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This is the next post in my series of Do's and Don'ts Healthcare IT. As we all know, some of our most important citizens live in rural settings, small cities, the countryside, or remote areas. These areas have smaller populations and less direct access to vital healthcare resources. In the past 15 years or so we've made some great strides in remotely accessible healthcare; these offerings, called telemedical tools, provide important clinical care at a distance. Here are some do's and don'ts of telemedicine:
What do's and don'ts would you add to a telemedicine strategy? Drop me a comment below.
I recently wrote, in Do's and Don'ts of hospital health IT, that you shouldn't make long-term decisions on mobile app platforms like iOS and Android because the mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A couple of readers, in the comments section (thanks Anne and DDS), asked me to elaborate mobile and mHealth strategy for healthcare professionals (HCPs) and hospitals.
A couple of the key points were:
The approach I recommend right now for mobile apps, if you're developing them yourself, is to stay focused on HTML5 browser-based apps and not native apps. So, to answer Anne's and DDS's question specifically, no you shouldn't wait to allow usage of mobile apps by anyone; but, if you're looking to build your own apps and deploy them widely (not in simple experiments or pilots) then you shouldn't write to iOS or Android or WP7 but instead use HTML5 frameworks like AppMobi and PhoneGap that give you almost the same functionality but protect you from the underlying platform wars. In the end, HTML5 will likely win and it's cross-platform and quite functional for most common use cases. If you're not developing the apps yourself and using third-party apps, then of course you must support the use of iOS native, Android native, and soon Windows native apps on your network.
So, from a general perspective you should embrace mHealth but do so in a strategic, not tactical manner. Here are the most critical questions to answer in a mHealth strategy — it's not a simple one size fits all approach:
If there is interest in this topic, I will expand on my list of Do's and Don'ts — mHealth is a very complex topic and requires a good strategy. Just saying that you allow the use of mobile devices like smartphones in your hospital is not an mHealth strategy.
In case you haven't seen it, MU attestations data is now available on Data.gov and it includes analyzable vendor statistics.
The data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the National Coordinator for Health IT, Certified Health IT Products List. This new dataset enables systematic analysis of the distribution of certified EHR vendors and products among those providers that have attested to meaningful use within the CMS EHR Incentive Programs. The data set can be analyzed by state, provider type, provider specialty, and practice setting.
The data set does not include dollar amounts or the difficulty of attestation (e.g. how many times it took to pass). I'll try and find out if that data might be available in the future. It's also unclear whether the provider counts were broken up into each line (meaning one provider per row) or if multiple providers were aggregated into lines (meaning multiple providers were grouped).
The dataset is available now on Data.gov at http://www.data.gov/raw/5486 and is worth checking out. Since the file has been downloaded over 75 times, it's clear some of you already know about this so if you've done some analysis with it; if you've done any analysis or posted results please drop me a note below so that everyone can benefit.
Last year I started a series of "Do's and Dont's" in hospital tech by focusing on wireless technologies. Folks asked a lot of questions about do's and dont's in other tech areas so here's a list of more tips and tricks:
One of the most important activities you can undertake before you begin your EHR implementation journey is to standardize and simplify your processes to help prepare for automation. Unlike humans, which can handle diversity, computers hate variations. Before you begin your software selection process, get help from a practice consultant to reduce the number of appointment types you manage, reduce the number of different forms you use, ensure that your charting categories ("Labs", "Notes", etc.) don't look different per patient type or physician, determine how you will manage medication lists and problem lists across the patient population, and deal with how you'll manage paper in your digital world.
If you spend even just a few hours a week doing the prep-work before you buy any software, you will be better prepared in your selection process. Without some level of standardization your EHR implementation will either fail, be delayed, or have many unhappy users; the more you can standardize and simplify, the more likely you will have a successful outcome. A strong project manager with authority to make decisions will be the difference maker in the simplification process.
To help you with your workflow assessment and standardization efforts, check out the The Agency for Healthcare Research and Quality (AHRQ.gov) Workflow Assessment for Health IT Toolkit. Even if you've done workflow assessments before, the toolkit is worth checking out.
As most of my regular readers know, I work as a technology strategy advisor for several different government agencies; in that role I get to spend quality time with folks from NIST (the National Institute of Standards and Technology), what I consider one of the government's most prominent think tanks. They're doing yeoman's work trying to get the massive federal government's different agencies working in common directions and the technology folks I've met seem cognizant of the influence (good and bad) they have; they seem to try to wield that power as carefully as they know how. Since most of you are in the technology industry, albeit specific to healthcare, I recommend that you learn more about NIST and the role it plays – they can make your life easier because of the coordination and consensus building work they do for us all. I, for one, was thrilled when NIST was picked as the governing body for the MU certification criteria. These guys know what they're doing and I wish they got more involved in driving healthcare standards.
A few years ago NIST came up with the first drafts of the seminal definitions of Cloud Computing; they ended up setting the stage for communicating complex technical concepts and helping making "Cloud" a household name. After 15 drafts, the 16th and final definition was published as The NIST Definition of Cloud Computing (NIST Special Publication 800-145) in September. It's worth reading because it's only a few pages and is understandable by the layperson. No computer science degree is required.
Yesterday I was speaking to a senior executive in the EHR space and we had a great discussion on what healthcare providers are doing in terms of cloud computing and how to communicate these ideas to small practices as well as hospitals. It reminded me of the numerous similar conversations I've had with other senior executives we serve in the medical devices and other regulated IT sectors. In almost every conversation I can remember about this topic over the past couple of years, I had to remind people that NIST has already done the hard work and that we can, indeed, rely on them. Most of the time the senior executive was unaware of where the definitions came from so I figured I'd put together this quick advisory.
