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Will New Doctors Hate EMRs the Way Older Doctors Do?

Posted on March 22, 2017 I Written By

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

Oh! Just the idiocy of it all!

That’s a quote from an email I got from an older doctor in response to a discussion about EHR software and in particular programs like meaningful use and now MACRA. This is a doctor who I’ve exchanged many emails with over multiple years. Needless to say, he’s not happy with what’s happening with EHR software and sees it as an awful thing for medicine. I think this is the view of most older doctors.

While most older doctors feel this way, I wonder if the next generations of doctors will feel the same. I’ll never forget my med school friend who said he hated rounding at a doctor’s office that didn’t have an EHR because he types faster than he writes. Or the middle-aged doctor that’s been a friend of my family since I was a kid that’s been on EHR so long that he once told me “I’ve never really known anything but an EHR, so I can’t imagine practicing medicine without it.”

I understand the doctors who complain about EHRs and more importantly complain about the regulations which are reflected in the features EHR software companies push out. EHR was a massive change for many of them and that can be brutal. Plus, there are plenty of issues with many EHR software and EHR implementations out there. Some that can be resolved and some that can’t. Not to mention that many regulation requirements aren’t clinically useful. We should be glad doctors are upset over this.

However, will the next generation of doctors care?

Besides the fact that new doctors are digital natives who grew up with technology, there’s also the fact that new doctors won’t know what life in a medical office was like before EHR. EHR documentation will just be part of the status quo for them and when you don’t know about the alternative, then you don’t hate it as much. It’s just a required part of the profession and it’s always been that way.

The reality for most new doctors is that there are so many things that are screwed up with our healthcare system, that the EHR is just one more to add to the pile of things that don’t make much sense. They’ll just consider it a feature of the profession and likely not complain much.

The one thing that could change all of this is for a new EHR or related solution to come out and blow all the current EHR vendors off the map. It would have to be something so dramatically better for organizations that healthcare organizations can’t resist it. Think of the way the iPhone made us rethink cell phones. It needs to be a solution which is that much better. Does such a solution exist? Can such a solution be built? Or do the current healthcare regulations prevent such a solution? Will it take changes in regulation and reimbursement to enable a new EHR that doctors love and not a change by an EHR software vendor?

Encouraged By Political Changes, Groups Question ONC Functions

Posted on March 21, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Riding on an anti-regulation drive backed by the White House, groups unhappy with some actions by ONC are fighting to rein it in. President Trump has said that he would like to see two regulations killed for every new reg, and the groups seemingly see this as an opening.

One group challenging ONC activities is HealthIT Now, a coalition of providers, payers, employers and patient groups.

In a letter to HHS Secretary Tom Price, Health IT Now argues that ONC exceeded its authority last year, when it backed an oversight rule designed to boost the certification process by evaluating vendor interoperability capabilities.

The 2016 rule also holds health IT vendors accountable for technology flaws that could compromise patient safety, an approach which, HITN argues, steals a move from federal agencies such as the FDA. The group also contends that ONC has not been clear about its criteria for critiquing HIT solutions for safety problems.

Meanwhile, a group of medical societies and specialties is asking federal health officials to hold off on 2015 EHR certification requirements, which providers are expected to start using January 2018, for at least one year. The group notes that since ONC released its final 2015 Edition requirements, few vendors – in fact, just 54 of 3,700 products currently certified – have fully upgraded their systems.

Given this situation, rushing to deploy the latest certification requirements could create big problems, including a major disruption to medical practices’ business, the coalition argues.

If they’re forced to choose from the small number of systems which have upgraded their platforms, “physicians may be driven to switch vendors and utilize a system that is not suitable for their specialty or patient population,” the group said in a letter to CMS acting administrator Patrick Conway, MD, and acting ONC national coordinator Jon White, MD.

In addition to addressing certification concerns, there’s much the federal government can do to support health IT improvement, according to attendees at HIMSS17.

According to HITN, attendees would like policymakers to address interoperability, in part by reviewing Meaningful Use and the ONC Voluntary Certification programs; to focus on improving patient identification systems, and avoid imposing barriers to private market solutions; to clarify the role of the ONC in the marketplace; and to encourage the use of real-world evidence in healthcare and health IT deployment.

