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The Challenge of Clinical Quality Measures – ONC Dashboard

The incomparable Mandi Bishop just pointed out to me an amazing ONC dashboard that’s tracking issues with the clinical quality measures (CQM). I don’t know how I’d never seen this before, but it’s a treasure trove of amazing information. I’m proud of ONC for being this transparent in their efforts to make the clinical quality measures as effective as possible.

It’s also an amazing illustration of how hard it is to get these clinical quality measures correct. As Mandi pointed out to me, Beta-blockers, for example, can’t be tolerated by Asian-Americans, but that’s a required CQM: prescribe beta-blockers within 24 hours of surgery for cardiac patients. That’s scary to think that a clinical quality measure could actually do harm versus improving quality.

We’ve heard this from doctors for a really long time. Medicine is complicated and each patient is unique. This dashboard illustrates many of those challenges.

Personally I think that the clinical quality measures were a step too far in the EHR incentive program. Although, I’ve long wished that all the incentive money would have been focused on establishing a standard for EHR interoperability and then paying organizations that were interoperable. That would do more impact for good on healthcare than these clinical quality measures.

What are your thoughts and experiences with clinical quality measures?

April 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Can We Learn Collecting System Data from How We Collect Medical Device Data?

We’ve been aggregating and sharing medical device data for a really long time in healthcare. Entire corporations are built around collecting and sharing medical device data with another healthcare IT system. If we’ve been able to share this data for so long, could we possibly learn from that experience and apply it to data collection and sharing in other health IT systems?

This is an open question which I hope you’ll join in answering in the comments of the blog. Many readers of this blog are more expert on this topic than I am. So, please chime in and add your thoughts. I think there is a real opportunity for us to learn from the past.

Here are a few of my thoughts:

Motivation – This is the biggest reason that medical device data collection and sharing happened. Organizations saw the value in having this data. I think we’re starting to see a shift in motivation when it comes to collecting system data in a healthcare organization as well. As I wrote about previously, we need data sharing as part of the Health IT procurement process. This will be a slow but important shift for many healthcare organizations. Otherwise you have lethal contracts that put huge financial barriers in the way of sharing data. ACOs and value based reimbursement will continue to motivate organizations to finally want to collect and share system data.

Standards – One of the benefits that device integration had was that there was more of a standard format for sharing the data. This is a lesson for other data system collection. We need a standard. Not a bunch of different flavors of standards, but a standard.

Multiple Standards – Some in the device space might argue that they had their own issues with standards. Every device company had their own standard and you had to integrate with each different device company. This depends on the device, but let’s just assume for a minute that this is indeed the case. How then were these organizations able to collect the medical device data? They just built up interfaces that understood each device’s standard. The key is that each company established a standard for their clinical device and stuck to that standard.

The challenge with other healthcare systems like EHR is that we have so many systems. Plus, even instances of the same EHR don’t follow the same standard. I’m not sure how to remedy this in the current EHR market, but it might be the key to us ever really collecting EHR data. I guess some would argue that market consolidation will help as well.

Connected Tech – One of the biggest challenges in the medical device space was having the technology in the medical device that allowed outside connectivity. Most new medical devices come with connectivity, but in the past you’d have to buy the connectivity separately and store it in a black box under the bed. This is a huge advantage for other healthcare IT software. The data is already connected to the internet.

Those are a few of my thoughts on what we can learn. I’d love to hear your thoughts.

April 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR and EHR Tops 400,000 Pageviews

I was flipping through my stats today and I was amazed to find that Hospital EMR and EHR just blew past 400,000 pageviews. We’re about 1 month away from the third anniversary for this site. I’d say that’s pretty amazing growth over that time period. Thanks everyone who’s been reading.

For those who love stats, we’ve published 583 posts in that time with 1844 comments. That means that a lot of you have been commenting on the site. Thanks so much!

I checked out the posts with the most comments and it was a tie between the following two posts:
Why Is It So Hard to Become a Certified Epic consultant?
Could Epic End Up The Victim Of Its Own EMR Success?

A couple of my other favorite posts are in the top 10 for comments:
Judy Calls Epic “Most Open System I Know”
“Old Boys Club” of Healthcare IT
Why Don’t We Groom the Next Generation of Health IT Leaders?

All of those posts are still really interesting today. I took a look at the stats for the most viewed posts and the above posts were all in there as well. That seems like statistics at work.

I wanted to recognize a key sponsor of Hospital EMR and EHR as well. Canon has been a sponsor of the site for a number of years now. If you need a scanner in your hospital (and sooner or later we all do), then take a look at the Canon products. I have a great Canon scanner in my office and I love that it just works. As much as I try to purge paper from my life, there are always many situations where I just need to scan something. I know in many hospitals they have dedicated scanning teams. Finding the right scanner for these people is really important. I appreciate Canon supporting the work we do on this site.