My strong recommendation to all senior healthcare executives is that we not come up with our own definitions for cloud components – instead, when communicating anything about the cloud we should instruct our customers about NIST's definition and then tie our product offerings to those definitions. The essential characteristics, deployment models, and service models have already been established and we should use them. When we do that, customers know that we're not trying to confuse them and that they have an independent way of verifying our cloud offerings as real or vapor.
Below I have copied/pasted from NIST 800-145 their key definitions. Imagine how many debates you would avert with technicians at clients when, during conversations with a client, you communicated some of the following information first, showed them how it was a "standard definition" and handed them a copy of the publication, and then mapped your offerings and discussions to the different areas. Your sales teams and the marketing teams would appreciate the clarity, too.
Note that you do not need to map every offering you have to every definition – just start mapping the obvious ones and then figure out how you can communicate the "gaps" as being not applicable to your products / services or if those gaps will be filled in the future as part of your roadmap. Treat these definitions as canonical but not inclusive – meaning that just because your SaaS offering doesn't fit every essential characteristic doesn't mean that you're not "cloud" – it just means partially cloud.
If you've got questions about how to map your product offerings, drop me some comments and I'll assist as best as I can.
Here are the key definitions from NIST 800-145, copied directly from the original source:
Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics, three service models, and four deployment models.
Essential Characteristics:
On-demand self-service. A consumer can unilaterally provision computing capabilities, such as server time and network storage, as needed automatically without requiring human interaction with each service provider.
Broad network access. Capabilities are available over the network and accessed through standard mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile phones, tablets, laptops, and workstations).
Resource pooling. The provider's computing resources are pooled to serve multiple consumers using a multi-tenant model, with different physical and virtual resources dynamically assigned and reassigned according to consumer demand. There is a sense of location independence in that the customer generally has no control or knowledge over the exact location of the provided resources but may be able to specify location at a higher level of abstraction (e.g., country, state, or datacenter). Examples of resources include storage, processing, memory, and network bandwidth.
Rapid elasticity. Capabilities can be elastically provisioned and released, in some cases automatically, to scale rapidly outward and inward commensurate with demand. To the consumer, the capabilities available for provisioning often appear to be unlimited and can be appropriated in any quantity at any time.
Measured service. Cloud systems automatically control and optimize resource use by leveraging a metering capability1 at some level of abstraction appropriate to the type of service (e.g., storage, processing, bandwidth, and active user accounts). Resource usage can be monitored, controlled, and reported, providing transparency for both the provider and consumer of the utilized service.
Service Models:
Software as a Service (SaaS). The capability provided to the consumer is to use the provider's applications running on a cloud infrastructure2. The applications are accessible from various client devices through either a thin client interface, such as a web browser (e.g., web-based email), or a program interface. The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings.
Platform as a Service (PaaS). The capability provided to the consumer is to deploy onto the cloud infrastructure consumer-created or acquired applications created using programming languages, libraries, services, and tools supported by the provider.3 The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, or storage, but has control over the deployed applications and possibly configuration settings for the application-hosting environment.
Infrastructure as a Service (IaaS). The capability provided to the consumer is to provision processing, storage, networks, and other fundamental computing resources where the consumer is able to deploy and run arbitrary software, which can include operating systems and applications. The consumer does not manage or control the underlying cloud infrastructure but has control over operating systems, storage, and deployed applications; and possibly limited control of select networking components (e.g., host firewalls).
Deployment Models:
Private cloud. The cloud infrastructure is provisioned for exclusive use by a single organization comprising multiple consumers (e.g., business units). It may be owned, managed, and operated by the organization, a third party, or some combination of them, and it may exist on or off premises.
Community cloud. The cloud infrastructure is provisioned for exclusive use by a specific community of consumers from organizations that have shared concerns (e.g., mission, security requirements, policy, and compliance considerations). It may be owned, managed, and operated by one or more of the organizations in the community, a third party, or some combination of them, and it may exist on or off premises.
Public cloud. The cloud infrastructure is provisioned for open use by the general public. It may be owned, managed, and operated by a business, academic, or government organization, or some combination of them. It exists on the premises of the cloud provider.
Hybrid cloud. The cloud infrastructure is a composition of two or more distinct cloud infrastructures (private, community, or public) that remain unique entities, but are bound together by standardized or proprietary technology that enables data and application portability (e.g., cloud bursting for load balancing between clouds).
The P Wave P waves are caused by atrial depolarization. In normal sinus rhythm, the SA node acts as the pacemaker. The electrical impulse from the SA node spreads over the right and left atria to cause atrial depolarization. The P wave contour is usually smooth, entirely positive and of uniform size. The P wave duration is normally less than 0.12 sec and the amplitude is normally less than 0.25 mV. A negative P-wave can indicate depolarization arising from the AV node.
Note that the P wave corresponds to electrical impulses not mechanical atria contraction. Atrial contraction begins at about the middle of the P wave and continues during the PR segment. The PR Segment PR segment is the portion on the ECG wave from the end of the P wave to the beginning of the QRS complex, lasting about 0.1 seconds. The PR segment corresponds to the time between the end of atrial depolarization to the onset of ventricular depolarization. The PR segment is an isoelectric segment, that is, no wave or deflection is recorded. During the PR segment, the impulse travels from the AV node through the conducting tissue (bundle branches, and Purkinje fibers) towards the ventricles. Most of the delay in the PR segment occurs in the AV node. Although the PR segment is isoelectric, the atrial are actually contracting, filling the ventricles before ventricular systole.
