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Shimmer Addresses Interoperability Headaches in Fitness and Medical Devices

Posted on October 19, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The promise of device data pervades the health care field. It’s intrinsic to patient-centered medical homes, it beckons clinicians who are enamored with hopes for patient engagement, and it causes data analysts in health care to salivate. This promise also drives the data aggregation services offered by Validic and just recently, the Shimmer integration tool from Open mHealth. But according to David Haddad, Executive Director and Co-Founder of Open mHealth, devices resist attempts to yield up their data to programmers and automated tools.

Every device manufacturer has its own idiosyncratic way of handling data, focused on the particular uses for its own device. According to Haddad, for instance, different manufacturers provide completely different representations for the same data, leave out information like time zones and units, and can provide information as granular as once per second or as vague as once per day.. Even something as basic as secure connectivity is unstandardized. Although most vendors use the OAuth protocol that is widespread on the Web, many alter it in arbitrary ways. This puts barriers in the way of connecting to their APIs.

Validic and Shimmer have to overcome these hurdles one by one, vendor by vendor. The situation is just like the burdens facing applications that work with electronic health records. Haddad reports that the cacophony of standards among device vendors seems to come from lack of attention to the API side of their product, not deliberate obstructionism. With all the things device manufacturers have to worry about–the weight, feel, and attractiveness of the object itself, deals with payers and retailers offering the product, user interface issues, etc.–the API always seems to be an afterthought. (Apple may be an exception.)

So when Shimmer contacts the tool makers at these vendors, most respond and take suggestions in a positive manner. But they may have just one or two programmers working on the API, so progress is slow. It comes down to the old problem in health care: even with government emphasis on data sharing, there is still no strong advocate for interoperability in the field.

Why did Open mHealth take on this snake’s nest and develop Shimmer? Haddad says they figured that the advantages of open source–low cost of adoption and the ease of adding extensions–will open up new possibilities for app developers, clinical settings, and researchers. Most sites are unsure what to do with device data and are just starting to experiment with it. Being able to develop a prototype they can throw away later will foster innovation. Open mHealth has produced a detailed cost analysis in an appeal to researchers and clinicians to give Shimmer a try.

Shimmer, like the rest of the Open mHealth tools, rests on their own schemas for health data. The schemas in themselves can’t revolutionize health care. Every programmer maintains a healthy cynicism about schemas, harking back to xkcd’s cartoon about “one universal standard that covers everyone’s use cases.” But this schema took a broader view than most programs in health care, based on design principles that try to balance simplicity against usefulness and specificity. Of course, every attempt to maintain a balance comes up against complaints the the choices were too complex for some users, too simple for others. The true effects of Open mHealth appear as it is put to use–and that’s where open source tools and community efforts really can make a difference in health care. The schemas are showing value through their community adoption: they are already used by many sites, including some major commercial users, prestigious research sites, and start-ups.

A Pulse app translates between HL7 and the Open mHealth schema. This brings Open mHealth tools within easy reach of EHR vendors trying to support extensions, or users of the EHRs who consume their HL7-formatted data.

The Granola library translates between Apple’s HealthKit and JSON. Built on this library, the hipbone app takes data from an iPhone and puts it in JSON format into a Dropbox file. This makes it easier for researchers to play with HealthKit data.

In short, the walls separating medicine must be beaten down app by app, project by project. As researchers and clinicians release open source tools that tie different systems together, a bridge between products will emerge. Haddad hopes that more widespread adoption of the Open mHealth schema and Shimmer will increase pressure on device vendors to produce standardized data accessible to all.

Prematurely Calling the End of Small Practices

Posted on October 16, 2015 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.

I continue to hear people predicting the death of small practices. In fact, I’ve met many vendor executives that have essentially started treating small practices as an extinct species. While there are certainly a lot of pressures and challenges associated with running a small practice today, we’re far from the end of small practices.

The biggest challenge to small practices is these major hospital systems that are buying up small practices left and right. We’ve seen this happen all over the country and they’ve become extremely dominant in some parts of the country. No doubt this is a threat to many of the small practices out there and is worth watching.

While many hospital systems are buying up practices, I over heard Dr. Halee Fischer-Wright, President and CEO of MGMA, make a really interesting counter point to this trend. The media and the acquiring hospital systems love to talk about small practices being acquired. However, we don’t give the same coverage to all of the doctors who leave a hospital system or those practices which get divested from a hospital system because they’re not working out as expected.

What does this mean? It means we hear about all of the small practices being acquired, but we don’t really hear about the small practices that leave the hospital system. This means we likely have a false impression of how many small practices actually still exist. I still know of many in my local area and I’m sure you do too. They just don’t get the same coverage as the large systems.

I do think that this current health care environment is harder for small practices than it was previously. The shift to value based care will continue that pressure. However, I heard over and over at MGMA about small practices coming together with vendors to be able to receive the benefits of value based reimbursement while still maintaining their independence.

Certainly this is no longer your father and your grandfather’s healthcare system. However, I still think the small practice is alive and will be for a long time to come.

Patients Designing Their Own Health Care Journey

Posted on October 15, 2015 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.

All across health care we see examples of patients starting to drive more of their health care decision making. This as all sorts of good and bad consequences, but I think it’s fair to say that this train has already left the station. I think that most of this shift is coming thanks to a massive increase in high deductible plans and easily accessible health information.

As part of the next evolution in patient involvement in their care, I was fascinated to discover patients designing their own health care experience in what they’re calling a d-Patient (a take off of the popular e-Patient). The movement is inspired and led by Katie McCurdy and her story.

The second in the series of D-Patient stories comes from Logan Merriam. Logan has Crohn’s Disease and had been battling this chronic disease for many years when he came to this realization:

I’ve realized that I am the only person who will prioritize the symptoms I care about, and I need to be responsible for solving them. And as it turns out, I’m also the foremost expert on my illness.

He then goes on to describe how he was able to better communicate his health challenges to his doctor:

At one point I was frustrated by a particular medication that was ping-ponging me back and forth between its side effects and my Crohn’s symptoms. I tried, clumsily, to explain the rollercoaster I was experiencing without much success. At the time I was getting my degree in graphic design, so finally I opened Adobe Illustrator, drew a graph of the situation, and emailed my gastroenterologist to show him what I was feeling:
Crohn's Disease Roller Coaster

This image immediately helped his doctors to be on the same page as him and start looking at options to solve his problems. Plus, he says that it forced him to codify and understand the problem himself.

You can go read the rest of his story here, but it leads to Logan designing his own health app called Flaredown including a successful Indiegogo campaign. What great examples of patients deciding not to wait. They’re starting to take control of their health and that’s a great thing. I love patients who are respectfully involved in their health care. The best doctors I know love it too.

90% of the World’s Data Was Created in the Last 12 Months

Posted on October 14, 2015 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.

Vala Afshar shared the following data insight from @salesforce.

Then, Jim Rawson, MD asked an important question for those of us in healthcare: How do you plan to manage it?

I’ve been having a discussion around healthcare data with a lot of people recently. One person I talked with at MGMA says we need more filters with that data. I thought it was interesting that he used the word filters. I’m not sure it’s quite the right word since filters means you only look at part of the data. In healthcare we need something that looks at all the data, but only boils up the data that matters to the healthcare provider at the time and place they need it.

Unfortunately, I’ve seen most healthcare analytics and healthcare data companies focused on the data. I haven’t seen many of them really work on the intelligence (filters if you prefer) that’s needed on top of that data. Healthcare organizations need solutions. They don’t need more tools.

We all know why companies are providing tools as opposed to solutions. It’s much easier to build the tools. It’s much harder to discover and share the solutions. However, the reward is going to be massive for those organizations that provide solutions.

Going back to the original question: How do you plan to manage all the data? I think that most healthcare providers have no idea. I think they assume they’ll be able to purchase solutions that do the work for them. I’m not seeing many of those solutions yet, but I’m sure they’re coming.

Chronic Care Management Infographic

Posted on October 13, 2015 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.

Smartlink Mobile Systems has put out an infographic that looks at interest in the chronic care management program by physicians. This data is quite interesting since the chronic care management program has been one of the popular topics at the MGMA annual conference this week. There’s a lot of discussion about the program and a lot of organizations trying to work out how to do the program effectively. I think that’s illustrated in the graphic below.
Chronic Care Management Infographic

What do you think of the Chronic Care Management program? Are you participating? Are you planning to participate? I’m sure we’ll be writing a lot more about this in the future.

Bold Insights from the #MGMA15 Keynote Kickoff

Posted on October 12, 2015 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.

Yesterday was the start of the MGMA Annual conference in Nashville. The event kicked off with a really great opening keynote from MGMA’s President and CEO Dr. Halee Fischer-Wright. While most keynotes from organization Presidents are boring and dry, I loved how candid and straight forward Dr. Fischer-Wright was in her comments. She definitely is pushing forward a new vision for the organization.

Here’s some highlights I tweeted from her keynote:


This reminds me of my post on EHR induced PTSD. I could have easily called that post Healthcare Buzzword induced PTSD.


Pretty brave of her to be so bold. I’ll be interested to hear people’s reactions.


I agree with her that Healthcare has changed, but I’d also argue that healthcare is still changing. That just compounds the problem.


I agree that apathy is an extraordinary challenge. Most doctors and healthcare professionals feel paralyzed and feel that they can’t do anything to make a difference or change the trajectory of where healthcare is headed. That’s a good thing since that’s a perception you can change. Apathy because people don’t care would be a much harder challenge.


This leads to some apathy as well, but also is converting to anger.

Needless to say I was impressed by Dr. Fischer-Wright. Appropriately, Jeremy Gutsche spoke after Dr. Fischer-Wright and commented about the need of organizations and people to take risks and fail. Much of the learning we get comes from taking risks and accepting that sometimes we’re going to fail. I think that’s where Dr. Fischer-Wright is taking the MGMA organization. She’s looking at big, ambitious goals. She might fail at some, but I predict that those that don’t fail are going to make a big difference.

Are There Any Doctors Optimistic About Healthcare?

Posted on October 9, 2015 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.

I realize that that’s a kind of catch all title, but it seems to be the case the more doctors I talk to about healthcare. Don’t get me wrong. I know a bunch of optimistic doctors. They are optimistic about life. They are optimistic about their patients. They are even optimistic about the future of the care that can be provided patients. In fact, it’s hard to be a doctor today and not be a bit of an optimist.

However, amidst all of that optimism I don’t many (possibly any) doctors that are optimistic about where healthcare is headed. We write about technology and EHR most of the time here, but this goes far beyond technology. Sure, EHR is the scapegoat for complaints when many times the real complaint is about the healthcare system in general.

My post about the myth of “Too Many EHR Clicks” has drawn the ire of many doctors. While there are plenty of issues with EHR software (especially some of them), most of the complaints I hear about too many clicks are a reflection of regulation and reimbursement. It still begs the question of whether an EHR can be beautifully built with very few clicks in the current regulation and reimbursement environment.

I get the pain. This tweet is an example of doctors reactions:

I could just as easily hear about doctors leaving medicine because they were spending too much time charting and not enough time with patients. Imagine if the meaningful use requirements were around in a paper chart world. We’d have even more complaints about time spent charting than we have today with EHR.

All of this to say that I don’t see much optimism about the future of healthcare from the doctors I meet. Will we reach the point that doctors kick against all of these pains and something changes? Do you see something on the horizon that will alleviate the pains that doctors now deal with today?

I’m excited by the technologies that will come out and change healthcare. I’m not optimistic that regulations and reimbursement will get any better. In fact, a lot of signs point to it getting much worse.

Ways to Grow and Market Your Medical Practice – Healthcare Scene “Minute”

Posted on October 8, 2015 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.

If you also read EMR and HIPAA (which you should), then you probably read that I hosted today’s #KareoChat where we discussed how to grow and market your medical practice. It was a lively discussion full of great insights.

After the chat, I decided it would be useful to hop on Periscope and share a Healthcare Scene “Minute” covering 4 insights into growing and marketing your practice that I gleaned from the chat. In case you missed it live, here’s the video recording below:

If you’d like to dive deeper into the topic, you can read the full transcript from today’s chat or check out the Storify that Kareo put together.

Let us know what you think about the 4 medical practice marketing insights I talk about in the video in the comments below.

Full Disclosure: Kareo is a Healthcare Scene advertiser.

Economists Display What They Don’t Know About the Health Care Industry

Posted on October 7, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Recently, I resorted to a rare economic argument in a health IT article, pointing out that it’s unfair to put the burden of high health care costs on the patients. Now 101 economists have come out publicly recommending that very injustice. Their analysis shows the deep reluctance of those who are supposed to guide our health care policy to admit how distorted the current system is, and how entrenched are the powerful forces that keep it from reforming.

My argument cited numerous studies and anecdotal reports to show the deplorable record of the US health care industry regarding costs: providers who don’t reveal prices, providers who don’t know what the patient’s out-of-pocket costs will be, wrenching differences in insurance payments for the same procedure, missing quality information that consumers would need to make fair comparisons, and more. Just as icing on the cake, the most recent Consumer Reports (November 2015) offered a five-page article on all the screw-ups that lead to medical “sticker shock.”

Probably I’m foolish to launch an economic argument with the distinguished signers of the brief letter to key members of Congress. The signers’ credentials are impeccable, placing them in an impressive list of universities and think tanks–all of which, I’m sure give generous coverage for any health care these economists need. If any of the signers should be burdened with the Cadillac tax, they could cover it with an extra consulting gig at the World Bank. (What’s the economics behind “nice work if you can get it”?)

But the economists just aren’t facing realities in the health care industry. Let’s expand their telescoped argument, full of assumptions and leaps of faith, to see what they’re saying.

First, they expect that the Cadillac tax will not be quietly absorbed by firms wooing professionals in high demand (such as health IT developers), but will drive those firms to reduce coverage. The burden will explicitly fall on the individual patient. I suspect that many firms facing staff shortages would just compensate key high-performers for the high-cost health coverage, but let’s accept the economists’ assumption and move on.

Next, the economists assume that the patient will make rational choices leading to what they call “cost-effective care.” What could such choices be?

Can the patient tell her doctor that a certain test is unnecessary, or that a certain treatment is unlikely to improve her condition? Does the patient know that the test has too many false positives, or is unlikely to add to the doctor’s knowledge? These questions lie precisely within the expertise of the provider, not the patient.

Can the patient determine whether a high-cost drug will pay for itself in reduced future health care and improved quality of life? This calls for extended longitudinal research.

Can the patient tell her provider or insurer to adopt a rigorous pay-for-value regime? If she goes looking for an ACO, will it actually gather enough data to treat her efficiently, and does it truly get rewarded for doing so? These are nation-wide policy issues outside the patient’s control.

As I pointed out in my earlier article, the patients lack the information needed to compare the costs and quality of procedures from different providers. Patients try to do so, but data is inadequate. Nor will yelling and screaming about it make any difference–we’ve all known about the problem for years and it hasn’t made much difference so far.

I don’t like dumping on economists. After all, they rarely cause the problems of the world, and are all too often tasked with solving them. The perennial occupational hazard of the economist is to be forced to make recommendations on the basis of insufficient knowledge.

But in this case, the average patient has knowledge that these economists lack. The problems are also well known to anyone in the health care industry who has the courage and clarity of vision to acknowledge what’s going on. If we want the system to change, let’s put public pressure on the people who are actually responsible for the problems–not the hapless patient.

Learn about New Requirements for Participation in EHR Incentive Programs

Posted on 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.

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) recently announced the release of final rules for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and the 2015 Edition Health IT Certification Criteria. The rules will be published on October 16, 2015, and are currently on display in the Federal Register.

The EHR Incentive Programs final rule provides new criteria that eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs. The final rule outlines program requirements in 2015 through 2017 (Modified Stage 2) and Stage 3 in 2018 and beyond, and includes a comment period for Stage 3.

The 2015 Edition Health IT Certification Criteria final rule builds on past editions of adopted health IT certification criteria, and includes new and updated IT functionality and provisions that support the EHR Incentive Programs’ care improvement, cost reduction, and patient safety across the health system.

EHR Incentive Programs Final Rule Provisions
Through the new requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology to promote health information exchange and improved outcomes. The rule also includes changes to the structure of the EHR Incentive Programs to improve efficiency, effectiveness, and flexibility.

Major policy provisions include:

  • Program modifications to reduce reporting burden, eliminate redundant and duplicative reporting, and to better align the objectives and measures of meaningful use with the Stage 3 requirements.
  • A revised single set of objectives and measures, including a reduction of the overall number of objectives to which a provider must attest.
  • Changes in EHR reporting periods, including a shift to calendar year for all providers and 90-day reporting for 2015.
  • Revisions to attestation and payment adjustment deadlines.
  • Optional Stage 3 reporting in 2017.

For more information about the EHR Incentive Programs final rule, view the Final Rule Fact Sheet that highlights key changes to the EHR Incentive Programs.

To learn more about the ONC 2015 Edition Health IT Certification Criteria final rule, visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-06.html