Thursday, December 27, 2012

Who's "We" Dr. Ashish Jha


I'm always unsettled when experts use We as Dr Jha does below, when he's quoted saying the Government's not going quite far enough with its new value-based purchasing program.

The CMS on Thursday released a list of hospitals' bonuses and penalties under the value-based purchasing program. Health policy experts have applauded such incentives, but some have questioned whether the money at stake will be enough to motivate hospital officials and doctors to adopt changes that will reduce waste and improve quality. "The purpose here is really straightforward and very reasonable," said Dr. Ashish Jha, an associate professor of Health Policy and Management at Harvard University. "Forever we have paid for a quantity of healthcare. We have not really paid for quality, and CMS has decided they want to change that." 
Explaining just who We are no easy task I suspect.  Whether the CMS that's decided they want to change that the We cited just before, a nice start Dr. Jha.  Who's the We you're talking about Doc and how do you read its mind?  Does We know CMS working its will on We's behalf?
 

Crains: Chicago medical records exchange falters

It all comes down to the dollars.
The price is too high for Loyola University Health System, says Arthur Krumrey, chief information officer at the Maywood-based hospital network.

Loyola, Evanston-based North-Shore University HealthSystem and Ann & Robert H. Lurie Children's Hospital of Chicago, which already use the same software system for their internal medical records, are discussing setting up their own exchange.

Advocate has not joined, but executives are “working on it,” says John Norenberg, a vice president at the Oak Brook-based system, with 11 hospitals statewide.

Mr. Norenberg, who is also chairman of MCHC's exchange advisory board, adds: “It's turned out to be a bit more difficult to get the players moving on this than I think anybody expected.”


Read more: http://www.chicagobusiness.com/article/20121222/ISSUE01/312229988/chicago-medical-records-exchange-falters#ixzz2GHEcBxUS
Stay on top of Chicago business with our free daily e-newsletters

HHS Stops Short Of Calling For Safety Regulation Of Digital Records – Capsules - The KHN Blog

HHS Stops Short Of Calling For Safety Regulation Of Digital Records – Capsules - The KHN Blog
The Obama administration Friday urged cooperation between software companies and caregivers to prevent patient harm caused by faulty electronic records. But it stopped short of calling for regulation or a federal requirement to report computer mistakes that pose a risk to patients.

“We are saying to the vendors: Step up and prove your ability to create a code of conduct that would be enforceable, that would bind you voluntarily to reporting safety events,” Dr. Farzad Mostashari, the administration’s coordinator for health information technology, said about the report. “And what we’re saying is: If you don’t step up, we can always look at more classic regulatory approaches.”
Sounds a bit collusional to me, but I'm not a legal sort.

HL7 versus CEN/ISO 13606

A question at Research Gate I can't answer at the moment for lack of approved membership there, Standards in medical informatics:
HL7 or CEN/ISO 13606 - can anyone explain it? What should be preferred in standardization of EHR ?  
The answer found here with a nice schematic.

The conclusion:
HL7v2.x messaging is an appropriate standard, at least for the short to medium term, for transmission of information from source clinical information systems to a Shared-EHR system. HL7 CDA may also be suitable for this purpose at some later stage. CEN EN13606 is an appropriate standard for the exchange of Shared EHR Extracts between different nodes of a multinode Shared-EHR system (e.g. the original national HealthConnect concept) or between different Shared-EHR systems
.
 'Nuff said.  Check the link for the diagram and full read of the standards.

Wednesday, December 26, 2012

Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News

Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News

They've got a nice link to a spreadsheet of winners and losers by state and referral region.  Note plenty of zeros in the readmission rates but the VBP rates fall into a nice normal curve.

Not sure what's going on there....  insights?

Friday, December 14, 2012

What’s Happening With the “Fiscal Cliff”? Premier’s Blair Childs Explains

Somehow, I don’t find this reassuring,

What other things are you hearing inside the Capitol?

You know, you go and talk to the members of Congress—and I’ve been talking to them in the past few days—and none of them know what’s going on. And these are fairly high-up people. And it’s because this really is a Boehner-Obama conversation [between President Barack Obama and John Boehner, Speaker of the House of Representatives]. And of course, Bohener is talking to McConnell [Mitch McConnell, Senate Minority Leader], and the President is talking to Reed [Harry Reed, Senate Majority Leader], and to a lesser extent, Pelosi [Nancy Pelosi, House Minority Leader]. Last week, I met with someone very senior in the Republican leadership in the House, and he really didn’t know what was going on.

Would you say this is unprecedented?

I would have said in 2011, when they did the sequestration solution  during the debt ceiling standoff, that that was equally unprecedented. And they put together a deal for that, and there was a fallback; and they could even potentially do the same kind of thing here. And if they pitch it to the committees, which I think is very possible, meaning the Congress has to work it out, then we’ll be back in the conflict between the House and Senate.

Read the whole interview here: What’s Happening With the “Fiscal Cliff”? Premier’s Blair Childs Explains

Thursday, December 13, 2012

More Signs of Rate Shock and Awe | The Health Care Blog

Robert Lazsewski writes,
Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act (“Obamacare”).  
Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.

The rest of it here: More Signs of Rate Shock and Awe | The Health Care Blog

 I think individual insurance just disappears alltogether, and soon.  It’s not worth selling and Insurers who saw big profits coming from these sales will be disappointed, the young folks are headed for Medicaid (a program ill equipped operationally or financially to accept them). Lazsewski writes further on,
I can also tell you that, so far, I have detected no serious effort on the part of Democrats to delay anything. Frankly, I think hard core supporters of the new health law and the administration are in denial about what is coming.  
I expect more health insurers to be echoing the Aetna’s comments in coming weeks. There is a real concern in the industry they need to get out ahead of this telling people why rates are shooting up to counter the “shoot the messenger” attacks that will be sure to come.

You bet the shoot the messenger attacks are about to come!  The Democrats who wrote this evolving law aren’t about to take ownership of the bad outcome. They’re bailing already.  Soon they’ll be looking for scapegoats.  The Blues, and Aetna are the targets.

Update: The reason why for sceptics.

Wednesday, December 05, 2012

Urban Versus Rural Performance by State Under Value-Based Purchasing

State-by-state comparison of scores between Urban and Rural providers.  Warmer and fuzzier in the country.

A state-by-state analysis of projected total performance scores (TPSs) for U.S. urban hospitals compared with those of U.S. rural hospitals under the Centers for Medicare & Medicaid Services’ Value-Based Purchasing (VBP) Program discloses some remarkable disparities between these hospital settings across the nation.

Overall, the TPSs are quite similar for urban and rural facilities. However, there is a clear trend for rural facilities to score higher than their urban counterparts with regard to patient-experience-of-care measures (PEOC). Meanwhile, to a lesser degree, there is also a trend for urban hospitals to have higher clinical-process-of-care (CPOC) scores.

Urban Versus Rural Performance by State Under Value-Based Purchasing

Tuesday, December 04, 2012

All-Payer Care Databases set stage for data-driven healthcare and big analytics - State and Local Connection

A nice post on predictive analytics.  Predictions don’t always pan out though, and I wonder if Healthcare not following the path of the Bankers’s Quants here.  One thing to have my 401k on the line; quite another to have my cracked chest on the predictive model.

All-Payer Care Databases set stage for data-driven healthcare and big analytics - State and Local Connection

SL Trib: Father of medical informatics, Utah’s Homer Warner dies

RIP Homer Warner,

Homer Warner, a Utah cardiologist widely recognized as the father of medical informatics, died last week from complications of pancreatitis. He was 90.

Warner’s research is still redefining medicine, colleagues say. Modern intensive care units can be traced back to the electronic systems he built to monitor heart patients in the mid-1950s. And his creation of one of the first electronic medical records in the ‘70s set the stage for a new academic field and multi-billion dollar health IT industry.

http://www.sltrib.com/sltrib/news/55391911-78/warner-medical-utah-homer.html.csp?page=1

A Case of Medical Data Redesign | asc_Blog

As we go colorful and graphical, keep in mind the prevalence of red / green color blindness please.

In his TED presentation, Thomas Goetz, the executive editor of Wired and author of The Decision Tree, explained about the need to change the way medical data is currently represented. He believes that we need to start providing better medical information, to help people know about the choices and actions that are available to them for the improvement of their health.

The method he proposed in his TED talk is actually a relatively simple notion: change text-based data into easy-to-understand graphical data. But this notion could have a profound effect in health care. I honestly wonder how no one has ever came up with this idea before. I mean if you looked at lab test results, they are confusing even for physicians, when it should be the patients who need to understand these reports more. It is, the personalized data of their health.

A Case of Medical Data Redesign | asc_Blog

LIVE FROM RSNA 2012: Are Radiologists Facing Existential Threats—Or Exciting Opportunities?

File this under Living in Interesting Times….