The QRS Complex In normal sinus rhythm, each P wave is followed by a QRS complex. The QRS complex represents the time it takes for depolarization of the ventricles. The Q wave is not always present. The R wave is the point when half of the ventricular myocardium has been depolarized. The normal QRS duration range is from 0.04 sec to 0.12 sec measured from the initial deflection of the QRS from the isoelectric line to the end of the QRS complex.
Normal ventricular depolarization requires normal function of the right and left bundle branches. A block in either the right or left bundle branch delays depolarization of the ventricles, resulting in a prolonged QRS duration.
The ST Segment The ST segment represents the period from the end of ventricular depolarization to the beginning of ventricular repolarization. The ST segment lies between the end of the QRS complex and the initial deflection of the T-wave and is normally isoelectric. Although the ST segment is isoelectric, the ventricules are actually contracting.
The T Wave The T wave corresponds to the rapid ventricular repolarization. The wave is normally rounded and positive.
Top 10 actions
Earth Day Canada president Jed Goldberg has identified his top 10 actions to make every day Earth Day.
1. Think before you act. Shopping has become a form of entertainment. While it can be difficult to avoid the seduction of advertising, Goldberg advises to think about what you need, not what you want, before you buy.
2. It's all about conservation. Goldberg says we need to make the shift from being "consumers" to "prosumers" – producing consumers – to conserve energy and resources. Planting a garden is a great way to start.
3. Go vegetarian one day a week. Meat production has a huge environmental impact. Eating lower on the food chain just one day a week helps to conserve water, reduce greenhouse gas emissions and preserve valuable farmland.
4. Rethink convenience. Goldberg says people do things because they perceive that it's easier, but easy isn't always what's best. Doing things in an environmentally responsible way can ultimately end up being more convenient and much cheaper, too! One example, stop buying bottled water and use tap water instead.
5. Eat and shop locally. Most of our food travels thousands of kilometres to get to our dinner plates. Ditto for our clothing and other consumers goods. Supporting local businesses also helps to build strong local communities.
6. Vote with your dollar. Advertisers and producers are conscious of what consumers want says Goldberg. Take the time to express your opinion to store owners with your wallet and your voice.
7. Use active transportation. Whether it's walking, cycling or rollerblading, when you use your body to get from A to B instead of a motorized vehicle, you not only get the benefit of improved fitness while reducing your environmental impact, but you get to experience your community.
8. Borrow, don't buy. Consider renting, borrowing or sharing what you need.
9. Refashion your yard. Instead of trying to achieve the perfect, lawn, why not get rid of the lawn altogether. Plant native shrubs, wildflowers or a vegetable garden. You'll use fewer resources and free yourself from the lawnmower, too!
10. Use your sphere of influence. Collectively we have a great influence over our politicians, says Goldberg. Engage your family, friends, coworkers and community.
Our pancreas is affected by diabetes – specifically, Type 2.Our body contains glucose found in the blood stream, which it gets from the sugar in food. Our body uses the glucose, but only when it goes into our blood cells and the insulin released by our pancreas converts it. Insulin production and utilization is difficult for someone who lives with Type 2 diabetes .There is a lot of glucose in the body, but your cells cannot locate them.
The American Diabetes Association has the duty of looking for information regarding this important medical condition. 23.6 million individuals living in America currently have diabetes, and because of this the country is seen as very unhealthy. Ninety percent of this figure has been diagnosed with Type 2 diabetes. Diabetes and the tendency to be overweight usually run in the family. If there is too much glucose in your body, it could result in serious internal organ damage and affect one's nervous system.
Living with Diabetes
A life with Type 2 diabetes is best lived in a healthy way. Diabetics will find that healthy practices will have a huge effect on them. Simple actions like eating healthy food and exercising are considered as healthy practices. Keeping the levels of your glucose within the appropriate range ensures you stay away from health complications.
To check the levels of blood glucose in your body, you can do the common finger prick test. Physicians say that such a test is comparable to the HbA1c test when tracking the glucose fluctuations in your body. This HbA1c test works by determining how high your glucose levels are and by identifying the blood's exact glycated hemoglobin percentage. According to results of the A1c tests, people who have diabetes maintain their levels at seven percent. A seven percent maintaining level of a1c, according to the CDC, can dramatically reduce the risks of this disease by around forty percent.
Too-Tight Controls
Many studies in the medical field show that if your a1c levels are below seven percent it could mean a bad thing. People who use insulin and people who have median a1c levels have a higher death risk, according to the Seattle Lancet and Swedish Medical Center's studies. Other tests maintain that keeping your a1c level at seven percent is still on the healthy side. Accredited endocrinologist Matt Davies shares that seven percent is healthy but it is still important for physicians to consider a patient's medical history before implementing treatment.
About the Author – Kristina Ridley writes for the bloodless glucose meter blog , her personal hobby blog focused on healthy eating and tips to measure blood glucose levels at home to help people understand early diabetes symptoms.
SmartOne ECG is a self-service consumer portable heart monitor for checking abnormal heart rhythms.
The device can safely measure electrical activities of the heart using one's finger tips without the need for any trained technician.Upon placing thumbs on the sensor panel of the portable ecg machine,a digital output of the heart rhythm is displayed.If the reading displays any abnormal heart rhythm,it indicates the user the type of abnormal heart rhythm.Atrial fibrillation is an important risk factor for stroke.
According to the WHO,15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community.
The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media. In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations. I also include a few examples of where social media is contributing to a more effective workplace in hospitals.
Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.
Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies.
I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology. It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.
Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life. And, I believe that this applies to older adults in general. There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.
I remember older adults thinking it was a bit silly for people to carry around a cell phone. But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else. If I'm correct, I also I believe this is how telephone adoption went. It took a long time for it to catch on and for people to find value in the technology.
