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Forrester’s Take On Computing Trends For Next Year

Posted on December 31, 2013 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.

Recently, Forrester Research’s J.P. Gownder released a list of six broad tech trends he feels will dominate 2014. While they’re not healthcare-specific, I thought our readers would appreciate them, as they are relevant to the work that we do.

Mobility:  Gownder is arguing that this year coming will see a “sustained mobile mind shift.” He argues that customers and employees are beginning to expect that the data they touch will be available to them in context on any device at the exact what would’ve need. He argues that customers will actively shun businesses that lack mobile applications.

Fragmentation:  While vendors would like to see us, as consumers, stick to one vendor and operating system, Gownder argues that just the opposite will happen in 2014, with people trading off between multiple devices and thriving across operating systems. This movement, driven by the seeming infinity of new mobile devices, makes things more difficult for health IT administrators, to be certain.

Wearables:  While the wearables devices your editor has seen strike her mostly as toys, Gownder is far more enthusiastic. He argues that next year will see commercial availability of a range of once theoretical wearables — and that enterprise wearables have a particularly rich future ahead of them.

Intelligent assistants:  For me, services like Siri and Samsung’s S-Voice are entertaining, but hardly add anything to the mix when it comes to what your phone tablet or PC can do. Gownder, however, believes that intelligent assistance will rise to prominence in 2014 as they become more sophisticated, interesting and useful.

Gestural computing: Expect to see new applications and scenarios for gestural computing this year, Gownder predicts, driven by phenomena like the presence of XBox Kinect in tens of millions of homes, the emergence of Leap Motion and the emergence of a new device known as Myo from Thalmic Labs. In this case he isolates healthcare specifically as a strong use case, in which professionals manipulate and navigate medical imaging using gestures.

Stores recognize you: Here’s one I can see direct healthcare applications for; next year, Gownder predicts, will be the year in which you walk into a store and the store “recognizes you” and tailors your experience accordingly. I can see this being relevant in virtually any public-facing healthcare setting, including the ED, medical clinics and perhaps even EMT settings. Sounds very much like John’s description of a “biometrically controlled healthcare system.

So which of these trends do you think will be the most important next year? How are you adopting them, if at all, in your healthcare organization?

Defining EHR Usability Isn’t for the Timid

Posted on December 30, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

Editor’s Note: A big welcome to Carl as a writer on EMR and EHR. He’s been writing guest posts across the Healthcare Scene network for many years, but we’re happy to have him now writing formally on EMR and EHR. You’ll be able to read all of Carl’s past and present posts on EMR and EHR here.

Sometimes it seems that EHRs and usability are like Earth and Mars. Their orbits get relatively close, but they’re never going to occupy the same place and time.

Of course, the two we’re occupied with aren’t cosmic equals. EHRs are specific systems, while usability is, at best, a concept with various definitions. In fact, the closer you get to a definition of usability the less focused it becomes. My late brother used to call things like that, “Far aways.” “The farther away you get the better they look.”

Indeed, most definitions of usability say it’s something that’s useful. Ugh. So, is there any way to bring some clarity to its definition, so it has greater precision?

Doing so, I think, requires not only defining what usability is, but also tackling when it’s not present what’s wrong.

Usability: A Different Definition Approach

Most definitions of usability I’ve seen push the issue off onto use or useful. That is, usability is defined as something that is useable. This isn’t far from using a word to define itself, which was a grammar school no no. It also fails to involve the user’s expectation. I would define it this way:

Usability is the ability of a system to supply a desired result with the minimum necessary information, conditions or steps.

This definition hinges on a user getting what they want expeditiously. Simply put, usability means no unneeded fuss or feathers. As I look at it, usability is to systems what parsimony is to logic. In logic, the simplest explanation that explains the occurrence is the best. Similarly, the most usable system is the one that requires the least effort to supply the correct response.

User Hostile Systems

If I left matters at this juncture, however, I wouldn’t have addressed a major related issue. When a system is user hostile, just where has it gone wrong. Each of us has experienced or heard these tales. You make a simple request and wind up in wilderness of documentation or your options are have everything but what you want.

These are negative examples of usability. It is, however, not enough to just stamp them as such and move on. It’s also important to say exactly where usability fails. To get a handle on these issues, I divide them into three classes:

Class One: Bug. Generally, a computer or software bug is anything that caused a wrong or unexpected response. I take a narrower view. To me, a bug represents a properly designed system that’s incorrectly implemented. That is, the program code fails to carry out the system designer’s intent. For example, you click Print and the system emails your Aunt Edna.