As I see it, these ideas veer between close-in detail and broad policy prescriptions, neither of which seem likely to have a big effect on their own.

On the one hand, while it might help to clarify ONC’s role, authority and process, the truth is that the health IT market isn’t living or dying on what it does. This is particularly the case given its revolving door leaders with too little time to do more than nudge the industry.

Meanwhile, it seems equally unlikely that the federal government will come up with generally-applicable policy prescriptions which can solve nasty problems like achieving health data interoperability and sorting out patient matching issues.

I’m not saying that government has no role in supporting the emergence of health IT solutions. In fact, I’m fairly confident that we won’t get anywhere without its assistance. However, until we have a more effective role for its involvement, government efforts aren’t likely to bear much fruit.

MACRA and MIPS Training and Resources – MACRA Monday

Posted on March 20, 2017 I Written By

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

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While we’ve covered a lot of ground in this MACRA Monday series, there are still a lot of details we haven’t covered. I’ve been debating how deep into the weeds of MACRA and MIPS we should go or not as part of this series. We’d love to hear your thoughts.

We’re partially reticent to go really deep, because there’s a lot of great resources out there to dive deeply into MACRA and MIPS. Plus, we don’t see many people doing higher level strategic decision making content that has opinions about what your organization should or shouldn’t do when it comes to MACRA.

If you’re looking for some deeper training on MACRA and MIPS, we’ll highlight a few courses and trainings out there that we know about.

4Med MIPS and MACRA Training
The people at 4Med have a whole series of training for MIPS and MACRA. They have a lot of past experience doing training for meaningful use and PQRS and they’re continuing that with their latest MACRA and MIPS Training. Here’s a look at some of the courses they have coming up (Note: each of these links automatically gives you a discount on each course):

MACRA-MIPS Quality Project Manager – Starts March 29 – A nice course focused on the quality portion of MIPS.

Patient Centered Medical Home (PCMH) Workshop – Starts May 3 – This goes beyond MIPS and MACRA, but is all part of the related trend.

HIPAA Compliance Officer – Starts April 19 – This isn’t really a MIPS and MACRA course, but they require you to do a HIPAA Risk Assessment, so this course could help you make sure you’re ready to fulfill that requirement. Plus, this is a good course given the importance of security in healthcare these days.

4 Med offers a number of other courses including an Advancing Care Information course as well, but it’s not scheduled right now. We’ll update you in the future as those courses are scheduled. Instead of the live training options above, you can also purchase the online version of these courses. If you use the promo code: HITC you’ll get 20% off those online versions.

MIPS Boot Camp
Another option to consider is this MIPS Boot Camp course offered by Jim Tate and Wayne Singer. The course is only 1.5 hours, but Jim is a true expert in this area and so it will be a great starter course. They obviously are trying to push their MyMipsScore™ App, but that might be something useful for readers as well.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Paper Records Are Dead

Posted on March 14, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s an argument that’s likely to upset some, but resonate with others. After kicking the idea around in my head, I’ve concluded that given broad cultural trends, that the healthcare industry as a whole has outgrown the use of paper records once and for all. I know that this notion is implicit in what health IT leaders do, but I wanted to state this directly nonetheless.

Let me start out by noting that I’m not coming down on the minority of practices (and the even smaller percentage of hospitals) which still run on old-fashioned paper charts. No solution is right for absolutely everyone, and particularly in the case of small, rural medical practices, paper charts may be just the ticket.

Also, there are obviously countless reasons why some physicians dislike or even hate current EMRs. I don’t have space to go into them here, but far too many, they’re hard to use, expensive, time-consuming monsters. I’m certainly not trying to suggest that doctors that have managed to cling to paper are just being contrary.