Health IT is just one more advancement that needs to progress through the adoption cycle.
I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously. However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.
Candy Stripers at Doctors Memorial Hospital, FL
I'd love to here your thoughts or stories about the youngest of our hospital workforce! If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com
I'm thinking I should also start researching the Pink Ladies, too!
The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism. I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.
All Changes to the Manual since the 2005 (fifth) edition
Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH). This means anyone can see the nosocomial infection rates of their local hospital by unit. But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital. Hospitals may be interested in using this data to benchmark themselves against other hospitals.
Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.
HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:
Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.
I participated in this morning's Gartner Worldwide IT Spending Forecast. Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time. The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.
The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand. There is some uncertainty about this timeline.
This means:
One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one. In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).
PC and software spending is down due to the downturn in the economy. But, there was one bit of good news that I pulled from the discussion on software. Spending on software (tools) for collaboration is increasing. Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people.
Now, I've been seeing this in other industries and have started to see it trickle into healthcare. With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.
AUSTIN, TX– Oct. 19, 2011–Drummond Group Inc. (DGI), the trusted interoperability test lab, last week submitted to the DEA its e-Prescribing of Controlled Substances (ePCS) Certification Process documentation. The DEA is currently reviewing this ePCS Certification Process for approval. Upon approval, DGI will be providing ePCS certification to healthcare software companies with the capability of e-Prescribing controlled substances.
Since 2005, Drummond Group has been the lead auditor and certification organization for the DEA's final rule regulations on the Controlled Substance Ordering System (CSOS). CSOS enables drug manufacturers, distributors and pharmacies to electronically automate the order and fulfillment supply chain of controlled substances. Drummond Group also serves as an Authorized Testing and Certification Body (ATCB) under the Health and Human Services' (HHS) electronic health records (EHR) certification program and has certified more than 450 software applications, including e-Prescribing solutions, since its inception in 2010.
For complete press release, please click here.
Last month, Steven Posnack, director of the Federal Policy Division within the Office of the National Coordinator for Health (ONC), wrote a very helpful blog on fact and fiction related to the ONC certification program. We have recently had many questions related to Drummond Group's involvement in the ONC Permanent Certification program and related certification. Here is our own QA session for questions and how that affects certification from the current Temporary Program.
Question: What is difference between the Permanent Certification Program and the Temporary Certification Program? What about ATCBs and ACBs? Is ANSI now involved in certification?
Answer: The Temporary Certification Program and the Permanent Certification Program are ultimately about the governance of the testing and certification program, specifically, the bodies that are testing and certifying, like Drummond Group. Their work and requirements are, in most ways, outside the concern of EHR vendors and HIT users. Meaningful Use measures and ONC certification criteria are completely separate from the Final Rules governing both certification programs.
The requirements within both programs are very similar. The chief difference is the accreditation method. In the Temporary Program, an organization like Drummond Group was required to take comprehensive tests and submit two sets of quality manuals: 1) for testing plans and processes and 2) for our certification processes. These were approved by ONC itself to be accredited as an ONC Authorized Testing and Certification Body (ATCB). In the Permanent Program, ONC is no longer acting as the accreditation body of either testing or certification although they will still oversee the program. Instead, there is a new ONC-Approved Accreditors (ONC-AA), ANSI, who will do the accreditation for the certification bodies as an ONC-Authorized Certification Body (ACB), and NVLAP, a division of NIST, will run the accreditation program for the testing bodies.
Question: Will Drummond Group be a part of the Permanent Certification Program? Will you also do testing?
Answer: Drummond Group's intention is to be an ACB (Authorized Certification Body), as well as an NVLAP accredited testing body for EHRs. We are currently working on preparations for approval in the Permanent Program.
Question: When will Drummond Group or others be named as ACBs? Do you have a timeframe?
Answer: We are really hesitant to even speculate on a specific date when ACBs will be open for business given there are many unknowns. Here is what we do know: NIST will be releasing the final testing accreditation requirements for testing agencies around December and will begin processing the applications on Jan. 15, 2012. We have no word from ANSI or ONC on details for applying to become an ACB, nor additional certification body accreditation requirements apart from the core ISO Guide 65.
Also, accreditation is just the first step. Only after you are accredited by ANSI for your certification quality procedures can you submit your application to ONC to be a part of the Permanent Certification program. In the Temporary Program, the submission to ONC to be an ATCB until official approval was a process that took approximately two months.
Question: Will there be new criteria to test and certify in the Permanent Program and will certified EHRs have to return and be recertified with an ACB to remain on the CHPL?
Answer: As stated above, the Temporary and Permanent Program Final Rules are ultimately about the governance of the testing and certification program but not about the criteria which the ATCBs or ACBs will certify. The testing requirements and certification criteria come from ONC separate from anything to do with the current state of the certification program.
Even in the Temporary Program, ONC could revise and update the certification criteria requiring products to be retested and recertified. In fact, they actually did make a revision to the public health surveillance criteria (170.302.l) in an interim rule in October 2010 although it did not require recertification. Eventually, the criteria will be updated when new meaningful use stages are introduced, but that is not connected with the timing or availability of the Permanent Program. Also, certified EHRs will not need to be recertified by an ACB simply because the ATCBs are dissolved with the closing of the Temporary Program.
Question: Once we are in the Permanent Program and new criteria are introduced, such as with Meaningful Use Stage 2, will certified EHRs to have to retest everything previously tested and certified in the temporary program?