Class Two: Design Failure. In these, the code is OK, but the requirements failed. The classic refrain for these is, “ Yes, that‘s what I asked for, but it isn’t what I wanted.” Fixing these, unlike bugs, requires correcting the requirements and conforming the code.

Class Three: Missing Requirement. Sherlock Holmes in the Silver Blaze mystery had this to say about EHR usability:

“Is there any point to which you would wish to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”
“That was the curious incident,” remarked Sherlock Holmes.

Nothing is less usable than something that doesn’t exist. It’s not a matter of getting wrong. It’s a matter of not getting it at all.

What makes this a difficult category to apply is the issue of user need. What some users think is fundamental, others may regard as a frill or not necessary at all. Usability, therefore, hinges on neither design nor programming but on policy. However, if policy deems the function important, then its omission is far more serious than the other two categories.

An example. I use a large practice associated with a local medical school. It uses Jardogs’ Followmyhealth (FMH) web portal. It conveniently combines PHR, email and scheduling. I especially like being able to email my PCP. Recently, however, I ran into a class three problem.

FMH lists my PCP and any other of my providers. My PCP suggested I see a specialist for a problem. I went to FMH to find a list of specialists and phone numbers. I got nowhere. I could remove a provider, but not find a new one. I searched FMH’s knowledge base for provider and got 40 hits, but nothing on finding one. I then went through the FMH Patient Guide again without luck. Frustrated, I left the system and went to the practice’s public web site. It had the list. I found the department and number I wanted. Once I got set up, the new provider appeared in FMH.

Wondering if I had missed something, I called support with the problem. The support rep spent several minutes, came back, and confirmed that it could not be done, which surprised him. He agreed they should at least have a link in FMH to search for providers. Whether FMH adds it, of course, is a policy question.

10,000+ Healthcare IT Professionals

Posted on December 29, 2013 I Written By

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

As we head to the end of the year, I’m really excited that Healthcare IT Central just reached an amazing milestone. That community just passed 10,000 active healthcare IT professional resumes (officially 10,070 as of this post). This sets Healthcare IT Central as one of the top (and possibly the #1) healthcare IT career website out there. As we head into 2014, we’re making plans to ensure that we are the #1 healthcare IT career website for those searching for healthcare IT positions and those looking for healthcare IT talent.

For those readers who might be looking to improve on their current job or are looking for a job, you can search for a health IT job. We’re adding more and more employers and more and more jobs. It’s exciting to see all the match making that happens on the site.

If you happen to be searching for a new or better job, you might check out some of the following links to popular health IT job searches:

Happy New Year to everyone! I hope each of you is able to reach your career goals in 2014.

FCC highlights ONC Office for Consumer e-Health plans for 2014

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

One of the things I would like to get back in the habit of in the new year is to contribute more again to this blog, which I started in 2009 with help from John Lynn at Healthcarescene.com.  Part of the challenge of keeping an ongoing stream of thoughts here has been both my busy life as an active provider of subspecialty healthcare, the growth of my practice as a business, and most importantly the emergence of new ideas for consideration and writing.

Luckily, I have been able to find some novel sources recently, and so I am going to try to reach out to these resources more often to gain insight and ideas for new and interesting topics on which to blog.

One of these sources recently highlighted an interview with Lygeia Ricciardi, the ONC Director of Consumer eHealth.  The ONC is under the purview of the Department of Health and Human Services.  Ms. Ricciardi recently attended the FCC’s mHealth Innovation Expo in Washington, DC, on 12/6/13.  She highlighted work on policies for mobile health apps and cited a goal of helping to reach everyday people and empower them to improve their ability to participate in their own healthcare.

M-health apps are currently under voluntary control in whether or not their developers follow ONC guideines for design. Such apps may help patients, who are now often referred to as “consumers”, in such tasks as shopping for good-quality healthy food and reading nutrition labels.  In 2014, the ONC Office of Consumer e-Health plans to launch a website for helping patients find where to gain access to their own health data online.  Such information can include medication lists, laboratory reports, and other records.  Ms. Ricciardi likens this initiative to the “Blue Button” project that targets making medical data available to veterans at VA hospitals.

Access remains a key concern since once patient data is downloaded through a third-party app, such data will then by definition not be protected under HIPAA.  A third-party app developer will automatically gain access to this data during the process.

Ms. Ricciardi also cited possible other uses for mHealth apps, including helping people make participating in the healthcare both fun and interactive.  Examples were provided of apps that can help patients play games to compete against each other to see who can follow healthy habits better, e.g. who can exercise more, check blood pressure more, lose more weight, and check their blood sugars more often (for diabetic patients).  She further stated that consumers are being brought into the ONC process for m-health app policy development on a regular basis to ensure that there is some public guidance for what is and is not desired.  She cited the new paradigm, often quoted by now, that a cultural shift is changing towards more shared decision making in healthcare and giving more power to patients to participate actively in their healthcare rather than being passive bodies directed by healthcare professionals.

She encouraged individual patients/consumers to get more actively involved in their own healthcare.  According to Ms. Ricciardi, although the current medical environment is still mostly of two separate worlds, with little sharing of medical information between medical practitioners and patients, the coming world of m-health apps promises much potential for changing this.

OCR Didn’t Meet HIPAA Security Requirements

Posted on December 27, 2013 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.

Oops — this doesn’t sound good. According to a report from the HHS OIG, the agency’s Office for Civil Rights has failed to meet the requirements for oversight and enforcement of the HIPAA security rule.

The 26-page report spells out several problems with OCR’s enforcement of the security rule, which was expanded by the HITECH ACT of 2009 to demand regular audits of covered healthcare organizations and their business associates. The vulnerabilities found leave procedural holes which could harm OCR’s ability to do its job regarding the security rule, the OIG said.

What was OCR failing to do? Well for one thing, the report contends, OCR had not assessed the risks, established priorities or implemented controls for the audits to ensure their compliance. Another example: OCRs investigation files didn’t contain the required documentation supporting key decisions made by staff, because the staff didn’t consistently follow the offices procedures by reviewing case documentation.

What’s more, the OCR apparently hasn’t been implementing sufficient controls, including supervisory review and documentation retention, to make sure investigators follow policies and procedures for properly managing security rule investigations.

The OIG also found that OCR wasn’t complying with federal cyber security requirements for its own information systems used to process and store data on investigations. Requirements it was neglecting included getting HHS authorizations to operate the system used to oversee and enforce security rule. OCR also failed to complete privacy impact assessments, risk analyses or system security plans for two of its three systems, the OIG concluded.

All told, it seems that if the OCR is going to oversee the privacy rule properly, it had better get its own act together.

All I Got for Christmas was a New Digital Health App

Posted on December 26, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Last week, I wrote that “All I Want for Christmas is a Doctor’s Appointment.” Turns out what I got – a flu-like cold – put that need into perspective. As luck would have it, I had recently read an article by fellow Healthcarescene.com blogger Neil Versel about AskMD, a new app from the folks at Sharecare. Being a mother of two children who are both in school, and thus exposed to their fair share of colds, I thought I’d get good use out of the symptom checker, which Versel explains, enables users to “choose which symptoms they are feeling and then see which potential health issues they might have. The app then walks the user through a “consultation” in which the app will ask the user a series of questions to identify more specifically what the symptom feels like, when it started, and if there are any other symptoms accompanying it. After the “consultation,” the user can enter in any information about medications that they are taking. When users have finished entering information, AskMD generates a list of potential problems the user might have ordered by the commonality of the potential problems.”

Before rushing to try and make an appointment with my local primary care physician during Christmas break, I decided to give AskMD a whirl. Anything that could potentially save me a co-pay, crowding into a waiting room with other sick folks, and then ultimately being told by my kindly nurse practitioner that the only treatment is rest and fluids, would be beneficial. After entering in an initial main symptom, the app took me through a series of 19 questions, resulting in a list of 11 possible causes, plus a link to find physicians and prepare for my visit. The list of physicians was helpful, and I was surprised to see that Cartersville Medical Center, where I had surgery over the summer, sponsored the results. It’s promising to see small, community hospitals are recognizing the importance of digital health tools.

photo

While a nasty cold wasn’t something I had bargained for over the holiday, it’s nice to know that a digital health app can bring me some peace of mind as I decide whether to treat my symptoms at home, or ultimately go into the doctor’s office. What digital health app did this Christmas bring your way? Or perhaps a new EMR was on your wish list? Let me know what health IT tools you’ll be ringing in the new year with in the comments below.

You might be an #HITNerd If…

Posted on December 23, 2013 I Written By

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

You might be an #HITNerd If…

you buy your staff HIPAA Training gift cards (coupon code: HCS40) for Christmas!

Note: Much like Jeff Foxworthy is a redneck. I’m well aware that I’m an #HITNerd. Good thing Nerds rule the world. At least that’s what I keep telling myself.

Patient Loyalty, EHR Adoption, and EMR vs. EHR

Posted on December 22, 2013 I Written By

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


This is interesting to consider. I’m really not sure how you can measure this result. I think this will eventually be true, but I don’t think we’re there yet. In theory everyone wants their doctor to have an EMR. However, they really just want more services for themselves as patients. That’s very different from what an EMR provides today.


My we’ve come a long ways. Now we’ll see how many organizations end up switching EHR software because they rushed their EHR implementation.


I prefer EMR and I think most doctors do as well. Although, $36 billion has a way of changing things.

All I Want for Christmas is a Doctor’s Appointment

Posted on December 20, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

A friend of mine had a very timely – and telling – prayer request at church the other day. She asked the Lord to help those in need of doctor’s appointments make them in a timely manner, both in terms of receiving care soon, and getting face time with a doctor before insurance deductibles roll over or cancelled policies end. It’s a prayer I’m sure many patients have been uttering just before they pick up the phone to see when their doctor’s next available appointment is; one that is all the more urgent for those with chronic conditions.

I have based past decisions on which new doctor to use based on their window of open appointments. Can’t see me for three weeks? Then you don’t get my business. Time is of the essence in healthcare these days. Patients want doctors’ time, and doctors don’t seem to have enough to go around. (Nor do they feel adequately compensated for it.)  Healthcare IT – patient portals, CPOE, natural-language processing systems, etc. – is certainly playing a role in helping doctors and ancillary staff get back some of that time. (Though many doctors contend entering data into EMRs is eating up a lot of that time savings.)

Some have postulated that healthcare IT, particularly digital health tools, will actually cause us to need doctors less. This counters the notion that we will soon see (if we aren’t already) a physician shortage, and an even greater lack of appointment availability thanks to the 27 million newly insured who will take advantage of their new policies in 2014. I’m not quite convinced that digital health devices and apps will cause me to go to the doctor any less. They may make the waiting in between my appointments less anxiety inducing, but I know myself too well to think I’d ever scale back on face time with my doctor. Perhaps those with chronic conditions feel differently. I’d be open to telemedicine and virtual visits, but those don’t seem to be on the radar of providers in my area.

Healthcare IT can certainly save time and improve access to care, but I don’t see how it can convince people to enter the healthcare field, which is where the true appointment availability problem seems to stem from. As a recent article at HealthcareFinanceNews.com points out, “retirement age physicians outnumber young members entering the ranks; over-worked physicians want to reduce their hours and care for fewer patients; and [there is a] general disenchantment with the state of healthcare.”

It’s a sad state of affairs when put that way. So what’s the answer? How can the healthcare industry – healthcare IT in particular –  work to ensure that prayers for timely appointment availability are no longer routine? Feel free to share your ideas in the comments below.

New ONC Coordinator – Dr. Karen DeSalvo

Posted on December 19, 2013 I Written By

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

Today it was announced that Dr. Karen DeSalvo would be the replacement to the beloved Former National Coordinator for Health IT, Farzad Mostashari. It seems that Dr. DeSalvo has an interesting history currently working as Health Commissioner for the City of New Orleans and Senior Health Policy Advisor to the New Orleans Mayor. She also has served as a member of the Steering Committee for the Crescent City Beacon Community grant.

I love Jacob Reider’s note to his ONC colleagues after serving as Acting National Coordinator:

I have been honored to serve as your Acting National Coordinator. Every minute has been inspiring, educational, and energizing. Both Lisa and I appreciate all of the support each and every one of you have given us and will give to Karen. The work of “team ONC” is a product of every team member contributing as much as we can toward our shared goals. As the baseball fans among you may recall, David Murphy, an outfielder for the Texas Rangers, was called upon to pitch in a game against the Red Sox last Summer. Like Murphy’s experience, our success has been a product of the team’s hard work and support rather than my personal achievements as your leader. As my tenure as your National Coordinator is now drawing to a close, I will return to the outfield where I am proud to serve as your Chief Medical Officer, and continue to work hard with you. We have a great team, great mission-driven people, and an incredible opportunity to change our world for the better.

I think the ONC is a great team that has the right ambitions and goals. Karen certainly has a tough act to follow. Plus, health IT is entering a new era in its history. I wish her the best of luck as she takes on this challenging position.