If any of you reading focus on the hospital healthcare IT market, we’d love to talk with you about our advertising options as well. Just drop us a note on our Contact Us page.

Thanks everyone for reading and supporting the site. We’ll keep providing the best quality information we can find.

April 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR and EHR Recruiting

Late last year, I acquired the healthcare IT career website Healthcare IT Central. Since bringing Healthcare IT Central into the Healthcare Scene family, I’ve dove head first into the healthcare IT Recruiting and career space. It’s been quite an adventure with a lot of great learning for me along the way.

What I’ve learned most is that there are some really amazing people working in healthcare IT and some really amazing companies that are trying their best to make healthcare better. There are a lot of screwed up things in healthcare, but the people are generally good people and a real pleasure to work with.

Health IT Job Seekers
If you’re in the job market and looking for a healthcare IT job, take a few minutes to register as a job seeker where you can upload your resume and apply for jobs at some of the top healthcare IT companies. Also, be sure to check out some of these popular job searches:

Of course, you can always do your own health IT job search using the criteria that matter for you. All of this is all free for the job seeker.

Health IT Employers
If you’re a health IT company or a hospital organization looking to hire qualified healthcare IT professionals, you can register and post your jobs as well. We just passed over 20,000 registered job seekers and are getting close to 11,000 active health IT focused resumes.

We also have other options available to employers like eNewsletter sponsorships (almost 16,000 email subscribers), webinars, and resume database access where you can search for specific candidates.

We’re working really hard to be an amazing health IT career resource for both job seekers and employers. If you have any feedback on the site and what we’re doing, we’d love to hear it on our contact us page.

April 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

A Meaningful EHR Certification

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

April 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Data Liberation Is The First Step Towards True Collaboration

I generally agree with this idea. It’s really hard to collaborate with someone if you’re not sharing the data about a patient. So, data liberation can be a true enabler for collaboration.

While I think most hospital CIOs will agree with this, I wonder how many act like data liberation is an important strategy for them. Is data liberation really a core value of their hospital organization? My guess is that for most of them it is not.

One major place they can start to make this part of the culture is in the procurement and contracting process. Software vendors are going to happily keep the data as closed as possible unless you require it of them in the contract stage. Once hospital systems make data liberation part of the IT systems procurement process, then we’ll finally be able to see the benefits of data liberation.

The problem we have today is that data liberation and sharing wasn’t part of the previous procurement and contracting process. My guess is that most assumed that being able to share data would be allowed, but few people looked at the fine print and realized what it would mean to them when it came to data sharing. Thus, we’re in a situation where many organizations have contractual issues which make data sharing expensive.

It will take a cycle of new contracts for this to be fixed, but even then it won’t be fixed if you’re organization doesn’t add this to their agenda. Software vendors happily provide the customer what they demand. We need more hospital organizations demanding data liberation.

April 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HIPAA Breach at Kaiser

Healthcare IT News reported that Kaiser had it’s Fourth HIPAA breach. Here’s a part of their description of the breach:

Some 5,100 patients treated at Kaiser Permanente were sent HIPAA breach notification letters Friday after a KP research computer was found to have been infected with malicious software. Officials say the computer was infected with the malware for more than two and a half years before being discovered Feb. 12.

We have confirmed that the infection was limited to this one compromised server, and that all other DOR servers were and are appropriately protected with anti-virus security measures,” said Tracy Lieu, MD, director of the division of research at Kaiser Permanente, in an emailed statement to Healthcare IT News. “It is important to note that the compromised server is used specifically for research purposes at the DOR and is not connected to Kaiser Permanente’s electronic health records system.

It’s quite interesting that in one part they say that the computer was infected with malware and that caused the breach. Then, they note that the antivirus software wasn’t being updated properly because of a “human error related to configuration of the software.”

This is a little disturbing to a tech person like me, because the person doesn’t know the difference between anti-virus software which works to stop and prevent viruses from infecting your computer and malware which usually isn’t covered by anti-virus software. They do have malware software to prevent malware, but it’s only so so in my opinion. It’s fighting a losing battle, but an important battle nonetheless.

I bet if we went into any hospital today, we’d find dozens of their computers infected with malware. Would be an interesting study for someone to do. I know many hospitals lock their computers down and block them from surfing many internet sites to try and deal with this problem. That can be pretty effective, but you do make many of your users angry in the process. The IT security people don’t mind that at all. Luckily, with phones people can still get their Facebook IV drip without having to infect the hospital computer. That is until the personal mobile phone gets compromised and infects the hospital network. That’s coming down the road as well.