Answer: On retesting previously certified criteria, the Permanent Program Final Rule does make a reference to allowing for "gap" certification of new or revised criteria added in later stages versus fully recertifying and retesting all criteria, including those unchanged from previous ONC rulings. However, it ultimately leaves this to the decision of the ACB. We (Drummond Group or any other ATCB) cannot speak definitely on this until we are an ACB and receive further guidance from ONC and possibly ANSI, which is the selected ONC-AA who will accredit us.
Question: In his blog, Steven Posnack stated that current CHPL certification will not expire. However, the certification seals issued in the Temporary Program make reference to 2011/2012. What does that mean?
Answer: Those 2011/2012 Certification Seal dates come from the ONC Final Rule on the Temporary Program, but they are not explicit expirations. Rather, they reflect what was anticipated as the timeline of the criteria and associated Stage 1 Meaningful Use measures.
It ultimately depends upon the current module criteria requirements. If they are not updated, then the certification is still valid.
As a testing company with more than a decade's worth of experience, we've certified many software products across multiple industries. In the process, we've worked with quite a few certification and standards-setting bodies.
For the past several months, we've been busy in the healthcare industry, working under the auspices of the government's electronic health records incentive program. As a matter of fact, since becoming an Authorized Testing and Certification Body (ATCB), we've certified more than 300 electronic health records systems using a testing script developed by National Institute of Standards and Technology (NIST) for the Office of the National Coordinator for Healthcare Information Technology (ONC-HIT).
Although we've tested systems for a variety of standards-setting groups, we weren't quite sure what to expect when we started working as a testing company under the purview of the Health Information Technology for Economic and Clinical Health (HITECH) legislation – a behemoth government program to say the least.
Much to our delight: We're really happy with the way things are going so far.
Why? First, we think the leaders in the government program got it right. The powers-that-be managed to develop clear technical requirements without imposing restrictive implementation methods, making it possible to ensure that certified EHRs all perform at a certain level, but also leaving enough flexibility for EHRs to meet specific user needs and for developers to continue to innovate. It's a tricky balance but one that the ONC seems to have mastered quite well.
As a result, there's plenty of room for developers to come up with products that push the envelope with new features and functions or to tailor systems to meet the very specific needs of certain specialists such as OB-GYNs, chiropractors or plastic surgeons. At the same time, end-users can rest easy, knowing that software systems that have been certified actually live up to the specifications that will make it possible for them to meet the government's meaningful use requirements and, subsequently, qualify for their share of the federal government's incentive funds.
We're also happy with our work in the program. We feel that Drummond Group has been able to add value to the overall process by infusing a healthy dose of neutrality into the testing and certification process. Steadfastly maintaining neutrality has, after all, been a concept that we have built our company on since the beginning.
Although happy to be a member of the healthcare IT community, we purposely shy away from becoming deeply involved in professional coalitions or advocacy efforts. As such, when we test a product, we test a product. We don't have to worry about the fact that an industry coalition spoke out against one of the ONC test requirements because our neutrality would keep us apart.
In essence, we make sure we don't attach to anything else, so that the only thing we are attached to is testing. It's a singular focus that serves software developers and the overall mission of the HITECH program well.
It's complicated. That's how many hospital leaders describe their electronic health records initiatives. These hospitals – instead of having a neat all-in-one EHR solution driving their efforts – have moved toward electronic records by cobbling together a variety of off-the-shelf, customized and possibly even home-grown solutions.
If you work at one of these facilities, you are probably all too familiar with the complications. And, when it comes time to get the stamp of approval needed to qualify for incentive funds, you probably don't know exactly where to start. No worries. Drummond Group is ready to help. We're taking applications from hospitals that want to achieve ONC-ATCB 2011/2012 certification for their unique EHR solutions. We stand ready to help hospitals in this situation move forward by testing their solutions to gain the certification required to move toward meaningful use.
Best of all, though, we are gearing up to truly offer more than a cursory certification. With more than 10 years of software testing experience, we have the interoperability know-how that you can tap into to truly get your miscellaneous solutions working together as one unified EHR. Having worked in a variety of complicated industries, we have encountered many difficult software and integration testing scenarios – and have had to evaluate a wide variety of software configurations from the simplest, out-of-the-box applications to complicated solutions derived from a variety of cobbled-together software applications.
What's more, we are truly committed to meeting the specific needs of healthcare providers. We are presently answering inquiries with hospitals and working on setting up certifications for them. And, while we are ready to start working with you today to qualify your customized or home-grown system for certification, we plan on rolling all of our know-how up into a formal service offering early next year.
Remember, though, to achieve ONC-ATCB 2011/2012 certification, EHR software has to be tested based on the official criteria as defined by ONC. Authorized Testing and Certification Bodies (ATCBs) test and certify the software and then HHS approves and lists these certifications on the Certified Health IT Products Listing (CHPL). Customized programs for hospitals or specific specialties – while designed to help meet the unique needs of various classes of HIT vendors — are not required for the certification that will enable your organization to meet meaningful use incentives.
We're often asked why we jumped into the healthcare industry. Our answer: It's simple Business 101 logic. We saw a need and we knew we could fill it.
First, we started hearing from healthcare information technology vendors about the need for software testing. We investigated and discovered that the Department of Health and Human Services (HHC) Office of the National Coordinator (ONC) for Health Information Technology was recruiting organizations to serve as Authorized Testing and Certification Bodies (ATCBs) to provide the stamp of approval to electronic health records (EHRs) that would be used by healthcare provider organizations as they seek to qualify for incentive funds under the American Recovery and Reinvestment Act.
All of this opportunity, of course, piqued our interest. Realizing that we really had something special to offer the healthcare industry, however, made us take the plunge.
