas from EMR implementation (and requisite clinical data standards) to market and vendor assessments, and data management activities throughout. With the dearth in qualified SME resources in the clinical data field, I look forward to learning about how Clinovations plans to manage their growth and retain key talent.

Who doesn’t love a great legacy decommissioning story? Mediquant proports adopting their DataArk product can result in an 80% reduction in legacy system costs through increased interoperability across disparate source systems and consolidated access. The “active archiving” solution allows for a centralized repository and consolidated accounting functions out of legacy data without continuing to operate (and support) the legacy system. Longitudinal clinical records? Yes, please!

Those are just a few on my must-see list, and I think Dr. Doug Fridsma would be proud of their vision, and find alignment to his ONC program goals. But will he be proud of their execution?

Can’t wait to find out, on the exhibit hall floor – and in the hallway conversations, and the client case study sessions, and the general scuttlebutt – at HIMSS!

Interoperability, Clinical Data, and The Greatest Generation

Posted on February 21, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As a healthcare IT zealot and wanna-be policy wonk, I find myself mired in acronyms, and surrounded (and indulged) by those who understand my rapid-fire Klingon-esque rants on BETOS and LOINC and HCPCS. The larger concepts of interoperability and meaningful use lose the forest for the trees of IHE standard definitions and specific quality measures. Have we lost sight of the vast majority of the healthcare consumers, and their level of understanding and awareness of those larger concepts? Could you explain HL7 ORUs or CCDs to your great-grandma?

I recently visited my 90 year-old grandparents, both remarkably healthy multiple cancer survivors who show no signs of slowing down, and have maintained enough mobility to continue bowling 3 times a week. After an evening of pinochle, my grandma asked me to please help her understand what it is that I DO for a living. We’ve had this conversation before.

“I’m a healthcare technology consultant, Grandma. I work with insurance companies and doctors to help them get all your information.”

Puzzled look.

“When you go to the doctor, Grandma, do they write anything down on paper, or are they using a computer when they talk to you?”

“Oh, they’re always on those computers! Tap-tap-tap. Every question I answer and they tap-tap-tap.”

She illustrates by typing on her lap, and I confirm that she’s a hunt-and-peck person. She stops only after I finish asking my next question.

“Do you have private insurance, or do you use the VA?”

“I have Blue Cross. Your grandpa uses the VA.”

“How many doctors did you have to see for your blood infection?”

“FOUR! Sometimes two in one day!”

“Did they all have to ask you for your history?”

“No – they already had it, on their computer. They even knew about my mastectomy, 30 years ago. One corrected me on the date; I’d thought it was only 20 years ago.”

“Well, Grandma, when you booked your appointment with the first doctor, their computer system automatically requested your medical records from your insurance company. And the insurance company automatically sent your records back to the computer. After the first doctor made notes on your visit, just after you walked out the door, the computer sent an updated copy of your medical records back to the insurance company, and it ordered the lab tests you needed before you went to the next doctor. Then, the lab automatically sent your results to the insurance company AND the doctor who ordered the tests.”

“But the other doctors had the test results.”

“Yes, ma’am. Each time you made an appointment with a new doctor, that doctor’s computer requested your medical records from the insurance company, and the insurance company sent out the most recently updated information. It only takes a minute!”

“Goodness. So, do you build the computer programs that make all that work?”

Eyes wide. THIS impresses her.

“No.”

Puzzled look again, so I quickly continue.

“But I make sure those computer programs can talk to each other, and that the insurance company can make sense out of what they’re saying.”

“Because if they couldn’t talk to each other, I’d have to haul a suitcase from doctor to doctor with my chart?”

“Yes, ma’am. That’s called ‘interoperability’. There are new rules for how doctors’ computers should talk to each other, and to the insurance companies. And I get to work with the insurance company to do other really cool stuff. I take a look at LOTS of people’s medical records to find patterns that might help us catch diseases before they happen.”

“And what’s that called?”

“Clinical informatics. It’s my favorite thing to do, because I get to study lots and lots and LOTS of information. That’s called ‘big data’.”

“Sweetheart, you lost me with the computer words. But I’m just so happy you’re happy!”

She hugs me and grins, and I finally feel like I’ve found the right way to talk about my passion: through use cases. Although, Grandma would call them stories.

And there you have it: the importance of interoperability and clinical data, through the eyes of The Greatest Generation. Check in next year for an update on whether my definitions stuck!

FilmArray Delivers Test Results in An Hour

Posted on February 18, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Maybe it’s because I live in Utah, so it’s easier for me to recognize the technology being created here, but it seems as if lately, I’ve been noticing a lot of medical devices created here. Last night I was reading KSL.com about a device that was recently designed that can apparently detect certain diseases — and, most impressively, in under an hour.

Waiting for lab results can be excruciating. Although I have access to the patient portal for Intermountain Healthcare, and can see results as soon as they are done (which is, most of the time, much faster than waiting for the doctor to call), it still takes longer than I would like. FilmArray is a test that can detect around 20 diseases in less than an hour.

The diseases that can be detected can be viral or bacterial, and are related to upper respiratory infections. This could be pretty helpful, especially when you or your child goes to the doctor, and they can’t really tell what’s wrong just by looking at them or listening to their lungs. It can help to get treatment started quicker, and hopefully shorten the length of the symptoms.