Still, for all but the most isolated and small providers, over the longer term there’s no viable argument left for shuffling paper around. Of course, the healthcare industry won’t realize most of the benefits of EMRs and digital health until they’re physician-friendly, and progress in that direction has been extremely slow, but if we can create platforms that physicians like, there will be no going back. In fact, for most their isn’t any going back even if they don’t become more physician firendly. If we’re going to address population-wide health concerns, coordinate care across communities and share health information effectively, going full-on digital is the only solution, for reasons that include the following:

  • Millennial and Gen Y patients won’t settle for less. These consumers are growing up in a world which has gone almost completely digital, and telling them that, for example they have to get in line to get copies of a paper record would not go down well with them.
  • Healthcare organizations will never be able to scale up services effectively, or engage with patients sufficiently, without using EMRs and digital health tools. If you doubt this, consider the financial services industry, which was sharing information with consumers decades before providers began to do so. If you can’t imagine a non-digital relationship with your bank at this point, or picture how banks could do their jobs without web-based information sharing, you’ve made my point for me.
  • Without digital healthcare, it may be impossible for hospitals, health systems, medical practices and other healthcare stakeholders to manage population health needs. Yes, public health organizations have conducted research on community health trends using paper charts, and done some effective interventions, but nothing on the scale of what providers hope (and need) to achieve. Paper records simply don’t support community-based behavioral change nearly as well.
  • Even small healthcare operations – like a two-doctor practice – will ultimately need to go digital to meet quality demands effectively. Though some have tried valiantly, largely by auditing paper charts, it’s unlikely that they’d ever build patient engagement, track trends and see that predictable needs are met (like diabetic eye exams) as effectively without EMRs and digital health data.

Of course, as noted above, the countervailing argument to all of this is the first few generations of EMRs have done more to burden clinicians than help them achieve their goals, sometimes by a very large margin. That seems to be largely because most have been designed — and sadly, continue to be designed — more to support billing processes than improve care. But if EMRs are redesigned to support patient care first and foremost, things will change drastically. Someday our grandchildren, carrying their lifetime medical history in a chip on their fingernail, will wonder how providers ever managed during our barbaric age.

 

What Do Doctors Need to Know About MACRA and MIPS? – MACRA Monday

Posted on March 13, 2017 I Written By

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

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While at the HIMSS 2017 conference, I had a chance to do a video interview with MACRA expert, Alexandria (Alex) J. Goulding, Public Policy Manager at iHealth. We cover a broad range of MACRA topics focused on the practical things that doctors should know about MACRA and MIPS.

You can find the full MACRA video interview at the bottom or click any of the links below to skip to a specific answer:

Do you have other perspectives and insights that you’d add to what Alex Goulding offered above? Please share them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

A New MACRA Tools Market – MACRA Monday

Posted on March 6, 2017 I Written By

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

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

One thing we’ve realized writing MACRA Monday is that there’s an insatiable appetite for MACRA right now. Webinar signups are through the roof when it’s on the topic of MACRA and MIPS. MACRA and MIPS training courses are selling like hot cakes. Everyone is trying to get the information they need to deal with MACRA and MIPS.

After talking with many companies at HIMSS, there’s a whole new market being created for tools that help organizations track and attest for MACRA as well. Of course, every EHR vendor is creating a solution for their providers. However, there are a lot of other companies that are looking at this as a big opportunity for them to provide tools to make tracking and reporting MACRA and MIPS easy.

Two companies that I ran into recently in this space are SA Ignite and SPH Analytics.

Both of these companies are focusing on MACRA, APM, and MIPS reporting at the higher end. We’re talking about hospital systems that have 100 medical practices and so they have a few hundred doctors who need to do MACRA reporting. Can you imagine managing that many attestations on Excel or something? That’s why I think these tools are going to become so popular.

A part of me hates that entire companies are being created around government attestation. However, the realist in me understands that these tools are needed by large health systems that have to comply with government requirements or lost a lot of money.

What do you think of this trend? Is it a microcosm of our current healthcare system? Do you know of other tools that can help organizations trying to handle MACRA reporting?

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: A Missed Opportunity For Primary Care Collaboration

Posted on March 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Tell me if you’ve run into the following.

You call your primary care doctor to set an appointment, wading through the inevitable voice-response prompts and choosing the right number to reach a clerk. You wait on hold for a while – perhaps a LONG while – and finally get a clerk.

The clerk asks why you’re booking an appointment, and you name a problem. The clerk says she needs to consult a nurse about the problem before she books you, so you wait on hold while she calls the nurse. Of course, the nurse is too busy to answer her phone, so you leave her a voicemail message.

The next day she finally calls back and tells you a standard appointment will be fine. Yay.

This might sound like an incredibly twisty process, but this is exactly how it works at my PCP office. And the truth is that I’ve been run through a similar mill before by other primary care practices of this size.

In theory, many of these problems would go away if my PCP office simply took advantage of the scheduling tools its portal already offers. But for some reason its leaders don’t seem to value that function much; in fact, when it went offline for a while the practice didn’t seem to know.

But there are alternatives to this crazy workflow pattern that don’t require the re-invention of the lightbulb. In fact, all it would take is adding a few functions to the portal to make progress.

Gathering the threads

From what I can see, the key to streamlining this type of process is to gather these threads together. And it doesn’t take much imagination to picture how that would work.

What if my initial contact with the practice wasn’t via phone, but via more sophisticated interface than a calendaring app? This interface should ask patients what prompts their requested visit, and offer a pulldown menu providing a list of standard situations and conditions.

If a patient chooses a condition that might be hazardous, the system would automatically kick the request to a nurse, who can email or call the patient directly, possibly avoiding hit-or-miss phone tag. Or the practice could provide the nurse with a secure messaging client to use in connecting with clients on the go.  Using such an app, the nurse could even conference in the doctor as needed.

Meanwhile, if a patient wants to get a provider’s opinion on their condition – whether they should wait and see what happens, go to urgent care, make an appointment or hit the ED – the same interface could route the request to the provider on call. If the patient can be treated effectively with a basic appointment, the clinician routes the request to the front desk, with a request that the clerk schedule an appointment. The clerk reaches out to the patient, which means the patient (me!) doesn’t have to call in and wait for an age while the clerk handles other issues.

The same process would also work well for medication refill and referral requests, which my practice now handles in the same cumbersome, time-wasting manner. Not only that, automating such requests would leave an audit trail, which doesn’t exist at present.

Pursuing the obvious

What bugs me about all of this is that if I can imagine this, anyone in healthcare could — it’s a massive case of pursuing the obvious. Though I’m an HIT fan, and I follow the industry closely, I’m no programmer or engineer. I’m just somebody who wants to do my business effectively. Surely my PCP does too?

Of course, I know that just because an approach is possible, it doesn’t mean that it will be easy to implement. Not only that, only the largest and most prosperous practices have enough clout to demand that vendors develop such features. So it may not be as easy as it should be to put them in place.

Still, I see a crying need here, or perhaps one might call it an opportunity.  If we arm primary care doctors – who will play a steadily-growing role in next-gen systems – with better workflow options, every part of the system will benefit.

Epic Launches FHIR-Based App Platform

Posted on March 2, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like Epic is getting on the FHIR train. According to an article in Modern Healthcare, Epic is launching a new program – serving physician practices and hospitals – to help them build customized apps. The program, App Orchard, will also support independent mobile app developers who target providers and patients.

The launch follows on the heels of a similar move by Cerner, which set up its own sandbox for developers interested in linking to its EMR using FHIR. The Cerner Open Developer Experience (code_), which launched in early 2016, is working with firms creating SMART on FHIR apps.

App Orchard, for its part, lets developers use a FHIR-based API to access an Epic development sandbox. This will allow the developers to address issues in connecting their apps to the Epic EMR. Previously, Epic wouldn’t let mobile app developers connect to its EMR until a customer requested permission on their behalf.

In addition to providing the API, App Orchard will also serve as an online marketplace along the lines of Google Play or the Apple app store. However, end users won’t be able to download the app for their own use — only software developers and vendors will be able to do that. The idea is that these developers will create the apps on contract to customers.

Meanwhile, according to the magazine, Epic will screen and pick an initial group of developers to the program. Brett Gann, who leads the Epic-based team developing App Orchard, told Modern Healthcare that factors which will distinguish one developer from the other include app safety, security, privacy, reliability, system integrity, data integrity and scalability.

As part of their participation, developers will get documentation listing these criteria and what they mean to Epic. The Epic team will expect the developers to commit to following these guidelines and explain how they’ll do so, Gann said.

While Epic hasn’t made any predictions about what types of apps developers will pursue, recent research offers a clue. According to new research by SMART and KLAS, providers are especially interested in apps that help with patient engagement, EMR data viewing, diagnostics, clinical decision support and documentation tasks.