Most importantly, we felt that we could offer the efficient and effective software testing that the industry needs –as vendors are scrambling to meet the needs of providers with officially certified EHR solutions. Because we have tested complex software products in a plethora of industries for more than a decade, we have what it takes to get the job done. As a result, vendors can quickly and affordably get their EHR solutions listed on the Certified Health IT Products Listing (CHPL) – and providers can use the solutions to qualify for incentive monies.
Our vision extends beyond the short-term, though. We also realized that we could offer healthcare information technology companies the testing services that they will need as meaningful use requirements evolve—and become more complex. Because of our extensive testing experience, we have become experts in interoperability and privacy issues. Also, we feel that we will be able to help healthcare IT vendors with these issues as meaningful use evolves.
Drummond Group's ONC-ATCB Certified EHR products have now been posted on the HHS Certified Health IT Products Listing.
Drummond Group's ONC-ATCB EHR Program
Problems viewing the HHS Certified Health IT Products Listing?
Please go to http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204
Home page of healthit.hhs.gov and look under "What's New"
Questions? Shoot us an email at email@example.com
Hew (hyū) v.
"In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it." – Michaelangelo
An unfinished Michealangelo sculpture.
I just re-read this quote – I think it is a powerful metaphor for any innovator that is out there trying to change the world.They are the ones that can see the fully defined, fully articulated, and fully functional end product within the building blocks that others pass off as mere landscape material. I think this gift of vision – this ability to "see" what others cannot – and the doggedness to stick to the mindless chipping away until others can see it enough to give you the tools you need to finish it off.
We are privileged to be working on a HUGE project right now with a highly innovative company that sees the value of what we are doing and wants to be a part of changing health care. It has been fun to work with them to begin the process of "hewing" away and to literally see the game changing product we have always seen begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding fingers. The process of discovery and refinement is almost as fun as seeing how the end product will move people.
I am on an email list of Bill DeMarco's, a reputable industry insider who has written and consulted extensively in the physician group and medical management space. He recently sent me a note about several physician aggregation events in New Jersey.
For some reason it struck a nerve with me . . . which led me to fire off the response below:
I thought we already saw this movie?
My question for you . . . besides banding together in some megagroup – what are these physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword excuse to aggregate physicians under a new moniker and a supposed new model.
I am highly suspect that these physicians are doing anything to change the relationship with their patients, to use enabling technology to create team based care, or actually be accountable for the outcomes they produce. What systems are they using to tie themselves together? What financial alignment do they have? What measures are they using to demonstrate superior outcomes? What about the patient experience – 7 minute visits that push pills as the "treatment" won't get it done in the future.
I think your closing statement, "Representatives from Summit and Optimus were unavailable for comment" says it all.
Am I seeing this the wrong way? Is there anything new about this model this time around? Am I getting old enough to see these things cycle through?
PS – and no, I don't mean a wolf. The sheep get nervous and band together waiting to get pounced on by wolves.
Relevant (rĕl'ə-vənt)
1. Having to do with the matter at hand; to the point
I read with amusement Susanna Fox's redux review about the relevance of Health 2.0 in general and in changing patient's behavior specifically. Here questions reveals her bias in a very limited definition of Health 2.0 that I attempted to abolish originally in some of my bantering with Matthew Holt. I always saw Health 2.0 as a "movement" that would not be defined so much by its technology but rather enabled by it. As an "enabler", the technology can help people do new things in new ways but I never believed technology in and of itself had the power to truly change health, health behaviors, or health care delivery in and of itself.
That is why my definition of health 2.0 was always more expansive and contemplated an entire "movement" to the next generation health care "system". This new system must include new delivery models, new financing mechanism, and the new tools and technology that bring all of this together in a simple, efficient, and affordable way. Clearly this next generation of care would include technology, the new tools, but until we had a new delivery system that is financed in a new way we are going to continue to have the same behaviors across the patient, physician, provider, and payor continuum.
So Susanna, I don't think your version of Health 2.0 (Tools and Technology) do much to get us to the behavior change you seek. In fact, getting to the root of behavior change requires almost a religious experience. Interestingly enough, the health care industry provides plenty of "religious" experiences including passing close to death, unbelievably poor customer experiences that invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we currently enjoy. So while the tools and technology show us what is possible, health care delivery and health finance are the catechismal doctrines we must reform first that actually incent the behavioral change we all seek.
So is Health 2.0 Relevant? I think it depends on your definition!
Extirpating (ĕk'stər-pāt') v.
I recently took a great road trip with my two boys. We rented one of the new Kia Soul's which my boys recognized from a very funny commercial developed to highlight its hipster (hamster?) vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy between two distinct choices.
This modern reinvention of that age old contrast struck me because it is something that I deal with everyday in explaining Crossover Health to people. It all stems from a pervasive misconception about the term "Health Insurance"
The challenge is that "Health Insurance" is a confused term which most people equate with both Health Care (care delivery) and Health Finance (how you pay for it). Our current employer based system (wherein your employer provides and in most cases pays for your insurance) as well as a third party insurance payment system (we have the insurance pay for us) creates all kinds of weird incentives but also results in no accountability in terms of cost, quality, or outcome. It is currently imploding before our eyes.
Our reaction, both opportunistic as well as obligatory, is to do something totally different by blowing up the current Health Insurance model and separating out Health Care from how you pay for it (Health Financing). We say that there is a better way to do BOTH – pay your physician directly for the care you need and then get smart about how you pay for it with the right insurance product. In fact, you should "self insure" with the highest deductible plan you can find and then take responsibility for your health for all the small stuff or hire someone to do that for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate with a parasitic organizations that are taking your premium dollars and wasting it on overhead, fancy offices, mindless phone trees, and my all time favorite "this is not a bill" disinformation pamphlets.
