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Where is Clinical Decision Support Heading?

Posted on April 7, 2014 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.

A few months ago I had a chance to sit down an interview Jonathan Teich, MD, PhD, Elsevier’s Chief Medical Informatics Officer and a physician at Brigham and Women’s Hospital in Boston. In our discussion we dig into the current and future state of clinical decision support. For example, I ask Dr. Teich if you’ll be able to be a doctor in the future without it. If you want to learn more about clinical decision support and where it’s going, you’ll enjoy this video interview:

Few Healthcare Pros Have Attested To Meaningful Use

Posted on February 25, 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.

Despite all of the attention given to Meaningful Use, it seems that eligible healthcare professionals have been relatively slow to achieve compliance. A new report published in the New England Journal of Medicine concludes that just over 12 percent of EPs had attested to the Medicare portion of Meaningful Use as of May 2012, well into the life of the program.

The reasons for this relatively low uptake are complex, but clearly, the EMRs physicians are buying are part of the problem. As a piece in iHealthBeat notes, the National Center for Health Statistics recently found that only 27 percent of office-based physicians had EMRs capable of supporting 13 of the Stage 1 objectives for the MU program.  Since EPs have to meet 15 core objectives, plus five of 10 menu options, that leaves the remaining 73 percent of office-based physicians out in the cold.

To calculate uptake of Meaningful Use attestation for the NEJM, researchers with Brigham and Women’s Hospital looked at combined CMS data from April 2011 to May 2012, and GAO estimates of the number of eligible professionals in the U.S.

The researchers found that 12.2 percent of 509,328 eligible professionals had attested to the Medicare portion of the MU program as of May 2012, including 17.8 percent eligible PCPs and 9.8 percent of specialists. PCPs accounted for 44 percent of all Medicare Meaningful Use attestations, the researchers concluded.

Looked at state by state, the median Medicare attestation rate was 7.7 percent of eligible professionals, though rates varied from 1.9 percent in Alaska and 24.2 percent in North Dakota.

These statistics must not be very encouraging ones for CMS, particularly the leaders are ONC. And they certainly make one wonder whether the mass of doctors will end up facing penalties in 2015 rather than making sure they attest to Meaningful Use Stage 1. This should be a real eye-opener for policymakers.  As for doctors whose systems simply won’t make the grade, well, this has been called the year of the big EMR switch. I guess we may see even more switching than we expected.

Electronic Medical Records Lost Using External Hard Drive

Posted on August 16, 2011 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.

I hate to call anyone stupid, but reading stories like Hospital Reports a Possible Data Loss really steams my Chinese dumplings.  According to the post, a doctor who works at two facilities, including the famous Harvard’s Brigham and Women’s hospital (of NOVA fame) walked out carrying a hard drive with over 600 patients’ personal, private medical records and then “lost” it on a trip to Mexico.  How could anyone commit or sanction such a risky action as walking out of a medical facility while hand-carrying an unprotected copy of so many people’s medical records in electronic form?!  And you gotta love that the records ended up in freakin’ Mexico of all places.  Whoever the legendary doctor was — who remains nameless — couldn’t have done a better job, short of sending the records to Al-Qaeda.  Can you imagine?!  Ugh…

You know what the answer to this is?  It’s quite simple — don’t store records on removable hardware. With the Cloud in place, I dream of the day when it’s mandated by law that health records cannot be stored on portable hardware.  We have so many brilliant companies using the latest SaaS technology that I really scratch my head wondering why this isn’t the default choice for all EMR and EHR systems.  There is little reason that the above disaster should still be allowed to happen in 2011.

Rather interestingly, and yet again, this is another example of data theft of patient records that was NOT electronic theft.  No usernames and passwords were hacked to get at the information.  It’s was just a plain, simple (at least as far as anyone knows) dumb-luck loss.  Another shining and yet pitiful  example of why I believe that records are far safer on the web and in the Cloud than in someone’s portable hard drive or laptop.  Do we really need to start anti-theft pad-locking and chaining hardware in place at medical facilities?

On another note, I’d love to have been the fly on the wall when the doctor was asked what happened that encouraged him or her to walk out with it.  Just how common is it?

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, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

This Is Not An Ad For The Connected Health Conference, But Go Anyway, OK?

Posted on April 20, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In October of this year, the very smart people at the Center for Connected Health in Boston will again hold their annual symposium.  And unless I get hit by a bus, I intend to be there and learn everything I can.

While you’ve seen me get flip here from time to time, I’m not joking now.  I think that it’s an event that should be taken dead seriously by essentially anyone who cares about the future of health IT, disease management and e-medicine.  Their mission, which I regard as central to the future of healthcare generally, is as follows:

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

By the way, in case you suspect the same, I’m not endorsing the conference because the center is backed by Partners HealthCare, an IDS backed by hoity-toity names like Mass General Hospital and Brigham and Women’s.   Their Harvard connection isn’t the point.

No, I’m ranting about the Connected Health Symposium because I think it’s exactly where HIT visionaries ought to be spending their time.  Their programs are demonstrating, today, how the living, breathing HIT structure can bring care to where it’s needed in addition to documenting what happens in traditional settings.

There’s too much going on at the Center for me to provide a wealth of detail, but here’s some examples of what it does (summaries borrowed from media announcements):

*  Last summer, the CCH announced the results of a medication adherence study, using a wireless electronic pill bottle to remind patients with high blood pressure to take their medication. The ongoing study measured a 27% higher rate of medication adherence in
patients using Internet connected medication packaging and feedback services compared to controls.

* Another study found that remote online visits with dermatologists, or e-visits, achieved equivalent clinical outcomes for acne patients. Data further revealed that this model of care delivery was popular with participating doctors and patients, ranking e-visits as convenient and time-saving.

* Data from a late 2009 pilot  conducted by the Center suggested that its online diabetes management program, Diabetes Connected Health, may lead to improved patient knowledge, engagement and accountability, as well as improved patient provider communication.

Don’t get me wrong, the industry can’t avoid wrestling with EMR implementation and management efforts even if providers spend a lot more on remote patient monitoring and telemedicine.  Any reasonable long-term vision of a fully-connected U.S. digital health network includes all of these technologies, plus mobile health innovations we probably haven’t even heard of yet.

But in the mean time, c-health is where the rubber meets the road. (If you want to know what c-health is, read the blog written by the Center’s Dr. Joe Kvedar.)

Hoping to meet y’all in October!