One thing to watch is how Epic decides to handle licensing, ownership, and charges for participation in their Orchard Program. If they have a true open API, then this will be a good move for the industry. If instead they choose to take ownership of everything that’s created, put restrictive licenses on developers, and/or charge huge sums to participate, then it’s unlikely to see much true innovation that’s possible with an open API. We’ll see how that plays out.

Meanwhile, in other Epic news, Becker’s Hospital Review notes that the vendor is planning to develop two additional versions of its EMR. Adam Whitlatch, a lead developer there, told the site that the new versions will include a mid-range EMR with fewer modules (dubbed “utility”), and a slimmer version with fewer modules and advanced features, to be called “Sonnet.”

Whitlatch said the new versions will target physician practices and smaller hospitals, which might prefer a lower-cost EMR that can be implemented more quickly than the standard Epic product. It’s also worth noting that the two new EMR versions will be interoperable with the traditional Epic EMR (known as “all-terrain”).

All told, these are intriguing developments which could have an impact on the EMR industry as a whole.

On the one hand, not only is Epic supporting the movement towards interchangeable apps based on FHIR, it appears that the vendor has decided to give in to the inevitable and started to open up its platform (something it hasn’t done willingly in the past).  Over time, this could affect providers’ overall Epic development plans if Epic executes it well and enables innovation on Orchard and doesn’t restrict it.

Also, the new versions of the Epic could make it available to a much wider audience, particularly if the stripped-down versions are significantly cheaper than its signature EMR. In fact, an affordable Epic EMR could trigger a big shakeup in the ambulatory EMR market.

Let’s see if more large EMR vendors decide to offer an open API. If access to EMR APIs became common, it would represent a major shift in the whole health IT ecosystem.

Selecting the Right AI Partner in Healthcare Requires a Human Network

Posted on March 1, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

Artificial Intelligence, or AI for short, does not always equate to high intelligence and this can have a high cost for healthcare systems. Navigating the intersection of AI and healthcare requires more than clinical operations expertise; it requires advanced knowledge in business motivation, partnerships, legal considerations, and ethics.

Learning to Dance at HIMSS17

This year I had the pleasure of attending a meetup for people interested in and working with AI for healthcare at the Healthcare Information and Management Systems Society (HIMSS) annual meeting in Orlando, Florida. At the beginning of the meetup Wen Dombrowski, MD, asked everyone to stand up and participate in a partner led movement activity. Not your average trust fall, this was designed to teach about AI and machine leaning while pushing most of us out of our comfort zones and to spark participants to realize AI-related lessons. One partner led and the other partner followed their actions.

Dedicated computer scientists, business professionals, and proud data geeks tested their dancing skills. My partner quit when it was my turn to lead the movement. About half of the participants avoided eye contact and reluctantly shuffled their feet while they half nursed their coffee. But however awkward, half the participants felt the activity was a creative way to get us thinking about what it takes for machines to ‘learn’. Notably Daniel Rothman of MyMee had some great dance moves.

I found both the varying feedback and equally varying willingness to participate interesting. One of the participants said the activity was a “waste of time.” They must have come from the half of the room that didn’t follow mirroring instructions. I wonder if I could gather data about what code languages were the specialty of those most resistant. Were the Python coders bad at dancing? I hope not. My professional training is actually as a licensed foreign language teacher so I immediately corroborated the instructional design effectiveness of starting with a movement activity.

There is evidence that participating in physical activity preceding learning makes learners more receptive and allows them to retain the experience longer. “Physical activity breaks throughout the day can improve both student behavior and learning (Trost 2007)” (Reilly, Buskist, and Gross, 2012). I assumed that knowledge of movement and learning capacity was common knowledge. Many of the instructional design comments Dr. Dombrowski received while helpful, revealed participants’ lack of knowledge about teaching and cognitive learning theory.

I could have used some help at the onset in choosing a dance partner that would have matched and anticipated my every move. The same goes for healthcare organizations and their AI solutions.  While they may be a highly respected institution employing some of the most brilliant medical minds, they need to also become or find a skilled matchmaker to bring the right AI partner (our mix of partners) to the dance floor.

AI’s Slow Rise from Publicity to Potential

Artificial Intelligence has experienced a difficult and flashy transition into the medical field. For example, AI computing has been used to establish consensus with imaging for radiologists. While these tools have helped reduce false positives for breast cancer patients, errors remain and not every company entering AI has equal computing abilities. The battle cry that suggested physicians be replaced with robots seems to have slowed robots. While AI is gaining steam, the potential is still catching up with the publicity.