As people begin to take this in (they always get how the practice model is a radically improvement), they immediately revert back to the combined "Health Insurance" concept. Does Crossover Health want to replace my current "Health Insurance"? The answer is slightly nuanced, but a resounding YES! I want to replace what you call "Health Insurance" with a direct "Health Care" product (Crossover Health) and a smarter Health Finance product (highest deductible you can get).
We believe there are large and significant opportunities to roll this into a single product that can be purchased by employers, families, and other organizations seeking fresh alternatives that can demonstrate not only trend bending improvements but trend busting outcomes.
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient's blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn't even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, "going forward":
The real message to practitioners moving to electronic health records is, don't look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples' time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors' offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
"When doctors and hospitals use health IT, patients get better care and we save money," said Secretary Sebelius. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs."
The press release continues to state: "HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012."" (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn't it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don't bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company's own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don't think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don't put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
Researchers from the University of Tennessee Space Institute are developing a device which should make eye exams in children a whole lot simpler. The device is called the Dynamic Ocular Evaluation System (DOES) and it can screen the eyes for abnormalities, while the children watch a cartoon or play a computer game. Here's how it works:
"DOES is low-cost, high-quality, and operator- and child-friendly. It takes about a minute to train someone to use it. The test is done as the child watches a three-minute cartoon or plays a computer game. Infrared light is used to analyze the binocular condition and the assessment is reported on-site within a minute. Neither eye dilation nor verbal response is required.
Hidalgo out of Cambridge, England has released its new wireless Equivital EQ02 LifeMonitor that can continuously record ECG, respiratory rate, skin temperature, and activity levels in patients. Data is analyzed using special software for PCs, web and mobile devices and can provide real-time results that can be immediately acted upon by clinicians.
Hidalgo's technology has already been in use by UK's Cambridgeshire Fire and Rescue, Addenbrooke's hospital, and the US Marine Corps in Iraq where wireless, mobile, and easy to use devices save the day.
Agfa received FDA clearance for its DX-M digitizer with needle-based detectors for use in mammography and general radiography. It features the firm's MUSICA2 advanced image processing software, three image resolution modes (50 μm pixel pitch (20 pixels/mm), 100 μm pixel pitch (10 pixels/mm) and 150 μm pixel pitch (6.7 pixels/mm)), a "drop-and-go buffer" for cassettes so you don't have to wait for the digitization, and a number of other features that improve workflow.
The system can support both needle-based detector cassettes and standard phosphor plate cassettes, and the two types are colored differently to eliminate confusion.
While joint arthroplasty has become impressively advanced over the past few decades, the essence of the procedure still ultimately boils down to trial and error. Using pre-operative X-rays and intra-operative sizing guides, joint surgeons pick from a pre-set list of joint replacement "sizes." Then, once the bone cuts have been made, temporary implants called "trials" are used to see how the fit is, and the best fit is selected. Rarely are these pre-determined sizes a perfect fit, but they are usually more than sufficient and function quite well.
However, in the quest for perfection, patient-matched custom implants are beginning to increase in popularity. Stanmore Implants just announced the launch of their custom matched unicondylar knee replacement system dubbed "Savile Row," after the famous Tailoring destination. Unicondylar knee replacements are used in patients with isolated arthritis in one part of their knee and only replace the damaged portion.
Laser eye surgeries like LASIK and especially photorefractive keratectomy (PRK) can be painful on the eyes for a few days following the procedure. To alleviate the pain anesthetic eye drops are used, which have to be regularly administered by the patient. Not only is that inconvenient, but one can actually overdose a bit on them drops.
Now researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion. And since many of the patients that undergo eye procedures have been wearing contacts prior, they're already used to putting them on.
Medtronic announced receiving European approval for its Endurant II AAA Stent Graft System and will be making it available globally.
The device provides a minimally invasive (endovascular) option for addressing abdominal aortic aneurysms and includes a few improvements on the previous model:
It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I'm mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.
As you can imagine, HIMSS is a perfect place for me and my business. I've often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it's like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after "eating" too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that's why I love living in Las Vegas (which is also convenient for this year's HIMSS).
HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn't be surprised if this year it's somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can't find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.
What does all this mean? Well, as my mother always told me: You can't do everything. I'd always look at her shaking my head saying, "You're right….but I'm sure going to try." I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.
Press at HIMSS
I'm sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I'm going to have to apply a pretty strict filter.
What then are my filters?
First, if you're an EHR company, then I'm probably interested in connecting with you in some form. Although, if you're an EHR company that's just seen me and has nothing new to say, then I'll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I'm going to bring around my flip video and do an EHR series called "5 Questions with EHR Companies." I'll see how many EHR companies I can get to answer the same 5 questions.
However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I'm a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?
The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I'll love you and likely write about that content.
I didn't realize this when I started blogging, but I'm not like a lot of journalists. I don't go to any conference with stories in mind. I'm not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I'm trying to discover what stories are being told at HIMSS that are worth telling. I'm always happy when people help me find interesting stories.
Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that's an almost impossible task to ask anyone to do.
Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I'm sure I'll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here's a bunch more HIMSS related social media hashtags you might want to consider:
HIMSS Social Media Center
If you love social media like I do, then you're also going to love the HIMSS Social Media Center. They're doing a number of Meet the Bloggers sessions again and I've been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I'm on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian's HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O'Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.
New Media Meetup at HIMSS
More details coming soon. We'll have to work on Neil Versel's idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.
Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it's a little different days than it's been in the past. I personally like these dates better than the other ones.