FilmArray also eliminates the need for someone to spend a ton of time in the lab working the results, as it takes less than about five minutes of a tech’s time. It’s a machine that is easy to learn how to use, so staff can be trained fairly easily, without much disruption in the regular schedule.

This graphic from the FilmArray website shows how easily it works, from start to finish:

filmarray_setup

The device has been available since 2011, though I don’t get the impression that it’s very mainstream yet. I think this could be a great thing for doctor’s offices and hospitals to invest it, because of it’s quickly produced results, and the ease of use involved. Even with an initial investment, it seems as if the time saved will pay it off in the end.

Does Healthcare IT Need Stability?

Posted on February 12, 2013 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.

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

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

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

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

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

I think you get the picture.

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

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

Yes, Healthcare IT Adoption Is Expensive AND Painful!

Posted on December 4, 2012 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

We’re talking about an industry that takes an average of 17 YEARS to put significant medical discoveries into routine patient care practice. (Numerous sources confirm this: The Healthcare Singularity and the Age of Semantic Medicine Translating Research into Public Health Action, etc.)

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

</Mandi’s Rant>

Five Helpful Mobile Apps for Radiologists

Posted on November 27, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

After seeing the popularity of my post about great mobile apps for medical students, I thought I would do a few more posts like that, focusing on different types of medical professions. Today, radiologists.

There are TONS of mobile resources for radiologists. Granted, the best ones are rather expensive, but from what I gather, well-worth the cost. However, there are also some pretty handy free (or really inexpensive) ones as well. After doing some research, here are a few of the apps I think could be helpful for those in radiology. Unfortunately, they are all for iOS devices, though some may be available for Android in the future.

1) Diagnostic Radiology App

iMedicalapps.com made the claim that this app is “possibly the best radiology app for iOS.” This is actually more like an interactive textbook. There is a very comprehensive, searchable database with over 30 different cases. The results from each case can be hidden in order to help the user think up their own solutions. There are excellent image sets included in each case as well. The app is meant for the iPad, but apparently, works rather smoothly on the smaller iPod and iPhone screens. This specific app is geared toward abdominal radiology, though other emphases are in the works. The app does cost quite a bit at $44.99, however, there is a free version which apparently is still very good. One reviewer claimed that “this app is amazing. I . . . expected a freebie with perhaps a bit of useful content. How wrong I was.”

This app is amazing. I downloaded it yesterday and expected a freebie with perhaps a bit of useful content. How wrong I was.

Download the full version here, and the free version here.

2) RSNA Radiology

This app is for Radiology, a top-rated, peer-reviewed journal. It contains tons of great articles that can be easily searched, as well as sent to colleagues. The font size is also adjustable, which accomodates the young and old radiologist. There are also included podcasts which can be listened to through the app. As I mentioned, the articles can be searched, which is definitely useful if someone is looking for a specific part of a certain article. New research with commentary and critiques from different experts in the radiology world is one of the highlights of RSNA Radiology. This app is totally free, which is awesome, considering all the great resources that it includes. It isn’t currently available for Android devices, though it can be accessed from Android phones and tablets at m.radiology.rsna.org.

Download for iOS devices here.

3) Radiology Toolbox

According to the description on iTunes, Radiology Toolbox is “the radiologist’s ectopic brain.” This app was created to anyone involved in radioloy, from the student just starting their studies, to the seasoned radiologist. There are two versions, the lite and the pro, and each include useful tools such as a GFR calculator, gastric emptying times, and a radiographic contrast premedication. The pro version has a lot more tools like a adrenal adenoma calculator and charts of AFI, pediatric spleen, and kidney size. The apps are still in their beginning stages, so expect updates to come regularly, but this is definitely an app that anyone in the radiology field should have.

Download the pro version for 4.99 here, and the free version here. This app is only available for iOS devices at this time.

4) SeeMyRadiology Mobile

This app allows users to view medical images and reports, right on their mobile device! Not only that, but photos can be taken directly with the mobile device and saved directly to the app or shared with others. It is HIPAA compliant, a secure cloud-computing platform, and approved by Accelarad for medical image review. Images can be searched for very easily, using either a patient’s name, time-frame, or medical record number. There’s a bunch of other neat features, and the app creators have gone to great lengths to ensure the security of the app (such as requiring a pin after a period of inactivity, and making sure no PHI is stored on the device upon closure of a case.) The app goes hand-in-hand with SeeMyRadiology.com. Best of all, it’s free.

Download for iOS here.

5) Radiology 2.0: One Night in the ED

For those that can’t afford Diagnostic Radiology, or simply would like another reference guide, this is another great option with tons of features. It has different cases that can be viewed, and the user is able to act as if they are actually reading and interpreting the CT scan from a PACS workstation. There are over 7,000 images included in the app and hundreds of pages of information, all of which can be viewed offline. It’s an excellent way to improve one’s ability to interpret images. Important information is highlighted and explained, and images are shown in a very realistic way.

Download for iOS here (the complete version, for free!)

Although I only highlighted five apps here, there are many more worthy to be on this list. Feel free to let me know what your favorite radiology app is!

Is there a specific field of medicine you’d like me to find good apps for? Leave a comment, and I’ll put in on my list! 

Will EMR Adoption Bankrupt Medicare?

Posted on I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!