As Dr. Shrestha notes, the vendors are still too locked into the old PACS idea. And though “VNA” (vendor-neutral archive) continued at this year’s RSNA to be as hot a buzz-term as it was last year, Joe Marion notes, “[I]t’s inevitable that because of the EMR integration, that imaging is going to have to expand beyond just radiology; it has to. And particularly so as it becomes more and more of a factor in meaningful use. So we’re moving towards an enterprise focus. “

LIVE FROM RSNA 2012: Are Radiologists Facing Existential Threats—Or Exciting Opportunities?

Friday, November 30, 2012

Tuesday, November 20, 2012

MidWest SAS Users Group Fall 2012 Conference Papers

A link to some of the papers from the fall conference.  I hadn’t attended one of these in a very long time.  Mistake on my part as I get into a programming rut using the same code over and over again.  Helps to see new tools, and new ways of doing things.

SAS Papers, Slides, Documentation, Tools, Linked Resources

Saturday, November 17, 2012

Three Republicans Urge House Leadership To Set Up New Health Care Committee

A committee with a fifth of the US Economy under its purview.

Three House Republicans are proposing to shift all health care jurisdiction away from the powerful Energy & Commerce and Ways & Means committees to a new Committee on Health Care, according to a 'Dear Colleague' letter they sent to Republicans Wednesday (Nov. 14), and are eying Rep. Paul Ryan (R-WI) as a potential head of the proposed committee, a source close to the issue says. The lawmakers intend to offer the proposal as an amendment at the Republican Organizing Conference on Thursday, and the source says the idea has support from many of the outgoing GOP freshmen.

A health care lobbyist told Inside Health Policy there is little chance of such a committee becoming a reality. The Ways & Means and Energy & Commerce chairmen could not be reached for comment by press time.

The proposal is being pitched by Reps. Doc Hastings (R-WA), Rob Woodall (R-GA) and Reid Ribble (R-WI), who said in their email to Republican colleagues that the current committee setup is a “relic of decades of Democratic control,” and if the party is committed to reforming the federal government and repealing the Affordable Care Act, establishment of a new health care committee represents the best chance.

Three Republicans Urge House Leadership To Set Up New Health Care Committee

Friday, November 09, 2012

Illinois hospital to open supermarket clinics - Modern Physician

Another step in the direction I suggested here.  Next step is not to just collocate and share space, but learn lessons on serving customers too.  Watch how they manage those queues at Jewel.

Edward Hospital, Naperville, Ill., will open two clinics inside suburban Chicago Jewel-Osco grocery stores.

The clinics will be open seven days a week and will be located inside the Jewel-Osco pharmacies; they will offer routine treatments and preventive care without an appointment. Family nurse practitioners and physician assistants from Edward Medical Group will provide care at the selected stores, located in Naperville and Romeoville, Ill. Edward Medical Group employs 45 board-certified family-practice and internal-medicine physicians.

"We're proud to partner with Jewel-Osco and provide high-quality healthcare that's convenient and that fits the busy lifestyles and schedules that many of us have," Edward Health Ventures President Bill Kottmann said in a news release.

Edward Hospital is a 330-bed facility about 30 miles west of Chicago.

Illinois hospital to open supermarket clinics - Modern Physician

Tuesday, November 06, 2012

MIT algorithm designed to clear up confusion in healthcare NLP

If you want to understand why a Medical App isn’t like your Accounting App.  Don’t hold your breath for this to be easily cleared up.

Massachusetts Institute of Technology researchers are working on algorithms to better distinguish the meaning of words that might be used in multiple ways--a common occurrence in healthcare, reports MIT News.

Since so much data is buried in physician notes, for instance, the implications for advancing natural language processing are huge. The problem lies in "word-sense disambiguation"--determining, for example, whether  "discharge" refers to a bodily secretion or release from a hospital.

The researchers, from MIT's Computer Science and Artificial Intelligence Laboratory, will present their new system next week at the American Medical Informatics Association's annual symposium in Chicago.

MIT algorithm designed to clear up confusion in healthcare NLP - FierceHealthIT

Healthcare Experts Balance Patient-Reported Data Promise, Problems -

Interesting use of Patient Responses linked to the EHR.

The Cleveland Clinic has collected patient-reported outcomes (PRO) data on more than 720,500 patient visits since 2007, including upwards of 83,000 in its Epic MyChart patient portal, according to neurologist Dr. Irene Katzan, director of the clinic's Center for Outcomes Research and Evaluation. The database contains about 13 million responses from 238,000 patients, and 1,062 providers actively contribute to data collection.

When patients arrive for appointments at several Cleveland Clinic departments, they enter information on tablets or on touchscreen kiosks in the waiting areas; the organization has deployed about 385 tablets for this purpose, Katzan said. Patients also can enter information online through Epic's MyChart, though only 30% of data collection is happening this way.

Healthcare Experts Balance Patient-Reported Data Promise, Problems -

Announcing SQL Server 2012 Express LocalDB RC0 - SQL Server Express WebLog - Site Home - MSDN Blogs

And I just loaded mine last night.

Announcing SQL Server 2012 Express LocalDB RC0 - SQL Server Express WebLog - Site Home - MSDN Blogs

Monday, October 22, 2012

OHSU to put $1M to work on 'smarter' EHR | Healthcare IT News

File this under solutions create the next set of problems: data dazzle via EHRs.

For example, Hersh explained that while it is difficult to cause direct harm with a stethoscope, improper use of a stethoscope could lead to inaccurate results, tests or treatments. Similarly, improper use of EHRs could lead a clinician astray, especially in the Intensive Care Unit (ICU) where an average of 1,300 data points per patient are logged every 24 hours.

The grant, championed by Jeffrey Gold, MD, will put OHSU at the forefront of this work. Through his past role as ICU director and current role as professor of medicine and program director for Pulmonary Critical Care and Critical Care Fellowships, Gold became interested in this work when he noticed that EHRs weren’t consistently providing clinicians with a clear picture of a patient’s health over time.

“In the past, all patient data was hand written, making it easier to remember and learn,” said Gold. “Electronic records are no doubt a useful tool in many ways, but now there are so much data in front of you that often you can’t see the forest for the trees.”

OHSU to put $1M to work on 'smarter' EHR | Healthcare IT News

Wednesday, October 03, 2012

Statistical method will analyze important, poorly studied areas of human genome

Just as God doesn’t play dice with the Universe, I suspect what seems junk, serves some purpose.  Scientists at U of W will tell. 

The Human Genome Project, completed in 2003, produced the identity of the entire human genetic code at the most fundamental level - the base. Three billion chemical bases from each parent pair together in a sequence along a twisting DNA ladder.

Only five percent of the material is actual genes; those 23,000 genes are the work horses that make molecules, usually proteins. The rest was initially thought to be useless "junk."

Wanting to understand how such waste could occur in nature, the NHGRI nearly a decade ago launched the Encyclopedia of DNA Elements, or ENCODE, to learn what that 95 percent was all about - particularly, where biological activity might be taking place in it. Last month, in a flurry of papers published in high-profile journals, ENCODE researchers concluded that, in fact, at least 80 percent of the human genome serves some biochemical purpose.

Now, building on the momentum, ENCODE has awarded another round of major grants to examine the data in new and even more rigorous ways to gain a deeper understanding of how the 80 percent affects genes. Keles' group will concentrate on areas of the genome that contain nearly identical repeating segments of base pairs. ENCODE did not include these repetitive areas in its earlier analysis.

Statistical method will analyze important, poorly studied areas of human genome

It’s Not About the $100 Million: What UPMC’s Senior Leaders Understand about Healthcare’s Future

I have a liberal friend fond of quoting Eisenhower’s Military Industrial Complex Speech.  I’d wager we have a Government Medical-Industry Complex now, investing big bucks, in big systems, and probably on a scale far larger than the Military ever envisioned for the Defense Industry.  Certainly an investment that will touch far more Americans very personally.  Hope we manage it as well as the Military did their, and avoid their mistakes too.

The announcement on Monday of this week that the University of Pittsburgh Medical Center (UPMC) health system was investing $100 million over the next five years on a comprehensive enterprise analytics initiative was a big one, to say the least. Try to name another, similar initiative on this scale, and one would be very hard-pressed to do so, with the notable exception of the years-long Kaiser Permanente KP HealthConnect/general IT initiative.

It’s Not About the $100 Million: What UPMC’s Senior Leaders Understand about Healthcare’s Future

Tuesday, September 25, 2012

Negative effects of EHR systems on adoption and informatics | EHRintelligence.com

Interesting article on the inability to get much out of EHRs.  They’re vendor centric, not patient or even provider centric systems.

While the architects of federal programs such as meaningful use have pegged EHR and health IT systems as the vehicles for driving changes in healthcare, Marsolo contends that their efforts to increase the adoption of these systems appear to have more significantly benefitted vendors rather than providers. While users of EHR systems must adjust to working electronically and avoid reproducing paper-based approaches to using this technology, they are subject to the vendor’s vision of how these systems work with limit power to effect change. “Without outside pressure from the marketplace, from patients, and from clinicians, however, vendors have no incentive or motivation to change,” argues Marsolo.