There you have it. I thought I'd do a short post on HIMSS and I guess I had a lot more to say. I'd love to hear if you're going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.
And the most exciting part of HIMSS…seeing old friends and making new friends. I can't wait.
No related posts.
One thing that I love about this industry is its willingness to collaborate, and I'm not just talking about collaborative care. I'm talking about healthcare IT's propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you're going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.
I've been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in "Finding an EMR Job Champion," I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.
In his comments, he advocates for a mentor-protégé program: "Students still need some more help finding jobs. What I think needs to happen is a "Mentor/Protégé" model. That is, pairing students with industry professionals who can mentor them into the industry. I've passively done that…to success. I think that will work." He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.
I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:
It seems as if you've been kicking this idea around for a while. How did it come about?
Being with the extension center, I've mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don't think it's really been tightly coupled with the workforce development program.
When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS' career development page to look around and see what they have out there. I'm thinking of how we can connect [what they're already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that's in their region. That's what's really missing. That's what's really necessary to get people plugged into this profession – especially if they're coming from outside of this profession.
HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don't think it's really tightly coupled. I think HIMSS recognizes this, so they've been developing their career development program. They're near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don't need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they're looking to get a job. That could be part of the whole mentorship program concept.
Isn't there a double-edged sword to it financially? Wouldn't students have to become paying members of HIMSS, and then would they have to pay for certification? If they're looking for jobs, finances might be tighter than usual.
That's a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There's a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that's going to be part of my brainstorming session. I'm going to meet up with them in Vegas when I go out to HIMSS.
One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they're already unemployed or they're financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.
I wonder if the vendors couldn't get involved and offer scholarships.
It's funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.
If you're in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.
This is part of the whole brainstorming session that I'm going to try to have over the next month or so. I'll vet this through HIMSS over the next couple of weeks and hopefully we'll come up with a good strategy by the end of February. And then we'll start piloting it in the March timeframe.
I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It's nice to know that one industry insider's idea, and subsequent blog comments, might actually create job opportunity in the industry.
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I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of "Top 12 Legislative Issues of 2012." It's an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won't have to focus all of their initial energy on budget shortfalls.
Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.
One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients' health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.
The disturbing part of the report comes in the "Health: Reform in the states, health care exchanges, technology and benefits. Here's the section on health IT, the EHR incentive money and HIEs.
HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.
I love how this basically assumes that by having widespread adoption of EHR software, that we'll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can't even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.
The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.
In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.
So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need "an online file cabinet" for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn't connected and there isn't one patient record. Each doctor maintains their own patient record and that's not going to change any time soon.
The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven't gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn't think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn't have some sort of HIE program in the works.
Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn't that be nice if it were the case?
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EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know I have. My New Year resolution was a very unambitious I will exercise at least every other day, and I couldn't hold on to that for a week. However, all is not lost. Even if you're falling short on fulfilling your resolutions, you can still make a compelling video on some kinds of health IT related resolutions and maybe walk away with a decent cash prize. Don't know what I'm talking about?
The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.
Here are some examples listed on the ONCHIT website:
I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.
I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.
I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)
I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.
I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.
I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.
Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to get creative and create your own HIT resolutions.
Of course, being as it is 2012, and well into Web 2.0fication of our lives, it's not enough to make resolutions about improving our health. If you want to participate in the ONCHIT challenege, you'll have to find ways to incorporate health IT into your resolution. I've worked pretty much my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT can only solve some classes of problems, so I'm a bit wary when developers and programmers bring their hey-I-can-create-an-app-for-that attitudes whenever they're confronted with any problems. That said, I do think some aspects of health IT can be useful. And I'm excited to see what creative things people will come up with.
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Time for the next entry covering Shawn Riley's list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you're all enjoying the series as well. This is the second to last post in the series of EMR tips
10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.
9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it's unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don't have your IT staff spinning their wheels and cursing your name for a bad policy.
8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don't assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don't shy away from the truth. If your EHR software has doubled the time it takes to do something, don't be afraid to find that out. It's better to know that there's a problem and try to fix it than to let the problem fester because you didn't want to know the truth.
7. Make sure IT shadows the clinicians
I'd probably take this one step further. If your IT doesn't want to shadow the clinician, then you might want to find other IT. There's no way that IT can help to design the proper system for the clinicians if they don't understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you're talking about implementing an EHR. It's not nearly as pretty if they aren't dancing together.
6. Use predicative analytics
I'm definitely not an expert on predicative analytics and its application, so I'll just give you Shawn's summary:
Predictive analytics are old hat in most industries. However, health care hasn't put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.
If you want to see my analysis of the other 101 EMR and EHR tips, I'll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.
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As most of you know, I'm attending the Digital Health Summit at CES this year. As happens at most conferences, it's hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it's a literal zoo) and the packed CES Press Room. Although, I must admit that I haven't found too many things all that impressive. More on that later.
For today, I thought I'd give you a little picture view of what I call the Garden of Eden booth that United Health Group has at CES (click twice to see full size image):
They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They're also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I'm doing at CES. At least this time we're not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I'm not bitter).
Also, I'm surprised how few people know about SOPA. So I thought I'd do my small part to get the word out to more people. SOPA is an abomination that they're trying to push through Congress. Here's the tweet I sent out recently about it:
Join me & change your profile picture to protest SOPA: BlackoutSOPA.org #BlackoutSOPA #vegastech #HITsm
— John Lynn (@techguy) January 12, 2012
As you can see I've put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I'm good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I'll see if I can do a full post on why SOPA is bad if people are interested.
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"The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the "harms" vs. "benefits" groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40's, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, "whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models."1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women's lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women's healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc."