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Weird News Wednesday – Man Arrives at Hospital with a Chainsaw Stuck in His Neck

I saw this picture and I knew that I just had to share it even though we usually don’t cover this sort of topic. It’s a picture from a hospital where the guy showed up with a chainsaw in his neck:

This isn’t really a health IT story like we usually do, but I will offer one health IT twist. You just really never know what’s going to come through the doors of the ED. You can plan for a lot in healthcare, but not everything. Maybe some of those funny ICD-10 codes are more common than we think.

April 2, 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.

The Forgotten Argument For ICD-10

The following is a guest post by Eric Hodge, Service Line Executive for Revenue Cycle and ICD-10 at Encore Health Resources.

Yesterday evening, the United States Senate joined the House of Representatives in Washington D.C., voting to delay ICD-10 adoption until October 2015.  That’s no surprise.  Truth be told, the vast majority of discussion related to ICD-10 has been all about how difficult it will make our lives.

Providers are asking, “Why is HHS forcing this down our throats when it obviously won’t help me do my job any better?” The AMA is throwing out headlines like, “ICD-10 Compliance Costs Are Triple What Was Expected,” while reminding us that they warned us all along. Now, many commentators are declaring the whole shmeer a disaster before it even goes live.

This attitude has skewed the thinking on ICD-10. Few providers are asking how they will benefit from the new information; the vast majority are simply asking how they will survive getting ready to meet the requirement. And that’s too bad, because what we as providers, as an industry, and even as an economy will find that ICD-10 is a key step toward gigantic improvement in how healthcare works in the U.S.

I am not going to argue that the transition is coming without cost or discomfort. But I am saying that this is how large-scale improvement of a system (a broken system, don’t forget) works, and that the benefits are clear and significant, at least for those who get past our first reaction (“Change frightens me!”) and take the time to understand what kind of system this whole healthcare reform effort is trying to build.

Benefits that I have seen with my own two eyes include:

  • Dramatic improvement in the assignment of costs to procedures performed. Most industry observers agree that we ought to move toward rewarding activities that keep a population healthy instead of getting paid for how many times we can treat a patient. Most would also agree that identifying the costs associated with certain disease states or treatments is the key to figuring out economical ways to promote healthy populations. ICD-10 will allow us to develop meaningful estimates about what a disease state or a procedure costs us, while ICD-9 is limited in what it can do in this regard.

    For example, I was working with a well-regarded regional hospital in the Mid-Atlantic on an effort to improve their charge capture. They knew they were losing money in their obstetrics operating room, but they were having a hard time figuring out exactly what was going on. Using ICD-9 information, all we could tell was that there were wildly variable times that a patient would spend in the OR for a cesarean procedure, but we could not gather any more detail. ICD-9 diagnosis codes do not have very specific information about the severity of the condition or comorbidities. Fortunately, this hospital was dual-coding at the time, and we were able to take advantage of the severity information included in the ICD-10 codes to identify the fact that they had a relatively high percentage of moderate and severe diagnoses — complications that were likely to lead to longer OR times and higher resource consumption (costs) to the hospital.

    This information allowed them to build a business case for establish pricing tiers for their OB OR services and gave them the information they needed to turn obstetrics surgery into both a profitable activity center and one that could revise treatment protocols for high-resource-consumption patients (costs).

    Could this have been done without ICD-10 data? Probably. But it would have taken many hours of chart review and qualitative analysis instead of the several dozen key strokes of a database query.

  • Identify opportunities to avoid cost and improve lives. The additional information inherent in an ICD-10 diagnosis code includes severity and specific comorbidity, as illustrated in the OB OR example, but it can also include information about demographics and some of the underlying reasons for the diagnosis. All of this information can easily be combined to make decisions that will save lives while cutting costs for a provider.

    I was working with a multi-facility provider in New England on vendor selection for revenue cycle technology, and I visited the cancer clinic. In talking with the nurses there about the kind of data that would help them care for their patients, they let me know that they would like to be able to flag patients with a high chance of readmission. One of the nurses told me that after 22 years of experience, she knew that a patient who was over 80 with moderate or severe lung cancer and a history of mental illness was going to be readmitted within three weeks. “And wouldn’t it be nice,” she said, “if my new system could flag those patients when they came in for an appointment?”

    Well, only ICD-10 codes include severity of illness, age, and the latitude to include reasons for a diagnosis. In this case, included in the diagnosis code was the fact that the patient was non-compliant in taking his/her medication. We were able to model this scenario for ICD-10 and identify these patients with a simple data query – in minutes. This allowed the clinic to first confirm the nurse’s intuition about those high-risk patients, and second to identify those patients who could use a case manager’s involvement to ensure that they are compliant with their regimen, saving the costly readmission and improving the quality of the patient’s remaining life.

    Again, this sort of effort is possible with ICD-9, but it would take chart reviews, extensive manual analysis, and aggregation of data from several sources to model this type of patient for predictive purposes. This organization did not have the extra resources or the budget to undertake such an effort.

  • Share higher-quality data with other providers and partners. When I meet with providers who are trying to figure out whether to start or join an Accountable Care Organization (ACO), the first question is generally, “What is this big pile of aggregated data going to do for us?” Actually, that’s the second question after, “What incentive dollars am I going to get for doing this whole ACO thing?” But it should be the first question.

    As the data sets grow larger, the ability to parse information into meaningful subsets will become more important. ICD-10 increases the amount of specific information in every diagnosis code and actually makes these large, aggregated pools of data from many providers useful. For example, ICD-9 has a code for laceration of an artery. ICD-10 lets you know if that artery was in someone’s finger or in their heart. If I want to be able to pull meaningful information out of my ACO data sets, I need to have the information that is included in ICD-10.

    I have helped organizations use aggregated diagnosis data like this to decide whether pursuing certain services in certain markets will pay off for them. We helped a provider in Washington State decide to extend its diabetes education services into rural Oregon and Idaho by demonstrating that there were enough diagnosed patients to support that business. This type of analysis becomes much faster and easier with ICD-10 data.

There are dozens of other tangible benefits to ICD-10 analytics, but this is a blog entry, not a thesis. Briefly, some of the biggies:

  • Being able to aggregate our diagnosis and procedure information with the rest of the industrialized world, which has already demonstrated that the benefits of ICD-10 will significantly advance healthcare service in the US. There are lots of sick people outside America, too, so being able to combine our coding data with theirs for analysis would be most helpful.  For example, the US has benefited from the increased data collected about the Avian Flu and how to best treat the disease based on ICD-10-collected information.
  • Reimbursements will better align with activity and cost. Payers will reimburse severe and complex cases better and simple cases at lower rates – because now they will be able to identify them as simple or complex from the codes. Those providers whose costs are higher will get paid more. Those whose resource costs are lower based on actual services rendered will get paid less. This principle is how the rest of the free market works; it should also work well in healthcare.
  • Outcome analytics will become more accurate and more efficient. I can quickly determine what happened to my severe CHF cases without having to go back through every single one of their charts or pull in data from multiple sources to figure out which CHF patients were only moderate or mild.
  • Population-based projections will become much more possible. If you want to look at the incidence of advanced diabetes in the aged population in southeast Missouri so you know how to negotiate your value-based reimbursement contracts, you can use ICD-10 data or you can go do a lot of legwork.

The point here is that ICD-10 makes coding information detailed enough so that American providers and payers can make healthcare work in ways that it doesn’t work now: like a free market, with costing and pricing that accurately reflects the effort and the expense. Like a continuously improving system where better courses of treatment are developed for more specific populations. And like a system where we try to prevent high cost and lousy outcomes before they happen.

Looks like we’re going to have to wait until 2015 before we see many of these benefits.

April 1, 2014 I Written By

SGR Fix and ICD-10 Delay

I’ve been captivated by the discussion of the bill that patches the SGR and would delay ICD-10 from being implemented until 2015. It’s amazing to see the congressional theatrics that occurs. Unfortunately, I’m a little disheartened by the discussion. You can see how much of it is politics and it’s sad. If you aren’t seeing it live, I think the link above will have a video recording of it.

I think we’re about a half hour from the actual vote on the SGR fix and delay of ICD-10. I’ll be surprised if it doesn’t pass. Although, it also is really clear that those who vote are voting on SGR and aren’t even thinking about the line that delays ICD-10 a year.

The overriding message I’ve heard is that we’re still kicking the can down the road. None of them want to make the tough decisions to fix SGR or any other part of healthcare. I don’t pretend to know much about politics in Washington or how to solve it. However, I don’t see us getting any dramatic solutions to our healthcare problems coming out of this group.

I’ll update the post once the vote is done. My prediction is that they’ll pass the bandaid SGR Fix and ICD-10 Delay.

March 31, 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.

Google Glass’ Impact on Healthcare

In today’s #HITsm chat one of the topics brought up the impact of Google Glass on healthcare. I provided a few insights into Google Glass (Yes, I own a Google Glass and so I can speak first hand on it) that I thought would be beneficial to others.


I believe Google Glass will have a powerful role in the hospital. However, it won’t be ubiquitous. It’s not like you’ll get hired at a hospital and be issued your access card and a pair of Google Glass (Yes, Glass could be your access card, but that’s an expensive access card). With that said, Google Glass will find some incredibly powerful uses and become an indispensable part of many hospital workflows.


While this post has been about Google Glass. I think Google Glass represents a whole class of eyeware technologies which are coming to market. I’m not sure that Google Glass will win that market, but they’re definitely the ones that defined the market and so that’s why we talk about them. Watch for other competitors that do something similar, but might actually be the dominate leader in eyeware technology.


I agree that Google Glass and other related technologies have their own HIPAA privacy and security issues. However, they can be made to be as HIPAA compliant and secure as any other device. The form factor doesn’t really change the privacy and security. It’s what you do with the device and how you implement the software on the device which determines the HIPAA compliance of the product.

March 28, 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 Culture of Patient Safety

One of the challenges with some health IT organizations is that they weren’t built from the ground up with a culture of patient safety in mind. There are certain aspects of an organization that need to become embedded in their culture for them to be a reality. Patient Safety is one of them. Privacy and security are another example.

The beautiful part is that once patient safety, privacy, security, etc become an embedded part of your culture, then amazing results happen.

Today I came across this incredibly compelling blog post on the Virginia Mason blog titled, “Terrible tragedy – and powerful legacy – of preventable death.” I love when hospitals are open and transparent like Virginia Mason is in that blog post. Ironically, their blog post is about transparency at an organization and the benefit to the organization. However, this line from the blog post struck me:

“Our board said that if we cannot ensure safety of our patients we shouldn’t be in business.”

-Cathie Furman, RN

This is a powerful question that makes me wonder how many companies shouldn’t be in business.

March 27, 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 HIPAA Compliance Dashboard

One of the interesting announcements coming out of HIMSS was a HIPAA Compliance Dashboard that was announced by INetU. The concept of a dashboard that shows you your HIPAA compliance is fascinating for me. The key question I’ve asked myself is can HIPAA compliance be automated into a dashboard?

Here’s a look at the HIPAA Compliance Dashboard they’ve created:

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INetU claims that the dashboard will keep track of both the business associate’s (in this case INetU’s) HIPAA compliance and the covered entities compliance with HIPAA. I need to dig into it some more, but I’d love to hear from some other HIPAA experts out there. Aren’t there pieces of HIPAA compliance that can’t be automated to a dashboard? I’d love to be proven wrong.

I also think the Dashboard is a nice building block to doing security beyond just HIPAA. It reminds me of this post titled, “Why HIPAA isn’t Enough to Keep Patient Data Secure.” This dashboard could provide a deeper look into security beyond just HIPAA. Although, it makes sense why they’re leading with HIPAA since organizations don’t mind coughing up money to ensure their HIPAA compliant.

What do you think of this idea? Can HIPAA Compliance benefit from a dashboard like this? Of course, this can be taken too far as well. We don’t need CIO’s that become complacent, because the dashboard says “HIPAA Compliant.”

March 26, 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.

Interview with Shahid Shah About HealthIMPACT Conference

The following is an interview with Shahid Shah about the upcoming HealthIMPACTconferences he’s helping to organize. The next one is in Houston on April 3rd and a few discount seats for HealthcareScene readers remain open. Register here using IMPACT10 as the code.

It seems like there is a health IT conference every day.  What will make this conference unique?

The first thing unique about HealthIMPACT is the length and locations – we’re choosing single day and “local” to many areas of the country (southeast, southwest, etc.) because busy people can’t take more than 1 day and probably can’t afford to travel. The second unique aspect is that we’re focused on “actionable intelligence” coming not from pontificators but those “in the trenches” doing the grunt work of health IT every day. The third, and perhaps the most unique, is that we teach audiences what kinds of tech to buy, what not buy, how to spot real trends from hype, and how not to fall prey to prevailing myths. This is going to be a no-nonsense, no fluff, no hype, “just answers” event. It’s not so much a “conference” but an educational event – audience members can even earn CME credits if they’d like. The fourth, and something useful for software and technology vendors and buyers alike, is a customized meeting with one or more CIOs or other tech-focused buyers that developers can use as a mini “focus group” to test ideas and ask buyers questions that will help improve products and sales.

What’s special about the format of the conferences?

The format is “no long speeches, no PowerPoint-centric presentations, all panels and interviews with high interactivity”. By making sure that there are no speeches we don’t have to worry about “death by PowerPoint” or folks presenting a viewpoint that audiences can’t easily interact with. The panels topics are focused on problems that audience members are regularly facing in their daily work environments. The panel members are all working “in the trenches” and coming prepared to interact with the audience. That’s why we say “no fluff, just answers”.

What kind of audience attends your conferences?

We have a list of attending organizations and their titles available here. We get CIOs, CFOs, CTOs, HIM, architects, engineers, consultants, and product vendors from both hospital / health system and ambulatory physician practices. It’s a mixed audience but I think what’s in common is that they’re all “in the trenches” folks solving hard technical problems every day.

What are some of the main topics that will be discussed at these conferences?

  • How IT can support the overarching financial, operational, and clinical goals of your organization
  • HIEs in your region and provider participation in them
  • Technologies that support value driven care and population health management
  • Cloud based systems in healthcare
  • Programs that drive patient engagement
  • Leadership strategies that drive innovation
  • Predictive analytics that improve care delivery
  • EHR implementation and meaningful use
  • ICD10 compliance, readiness and physician training

Where can people go to learn more about the conferences?
You can find more information on the HealthIMPACT website and if you use the discount code IMPACT10, you’ll receive a 10% discount for being a Healthcare Scene reader.

March 25, 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.

Moving Hospital EHR to the Cloud

I’ve long been interested to see how hospitals were going to handle the shift to “the cloud.” Obviously, most hospitals have made a big infrastructure investment in huge data centers and so I’ve always known that the shift to the cloud would be slow. However, it also seemed like it was inevitable.

I was interested to hear Jason Mendenhall talk in our Healthcare Data Center Google Plus hangout about healthcare entities moving their technology infratructure into their data center. Plus, I pair that with the smaller rural hospital CIO I met who balked at the idea of having a data center or really even having any sys admin people on staff.

Plus, I’m reminded of this quote I heard Dr. Andy Litt tell me about when hospitals will start using Dell to host their Epic EHR:

The opportunity to host an Epic or other EHR is in first install, not for existing ones that have invested in a data center already. -Andy Litt, MD, Dell

I can’t imagine that many institutions really want to move their Epic EHR hosted locally into the cloud. That just doesn’t happen. At least it doesn’t right now. Will we see this change?

I think the answer to that is that we will see it change. There’s a really good argument to make that hospitals shouldn’t be building data centers and that there’s tremendous value to using an outside provider. Plus, many of these “data center” companies are becoming more than just a set of rails, power, and cooling. They are now working with a variety of cloud providers that can provide you more than just a place to put your own servers.

I’ll be interested to see how this plays out, but I think we’ll see fewer and fewer hospital data centers. The outside options and connectivity to those outside data centers is so good that there’s going to be no need to do it on your own.

March 24, 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.

The Hospital CIO Is a Salesperson

When you look at the job of a hospital CIO, I think their number one job is as a salesperson. A hospital CIO’s day is full of sales meetings. I’m sure that many won’t like to see it that way, but it’s true.

Think about the hospital CIO budget. The hospital CIO’s job is to sale the budget to the other hospital executives. If they don’t do a good job selling the budget to the executives, then you might not get the budget you need and then you’ve got other issues. In fact, the biggest issue you have to face is how you’re going to sell the smaller budget to the people who work for you.

Another important job of a hospital CIO is to set the vision for the organization. Making sure everyone in the organization is proverbially “paddling in the same direction” is fundamental to leadership in general and particularly to a hospital IT organization. How do you make sure that your vision is understood and executed by your organization? That’s right, you have to sell it to them.

Hiring the right people is also crucial to the success of a hospital CIO. Convincing the best people to come and work for you instead of someone else is a sales job of the highest degree. Ok, you get the point. A hospital CIO is a salesperson.

If you haven’t brushed up on your sales skills lately, you might want to expand your reading and consider some reading focused on selling techniques. The dynamics of what a hospital CIO sells are different and maybe no money changes hands in the transaction. However, you can be sure that every successful CIO is a good salesperson.

March 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.

Are We Using All the Data We Have?

Many of you might remember the post I wrote previously about the real cause of hospital readmissions. In that post, I quote Stuart Long, Chief Marketing and Sales Officer at CapsuleTech, who shared with me some internal survey results. While I found those survey results really interesting Stuart also offered me a number of insights that I thought other might find interesting as well.

First, in our conversation Stuart commented off hand that “even in the hospital today we have to throttle the data we send them.” For some context, Stuart is referring to how much data the medical devices that Capsule connects to the hospital can send. Basically, he’s saying that these medical devices have a lot more data that they could share with the hospital, but the hospital IT systems can’t handle all the extra data.

I’m sure we could have a deep discussion of the value (or lack thereof) of the data that’s not being sent to the hospital systems. However, I think this is all part of a larger question we need to ask ourselves in healthcare. Are we using all the data that we have available to us? Maybe there is value in some of the data that the medical device is collecting and not transferring to the hospital IT system.

This topic also takes me to discussions around patient generated data. Millions of patients are tracking their health using hundreds of tracking devices. That’s a lot of data available for us to use. Are we using it? I can think of a few hospitals that have focused uses of this patient generated data. However, we certainly aren’t using the vast majority of this data.

Are We Using All the Data We Have? The answer is clearly no. The question then remains, should we be using more of the data that’s available to us? Should someone be responsible for making sure we’re using the data we have available to us the best way possible?

Another interesting insight that Stuart provided was that Capsule was looking to extend charting ability to point of care. For those who don’t know much background on Capsule, go and read medical device guru Tim Gee’s HIMSS 2014 blog post where he talks about them in some detail. When you think about the interfaces that Capsule has created for medical devices, they aren’t that much different than an interface between a charting application and the EHR. The big difference is that a medical device is capturing the data versus a human entering the data in the charting application. The method the data uses to become digital is irrelevant. After that it’s the same plumbing that gets that data to the EHR.

I’ll be interested to see how far they take this. One of my big topics of interest coming out of HIMSS 2014 was to dig deeper into the idea of external EHR interfaces. I heard about some huge teams that are creating generic EHR data interfaces that push the data to the EHR. I’ll be interested to see how far we go with this trend.

March 19, 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.