And here are the winners !! Some of this is my bizarre sense of humor.
September 12,2010 A Gem on HIT, even if I say so myself, a moment of inspiration !
I will be posting Part II in the next blog post.
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Thursday, December 23, 2010
Monday, December 20, 2010
Predictions for Beyond 2011
Perhaps I am foolish to even try to predict 2011, and even more so for the coming decade.
However, I have found a reasonably credible business source for these predictions.
The Crystal Ball
The effects of information technology will increase not only in healthcare, but for the rest of the economy and the percentage of the GDP to which it will contribute.
Gartner Consulting of Stamford, CT prognosticates
By 2015, a G20 nation's critical infrastructure will be disrupted and damaged by online sabotage.
By 2015, new revenue generated each year by IT will determine the annual compensation of most new Global 2000 CIOs.
By 2015, information-smart businesses will increase recognized IT spending per head by 60 percent.
By 2015, tools and automation will eliminate 25 percent of labor hours associated with IT services.
By 2015, 20 percent of non-IT Global 500 companies will be cloud service providers.
By 2014, 90 percent of organizations will support corporate applications on personal devices.
By 2013, 80 percent of businesses will support a workforce using tablets.
By 2015, 10 percent of your online "friends" will be nonhuman.
del.icio.us Tags: predictions,gartner,health train express,information technology,cloud services,tablet pc
Top Advances in Medicine during the Past Decade
1. Thermo stabile vaccines and Nano particle enhancements
The first attaches vaccines to nanoparticles that can be absorbed by the skin inside the nostrils. Dr. James R. Baker Jr., director of the University of Michigan’s nanotechnology institute, said it works with hepatitis B and flu vaccine. He won a new grant to test the respiratory syncytial virus, which causes pneumonia.
The particles are in what Dr. Baker described as a “proprietary formulation of mayonnaise” based on soybean oil. The vaccine ends up inside the oil particles, which protect it from temperature changes and microbes. The immune system is “made to eat oil droplets,” Dr. Baker said, because it targets viruses, which are essentially time bombs of genetic instructions inside casings of fats. The “mayonnaise” is so safe, he said, that rats fed the equivalent of two quarts a day had only one side effect — weight gain. The emulsion by itself cures viral lesions like cold sores, he said; its surfactants harmlessly penetrate the skin but break up the herpes virus inside.
The second thermo stabilized vaccine the foundation is still backing is a complex one against malaria. It fuses the genes for parasite proteins onto a “genetic backbone” from vaccines against smallpox and a chimpanzee virus.
Rather than being bottled, the vaccine can be dried onto a bit of filter paper.
2. Alzheimer’s Disease is now a public health challenge. Over the past quarter of a century and with the relative success dealing with infectious disease, cardiovascular disease, longevity has produced CNS deterioration as a major social and public health issue. Much research and clinical trial resources are now focused on Alzheimer’s Disease. Dr. Howard Fillet, also a geriatrician and executive director of the Alzheimer's Drug Discovery Foundation, said this week that more than 150 clinical trials worldwide are testing dozens of drugs that may be the answer to combating the disease itself, and not just the symptoms. (Seattle Times) . Clinical Trials.go lists 861 studies in progress or completed.
3. The Intraoperative MRI For Brain Tumors
4. Advances in Oncology The use of targeted monoclonal antibodies has gained wide acceptance as the SOC. The use of anti-vascular growth factor also has become SOC.
5. Advances in Urology Two major advances over the past decade have markedly reduced human suffering; alpha agonists for the almost elimination of urinary retention from BPH (benign prostatic hypertrophy) and the pharmacologic treatment of male impotence with the use of Viagra (Sildenafil), Cialis (Tadafil) and others
6. The advent of Robotic Surgery as well as the use of Endoscopic Surgery has revolutionized many surgical specialties It has had multiple applications: (Wikipedia)
There are many more, these are just the highlights and ‘Gee Whiz” items.
8. Regenerative Medicine or the use of stem cell biology for treatments of degenerative or traumatic injuries as well as many other applications. (Regenerative Medicine.net)
9.Finally, the use of Health Information Technology has and will create a tsunami of events, improving patient care, easing clinicians access to medical records, imaging, learning and CME experience as well as telemedicine and communication with colleagues.
TOP 20 Software and Service Vendors (in HIT)
The end of a year and a decade (wasn’t it just 2000, Y2K)?. I have been busy reviewing things new, things old, things good, and things bad.
Here is the next.
As part of the annual review of best and worst, here is the lineup for HIT.