Even if an AI company has stellar computing ability, buyers should question if they also have the same design for outcome. Are they dedicated to protecting your patients and providing better outcomes, or simply making as much profit as possible? Human FTE budgets have been replaced by computing AI costs, and in some instances at the expense of patient and data security.  When I was asking CIOs and smaller companies about their experiences, many were reluctant to criticize a company they had a non-disclosure agreement with.

Learning From the IBM Watson and MD Anderson Breakup

During HIMSS week, the announcement that the MD Anderson and IBM Watson dance party was put on hold was called a setback for AI in medicine by Forbes columnist Matthew Herper. In addition, a scathing report detailing the procurement process written by the University of Texas System Administration Audit System reads more like a contest for the highest consulting fees. This suggests to me that perhaps one of the biggest threats to patient data security when it comes to AI is a corporation’s need to profit from the data.

Moving on, reports of the MD Anderson breakup also mention mismanagement including failing to integrate data from the hospital’s Epic migration. Epic is interoperable with Watson but in this case integration of new data was included in Price Waterhouse Cooper’s scope of work. If poor implementation stopped the project, should a technology partner be punished? Here is an excerpt from the IBM statement on the failed partnership:

 “The recent report regarding this relationship, published by the University of Texas System Administration (“Special Review of Procurement Procedures Related to the M.D. Anderson Cancer Center Oncology Expert Advisor Project”), assessed procurement practices. The report did not assess the value or functionality of the OEA system. As stated in the report’s executive summary, “results stated herein are based on documented procurement activities and recollections by staff, and should not be interpreted as an opinion on the scientific basis or functional capabilities of the system in its current state.”

With non-disclosure agreements and ongoing lawsuits in place, it’s unclear whether this recent example will and should impact future decisions about AI healthcare partners. With multiple companies and interests represented no one wants to be the fall guy when a project fails or has ethical breaches of trust. The consulting firm of Price Waterhouse Coopers owned many of the portions of the project that failed as well as many of the questionable procurement portions.

I spoke with Christine Douglas part of IBM Watson’s communications team and her comments about the early adoption of AI were interesting. She said “you have to train the system. There’s a very big difference between the Watson that’s available commercially today and what was available with MD Anderson in 2012.”  Of course that goes for any machine learning solution large or small as the longer the models have to ‘learn’ the better or more accurate the outcome should be.

Large project success and potential project failure have shown that not all AI is created equally, and not every business aspect of a partnership is dedicated to publicly shared goals. I’ve seen similar proposals from big data computing companies inviting research centers to pay for use of AI computing that also allowed the computing partner to lease the patient data used to other parties for things like clinical trials. How’s that for patient privacy! For the same cost, that research center could put an entire team of developers through graduate school at Stanford or MIT. By the way, I’m completely available for that team! I would love to study coding more than I do now.

Finding a Trusted Partner

So what can healthcare organizations and AI partners learn from this experience? They should ask themselves what their data is being used for. Look at the complaint in the MD Anderson report stating that procurement was questionable. While competitive bidding or outside consulting can help, in this case it appears that it crippled the project. The layers of business fees and how they were paid kept the project from moving forward.

Profiting from patient data is the part of AI no one seems willing to discuss. Maybe an AI system is being used to determine how high fees need to be to obtain board approval for hospital networks.

Healthcare organizations need to ask the tough questions before selecting any AI solution. Building a human network of trusted experts with no financial stake and speaking to competitors about AI proposals as well as personal learning is important for CMIOs, CIOs and healthcare security professionals. Competitive analysis of industry partners and coding classes has become a necessary part of healthcare professionals. Trust is imperative and will have a direct impact on patient outcomes and healthcare organization costs. Meetups like the networking event at HIMSS allow professionals to expand their community and add more data points, gathered through real human interaction, to their evaluation of and AI solutions for healthcare. Nardo Manaloto discussed the meetup and how the group could move forward on Linkedin you can join the conversation.

Not everyone in artificial intelligence and healthcare is able to evaluate the relative intelligence and effectiveness of machine learning. If your organization is struggling, find someone who can help, but be cognizant of the value of the consulting fees they’ll charge along the way.