April 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HHS Secretary Sebelius Resigns

The big news coming out of Washington yesterday was that Kathleen Sebelius is resigning as secretary of HHS. This is the end of a stormy 5 year tenure filled with Obamacare and the famed roll out of Healthcare.gov. I can’t imagine the temporary SGR fix and the ICD-10 delay didn’t help keep her around longer either. For those of us who live and breathe the HITECH Act and EHR incentive money, my guess is that the $36 billion is barely a blip on Sebelius’ radar.

Word is that she chose to leave and wasn’t forced out by the administration. To be honest, would any of you have wanted to be in her position? What a tough job she’s had. Many called for her resignation after the botched Healthcare.gov roll out, but she stayed. At least she stayed long enough for that to mostly roll through.

In fact, I find the headlines of her departure pretty interesting. For example, the New York Times says, “Sebelius Resigns After Troubles Over Health Site.” Farzad pointed to an article by Vox that says, “Kathleen Sebelius is resigning because Obamacare has won.” Seems like the headline people choose/tweet is in line with their politics.

Word is that Sylvia Matthews Burwell will be nominated as Sebelius’ replacement. You can read more about Burwell here. I saw a doctor tweet the question of whether this is the best we can do, someone with work history at foundations. I imagine many doctors feel the same way. Although, we all understand that the HHS secretary is very much part of the political discussion.

All in all, I don’t think Sebelius being gone will mean much change for those of us in the trenches.

April 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Outsourcing Your Disaster Recovery Team

I imagine most hospital CIOs are overwhelmed by the total number of systems and applications that they have to support. Hospital systems can have hundreds of applications that they’re required to support. Along with having to support the day to day operations of these systems, you also have to plan for business continuity and disaster recovery as well.

Every 6 months to a year, it seems we get a stark reminder of the need for good disaster recovery thanks to some devastating hurricane, earthquake, or other natural disaster. Plus, the stories of Hurricane Katrina and Super Storm Sandy and their impact at hospitals still ring in my ears and likely many other hospital CIOs.

Considering this background, I was intrigued by this Florida Hospital Case Study on Disaster Recovery. Obviously, Florida sits out there in a position that’s just waiting to be hit by a hurricane. So, good disaster recovery is a necessity for them.

What was most intriguing to me was that this hospital chose to use a managed recovery program from SunGard to make this a reality. While I don’t suggest outsourcing all of your disaster recovery (you need in house expertise deeply involved), I think it’s a great idea to work with a third party provider for your disaster recovery.

First, there are so many systems that it’s great to have a third party hold you accountable for all of your systems. Second, a third party can ensure that you do proper and regular disaster recovery testing of your systems. Third, they can provide an outside perspective that can improve your internal approach to disaster recovery.

Many of the above items can be done in house as well, but we all know that there’s a certain level of accountability that comes from having paid someone to hold you accountable. Otherwise, it’s really easy for one of your staff who’s being pulled in a hundred different directions to let your disaster recovery program slip through the cracks.

April 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

What About Data Beyond the EMR?

I saw this tweet from the famous @HealthcareWen which asks a really good question:

While I enjoy the humor of the tweet as much as the next person (everyone who knows me knows I’m all about the humor), this conversation reminds me a lot of what was done with ICD-10. The “funny ICD-10 codes” got all the attention and made ICD-10 a joke in the minds of so many people. This was highlighted by this guest post on EMR and HIPAA called “Why Do People Find ICD-10 So Amusing?” Those who support the shift to ICD-10 did a poor job explaining why ICD-10 was valuable to the quality of care a patient gets. Talking about all the funny ICD-10 codes (and they are funny) goes against the goals of those who see value in the move to ICD-10.

I bring this up because the same thing could easily happen with big data in healthcare. While it’s funny to think about how a doctor might treat us if they know we had a donut for breakfast, there are really meaningful data sources beyond the EMR. If we focus too much on the periphery of the data, then we’re going to miss out on a lot of the value that comes from the not so funny parts of big data.

Right now our EMR systems can’t support most of the data that could come from outside the EMR. However, that shift is going to happen and it’s going to happen quickly. My gut tells me that it will start with the wave of consumer centric medical sensors. Then, I see genomic and social data getting integrated next (both really large projects). These three areas will set the baseline for how outside data is integrated with the EMR data.

Let me offer the key points to consider in these data integrations:
-Automated: The data must pass seamlessly without the need for user interaction
-Smart Data: The user of the system needs the system to be smart. The user should only be notified with what’s actionable, but with the ability to drill into the data as needed.
-Bi Directional: The data needs to be seen and updated by both provider and patient. The system will need to have a great way to track who updated which data. However, we need both the patient and providers eyes on the data with the ability to update incorrect data.

These points should illustrate why integrating outside data is going to be such a challenge. However, it’s also why it holds such promise.

April 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.