KLAS, an organization that evaluates medical software has announced it’s top 20 list for 2010. The top are:
For software:
The 2010 "Best in KLAS" vendors for software:
- Acute Care EMR – Epic EpicCare Inpatient EMR
- Ambulatory EMR (more than 100 Physicians) – Epic EpicCare Ambulatory EMR
- Ambulatory EMR (26-100 physicians) – eClinicalWorks EMR
- Ambulatory EMR (6-25 physicians) – Greenway Medical PrimeSuite Chart
- Ambulatory EMR (2-5 physicians) – e-MDs Chart
- Business Intelligence/Reporting – Dimensional Insight The Diver Solution
- Cardiology – Digisonics DigiView
- Community HIS – McKesson Paragon
- Decision Support – Business - Allscripts Sunrise EPSi Decision Support (Eclipsys)
- Document Management and Imaging – MedPlus ChartMaxx
- Emergency Department – Wellsoft EDIS
- Enterprise Scheduling – Unibased Systems Architecture RMS
- Financial/ERP – McKesson Pathways Fin./Materials/HR Mgr
- Homecare – Homecare Homebase
- Laboratory – Siemens Novius Lab
- PACS – DR Systems Unity
- Patient Accounting and Patient Management – Epic Resolute Hospital Billing
- Pharmacy – Epic Willow
- Practice Management (more than 100 physicians) – Epic Resolute/Prelude/Cadence
- Practice Management (26-100 physicians) – McKesson Horizon Practice Plus
- Practice Management (6-25 physicians) – Greenway Medical PrimeSuite Practice
- Practice Management (2-5 physicians) – e-MDs Bill
- Radiology – Epic Radiant
- Speech Recognition – Nuance eScription
- Surgery Management – Unibased Systems Architecture ORMS
For Services:
The 2010 "Best in KLAS" vendors for professional services:
- Application Hosting (CIS/ERP/HIS) – Cerner
- Claims and Clearinghouse Services – Navicure
- Clinical Implementation Principal – Deloitte Consulting
- Clinical Implementation Supportive – Innovative Healthcare Solutions Inc.
- Financial ERP Implementation – ACS
- IT Outsourcing (extensive) – CareTech Solutions Inc.
- Planning and Assessment – Impact Advisors
- Revenue Cycle Transformation – Deloitte Consulting
- Technical Services – ACS
- Teleradiology Services – Virtual Radiologic (vRad)
- Transcription Services – Webmedx
To purchase the full report, providers and vendors can visit www.KLASresearch.com/top20
Who is KLAS?
- KLAS conducts over 1,900 healthcare provider interviews per month, working with over 4,500 hospitals and over 3,000 doctor’s offices and clinics
- KLAS is independently owned and operated
- KLAS has ratings on over 250 healthcare technology vendors and over 900 products and services
- KLAS publishes approximately 40 performance and perception reports per year
- KLAS is headquartered in Orem, Utah, with independent researchers working throughout North America
Saturday, December 18, 2010
The Cookie Monster or Who Ate My Cookie ?
Kermit and the rest of the Sesame Street not withstanding, there is a great danger in talking about cookies. So Steven Duckett discovered when he was summarily dispatched from the cookie jar of Alberta’s Health System. He was caught with his hand in the ‘ proverbial cookie jar, and on camera. When discovered, he had the audacity to exclaim “ I am eating my cookie, you will have to wait.” Politely he offered the remains of one cookie to an eager news lady as she chased him through the lobby. Numerous passerby's were noted to ignore the incident and offered no assistance to Duckett. Neither Duckett or his attorney are returning telephone calls.
The incident has been documented on several videos that have been ‘leaked’ to you tube which have become viral. Canada’s Department of Health is investigating the incident. Although Duckett posted bail his passport has been revoked, and he is required to wear an ankle bracelet, as well as being forbidden from entering the U.S. for health care. The Canadian Minister of Finance is reviewing Duckett’s financial records to determine if public funds were diverted into cookie dough.
The Cookie Caper
Several media companies have capitalized on his mis-fortune cookie.
Caught on Sesame Street
Wednesday, December 15, 2010
More on Merger Mania
There is a flurry of mergers and acquisitions in the health insurance and hospital industry. There are several driving forces creating this activity. The first is the mandate to obtain electronic medical records both by individual providers, and hospital systems. The federal government is incentivizing this activity but also holding a big stick threatening penalties in reimbursements if providers do not adopt EMR and HIT systems.
The second factor is the proposition to form Accountable Care Organizations (ACOs).
The merger mantra is not fueled by healthcare reform, the rationale is market share.
The acquisition of HIT is expensive, either way. However hospital administrators wish to capitalize on size for market share, as well as IT. Other HIT requirements regarding interoperability amongst differing hospitals creates the need for forming regional health information exchanges. Merging two entities into one enables easier legal requirements for exchanging data without the complexities of separate Health Information Exchanges. The incentives offered by the federal government to fund EMR and HIE are inadequate, and do not take into consideration ongoing maintenance expenses. To be sure, reimbursements will continue to decrease just as the water level subsides when the tide goes out.
The health care market place has already seen mergers, such as [Humana-Concentra[,[ Community Health Systems-Tenet Care], [Steward Health Systems-Merrimack Valley-Neshoba Valley], [Peace Health System – Southwest Washington Medical Center][Inova Health Systems – Prince William Health System ]
These mergers and the need for IT mean big business for IT hardware and software vendors.
There have been several mergers and dissolutions amongst EMR vendors. Misys was purchased by All scripts about 24 months ago. That marriage dissolved quickly in June 2009, when Misys dumped Allscripts by merging it with Eclypsys, another EMR software vendor. Mike Laurie read very well the signs of demand for HIT companies in purchasing Misys, and then taking a quick profit by dumping Allscripts when it became evident that the EMR market is highly competitive and not very profitable.
Wise investors in Health IT and software must have knowledge and expertise about much minutiae and realize that HIT software is not something bought off the shelf. The applications are highly specialized in a market that is not user friendly amongst providers.
The number of overall mergers peaked in 2006, and the number of independent hospitals as opposed to hospital systems has decreased during that same time period (see figure)
What is a Prezi ??
I wanted to take a break from all the ‘serious nonsense’ that effects each and every one of us, from doctors to patients.
In today’s blog I am introducing “Prezi”. Rather than go into a long dissertation about it, just go to prezi.com I have inserted just a sample in today’s posting. Give it a second or two to load, then click on the play arrow. To proceed, advance by clicking on the arrow again. Caution, the web site advises that some viewers become disoriented, dizzy and nauseous. I am usually that way without Prezi.
Enjoy, there will be more coming as I learn how to use Prezi.
Monday, December 13, 2010
The Lancet Commissions
Health professionals for a new century: transforming
education to strengthen health systems in an interdependent world
The Journal Lancet this week features an article whose research has been supported by, The Bill and Melinda Gates Foundation, The China Medical Board, and The Rockefeller Foundation.
It is an exemplary and exhaustive analysis of world health resources, past, present and future requirements.
As we rush along into the second decade of the 21st Century it seems that health care throughout the world is suffering. The United States is battling with the concepts of ‘collective health’ delivery which seems to run counter to the republic and it’s constitutional guarantees of freedom of choice.
In Europe we witness the strains about the UK N.H.S. as it becomes introspective about it’s systems shortfall.
Perhaps neither system will benefit global health, and a more uniform health system will morph from the present near ruins.
The article is an involved read, and not for the weak of heart, mind, or eye.
Mergers and Acquisitions
Mergers and acquisitions are not something most physicians pay any attention to, unless it is one of your daughters getting married.
In the world of finance and industrial companies they are common. Witness the recent bailouts of huge financial institutions where mergers of banks, and acquisitions of financial organizations took place faster than a roving sperm trying to get to the ova.
The recent passage of the Affordable Patient Care Bill has alerted many insurance companies, hospitals, medical groups and even individual solo practitioners that something huge may be about to take place in health care and the health industry at large.
Accountable Care Organization (ACO) stands for much more than it’s name implies.
Not surprisingly, government healthcare reform initiatives will be the biggest driver of M&A activity, according to 65 percent of investors. The Patient Protection and Affordable Care Act's "clear intent ... is to spur provider collaboration," said Robert Berg, an Atlanta, Ga.-based member of EpsteinBeckerGreen. "From hospital acquisitions of physician practices (with physicians then becoming employees of the hospitals), at one extreme, to the formation of large accountable care organizations [ACOs] comprising a wide variety of independent health care providers and provider groups, at the other extreme--and all manner of provider mergers and joint ventures in between--we are likely to see an unprecedented era of collaboration and consolidation among those who provide health care services."
Gone are the barriers between profit-non profit, secular v. non-secular religious institutions in merger mode, although some fears remain.
“As nonprofit hospitals become increasingly attractive to for-profit companies looking to capture more of the hospital market, one question that looms is whether the non-profits will be able to stay true to their mission. Some worry that patients could lose out, according to Kaiser Health News/USA Today.
For example, Detroit Medical Center's (DMC) network of eight hospitals has long served as a safety net for poor patients. But because it's been cash-poor, it has not been able to borrow the money to upgrade technology, let alone keep the facilities operating properly.
After DMC CEO Michael Duggan approached Vanguard, though, the private equity firm offered a way out. It agreed to pay DMC $417 million to reduce its debt and promised to invest another $850 million in DMC's facilities. The deal has yet to be approved by the state attorney general.
Vanguard, which is best known for buying Chrysler--which was later bailed out by the federal government--pledged to keep the system's five acute-care hospitals open, and to continue its commitment to charity care for at least 10 years. But Rev. Skip Wachsmann, a pastor at the Genesis Lutheran Church on the city's east side for 34 years, said he worries about how the sale will affect poor people. He told KHN: "What happens in 10 years and one day?"