Back to the dancing. Artificial does not equal high intelligence. Not everyone involved in our movement activity realized it was actually increasing our cognitive ability. Even those who quit, like my partner did, may have learned to dance just a little bit better.

 

Resources

California Department of Education. 2002. Physical fitness testing and SAT9 Retrieved May 20, 2003, from www.cde.ca.gov/statetests/pe/pe.html

Carter, A. 1998. Mapping the mind, Berkeley: University of California Press.

Czerner, T. B. 2001. What makes you tick: The brain in plain English, New York: John Wiley.

Dennison, P. E. and Dennison, G. E. 1998. Brain gym, Ventura, CA: Edu-Kinesthetics.

Dienstbier, R. 1989. Periodic adrenalin arousal boosts health, coping. New Sense Bulletin, : 14.9A

Dwyer, T., Sallis, J. F., Blizzard, L., Lazarus, R. and Dean, K. 2001. Relation of academic performance to physical activity and fitness in children. Pediatric Exercise Science, 13: 225–237. [CrossRef], [Web of Science ®]

Gavin, J. 1992. The exercise habit, Champaign, IL: Human Kinetics.

Hannaford, C. 1995. Smart moves: Why learning is not all in your head, Arlington, VA: Great Ocean.

Howard, P. J. 2000. The owner’s manual for the brain, Austin, TX: Bard.

Jarvik, E. 1998. Young and sleepless. Deseret News, July 27: C1

Jensen, E. 1998. Teaching with the brain in mind, Alexandria, VA: Association for Supervision and Curriculum Development.

Jensen, E. 2000a. Brain-based learning, San Diego: The Brain Store.

Reilly, E., Buskist, C., & Gross, M. K. (2012). Movement in the Classroom: Boosting Brain Power, Fighting Obesity. Kappa Delta Pi Record, 48(2), 62-66. doi:10.1080/00228958.2012.680365.

Physicians Ask New HHS Head For Health IT Help

Posted on February 28, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The American Academy of Family Practitioners has written to new HHS Secretary Tom Price with a list of areas in which health IT could use a helping hand.  In its letter, the group outlines issues with physician use of health IT that the new leadership could tackle.

According to the AAFP, the top issues policymakers need to tackle include:

  • Lack of healthcare data access undercuts care: Without interoperability, it will be hard for doctors to ensure continuity of care, care coordination and a learning and accountable health system, the group says. It names the Direct protocols as an example of progress on this front.
  • HIT functions are too business-oriented: According to the AAFP, the healthcare industry has spent too much time focused on automating the business of healthcare, particularly documentation. The letter argues that it’s time to flip the focus from business functions to delivery of appropriate care.
  • HIT reduces physician satisfaction: The group argues that current health IT solutions are “extinguishing the joy of practice” for physicians and contributing to physician burnout and frustration.
  • EHR certification standards are undercutting clinicians: The AAFP contends that existing standards for EHR certification are causing problems physicians, as they don’t do much to push vendors to meet user demands or improve their technology.

This is certainly a reasonable summary of issues in physician HIT adoption. And they deserve to be addressed Unfortunately, it’s not likely that that the AAFP will get much satisfaction from HHS, CMS or any other government entity. I’ve reluctantly come to the conclusion that agencies like ONC aren’t going to get much more done.

I do have hope that current waves of technology will allow health IT issues to self-heal to some extent. In particular, as healthcare technology becomes more decentralized, connected and mobile, providers won’t have to manage clumsy, ugly EMR interfaces on the desktop. In part due to some chats with vendors, I’ve become convinced that next-gen HIT solutions will present data via lightweight clients (perhaps even lighter than existing apps) which create an EMR-on-the-fly. One example of a company working on this approach is Praxify which Healthcare Scene recently saw at HIMSS. This lightweight client approach could make existing concerns about HIT usability and architecture obsolete.

However, I’m realistic enough to know that no matter how nifty emerging HIT approaches are, we still have to get from here to there. And as long as clinicians remain something of an afterthought when EMRs are designed – something which despite vendor denials, remains a big issue – we’re likely to keep struggling with today’s HIT issues. Let’s hope the revolution comes before we’ve exhausted our issues fighting current health IT demons.