Negative effects of EHR systems on adoption and informatics | EHRintelligence.com

Friday, September 21, 2012

Answer to: A Major Glitch for Digitized Health-Care Records

The link below references a WSJ column that’s subscription only and I don’t subscribe so unable to way if I agree with the assertion here or not.

Based on a WSJ Opinion piece EMR software is “is generally clunky, frustrating, user-unfriendly and inefficient.” Although I will not disagree with this “generalization,” I do take exception with the articles na├»ve view that Health IT systems have not improved patient health.

Answer to: A Major Glitch for Digitized Health-Care Records

I’ll track it down though, and read and comment, as it’s an assertion that’s not going to go away and will be the subject of some research (I hope).

Tuesday, September 18, 2012

The Big Shortage: Rethinking The Need For More Primary Care Doctors – Health Affairs Blog

Last week’s most read article.  Teams and technology as replacements for the primary care model.

I think it’s time. A thoughtful article that should be most read.

The Big Shortage: Rethinking The Need For More Primary Care Doctors – Health Affairs Blog

Doctors Use EHRs To Do 'Chart Biopsies' - Healthcare - Electronic Medical Records - Informationweek

I’m always curious about trade-off moments and what information’s exchanged in them.  I’m not certain the  EHRsys I know would lend itself to this pre-tradeoff inquiry.

As the number of hospitals with electronic health record systems grows, a new study finds that inpatient physicians who receive patients from the emergency department have begun to do "chart biopsies" of electronic records to prepare for the handoffs.

Doctors Use EHRs To Do 'Chart Biopsies' - Healthcare - Electronic Medical Records - Informationweek

Tuesday, July 17, 2012

The first SAS PROCs - The SAS Bookshelf

The codes older than many of the folks I work with here.  Via Kathy Council’s blog (link below) on some of the first SAS Procedure statements circa 1970.  The hardware changes all the time, but code lingers.

  • PROC REGR - regression
  • PROC ANOVA - analysis of variance
  • PROC FACTOR - factor analysis
  • PROC AOV - alternate analysis of variance (treats missing values as zero; not as efficient as ANOVA)
  • PROC LATTICE - analysis of variance with three types of analysis (square balanced, square unbalanced, rectangular)
  • PROC DUNCAN - Duncan’s multiple range test
  • PROC PLAN - randomized plans
  • PROC CORR - bivariate statistics
  • PROC SORT
  • PROC MEANS
  • PROC NESTED - nested analysis of variance
  • PROC PRINT
  • PROC FREQ
  • The first SAS PROCs - The SAS Bookshelf

    Monday, July 16, 2012

    Montefiore Hospital Tackles Worrisome Computer Physician Order Entries - Healthcare - CPOE - Informationweek

    Blame it on the Docs.  Could article on Physicians entering orders on the wrong patients.

    Montefiore Hospital Tackles Worrisome Computer Physician Order Entries - Healthcare - CPOE - Informationweek

    The researchers at Montefiore Medical Center in New York wanted to find a way to detect wrong-patient orders in their CPOE system. Since clinician reports were unreliable, they looked at a marker for these errors: the retraction of orders within 10 minutes of placement, followed by reorders 10 minutes later. The investigators hypothesized that doctors had placed many of these orders on wrong patients, and it turned out they were right: Interviews with 233 physicians over a four-month period showed that 76% of the original orders had been for the wrong patients. In other words, they were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications

    Monday, January 09, 2012

    Is Age Just a Number, or Will it Pose a Challenge to Widespread Health IT Adoption? | Healthcare Information Technology

    Interesting paper on age and adoption with a bottom line below: it’s more how one manages the workflow changes than anything else (IMO).

    One particularly important part of HIT training is learning how to change one's workflow to optimize the process using technology. Understanding and documenting current processes and designing more efficient workflows is essential to integrating technology into a healthcare professional's practices. "When workflow is interrupted by technology, people get really crazy," Ms. Eichenwald-Maki says. "Workflow has to be a top priority in the planning phase and training phase." For example, Ms. Thielst says using tablets may be easier for older practitioners to adopt because it is similar to holding a clipboard and writing information during patient interviews.


    Moreover, workflow training is important not just for older adults, but for clinicians of all ages. "Health IT implementations that don't fit into user workflow(s) are likely to fail, no matter the person's age," Ms. Thielst says. "Older [adults] get frustrated faster, but younger ones get frustrated as well if it's not properly planned out."

    Is Age Just a Number, or Will it Pose a Challenge to Widespread Health IT Adoption? | Healthcare Information Technology