"You can probably expect more stories like this, with the uptick in M&A activity. That's because the health overhaul law's eventual extension of coverage to another 32 million people made urban hospitals more attractive acquisition targets. "Health reform gets rid of a big chunk of the uncompensated care problem," Jack Wheeler, a professor of health management and policy at the University of Michigan told KHN.”
One interesting merger is on the plate in Albany, New York.
In the New York deal, three profitable health systems--Albany-based St. Peter's Health Care Services and the two Troy-based systems, Seton Health and Northeast Health--have formalized plans to merge and form a new nonprofit corporation after 17 months of talks, reports the Albany Business Review. The as-yet-unnamed regional powerhouse will include five hospitals and 12,000 employees. The organization will be secular but operate as an affiliate of St. Peter's parent, Catholic Health East.
In other actions dissolutions and break ups are occurring in many instances as some organizations prepare to cut possible losses as a result of ACOs.
Case in Point. Misys separates itself from Allscripts after a very short lived dalliance in the heat of EMR and ‘stimulus funding”. Misys has previously been grounded in banking and business solutions with a very small arm into EMRs. The smell of ‘honey’ at the EMR hive apparently is not inviting enough to warrant the risks of ACOs and other ‘stings’ to the health care industry.
The Year in Review 2010–Hospitals
Gary Levin M.D.
The last half and quarter of 2010 unveiled an explosion of mergers and acquisitions in the hospital industry. This is also occurring in the health insurance sector.
Hospitals have reacted to the Affordable Care Act, and the prospects of Accountable Care Organizations (ACO) with a flurry of activity to increase their size for multiple reasons. A major factor is the enormous investment of capital and human resources to obtain and implement HIT as mandated by ONCHIT and HITECH. The magnitude of the investment for HIT can only be well served by a larger organization. Even large systems feel the threat of being unable to manage this aspect of technology.
In rather typical fashion the government by it’s action to reduce health expenditures and increase cost effectiveness and better outcomes has guaranteed further health care cost increases.
21 Recent Hospital and Health System Transactions
Health reform sparks hospital merger madness
by Anne Law, December 10th, 2010, Friday.
Community Health Bids for Tenet
PeaceHealth to Merge with Southwest Washington Health System
Newton Memorial Hospital Merger with Atlantic Health System
Mega merger: CHI, Jewish Hospital and U of L in talks to create new regional system
Illinois' Loyola University Health Considers Merger
Shamokin hospital to merge with Geisinger
Jewish Hospital and St. Mary’s Health Care
This sector of the Year In Review is just part of the 2010 Health Train Year in Review.
del.icio.us Tags: mergers,hospitals,accountable care organization,affordable care act,health train express
Sunday, December 12, 2010
It’s That Time of Year
Beginning on Halloween the fall and winter season begin with a variety of sequential days off, decorations and fond memories of past year’s events. We anticipate the holidays each year either in dread, or with excitement and anticipation and/or a little of each.
I am preparing my “The Year in Review” in regard to health care reform, innovation, and scientific breakthroughs. We all know 2010 was a banner year for health care debate. (And it is far from over)
I will include the new category, “Movers and Shakers” in the Annual Review of Health Train Express.
Patients
To Be Announced
Look for this review somewhere between December 26-31 2010. It all depends on what I get for Chanukah.
Menorah
Chanukah came earlier this month, however wifey celebrates Christmas, does not believe in early gifts, and locks things down until 4AM on the 25th of December.
This is my small contribution to our ecumenical family. Actually I have the best of both worlds, I celebrate both events.
Friday, December 10, 2010
A Simple Solution
If there is a simple solution to a problem, and you want to sandbag it, give it to a committee to make the decision, (or the government)
Admittedly HIT and EMR appears to be complex, but the situation may be simplified greatly, and in the end much more cost effective, efficient and would provide a uniform system that would function across multiple enterprises, and clinics.
What brought this to my attention was the surprise delivery of the new Google Chrome Notebook
I had signed up about a week ago for their pilot program (and forgot about it) Yesterday UPS overnight delivered a strange flat box to me with the big Google stamped on the box.
It was my early Chanukah present ! Like a child I ripped it open, and as usual did not bother to read the instructions or even plug it in. There was enough battery life to boot it up (just by opening the lid).
The Google CR-48 Notebook
About 20 seconds later I was surfing the web, using Google’s Chrome Browser.
Built into it is 3G Verizon cell coverage, and Wi-Fi.. I closed the lid and it shut down.
It is a very simple web browser that uses the internet to access all that is in the world. No hard drive, only a minimal flash drive.
So where am I going with this?
I believe one of the main functi0nalities of EMR should be it’s uniform interaction with physicians, portability, and a one time learning curve to use the EMR. Physicians would love one program to use at their office, ASC, and/or multiple hospitals.
Without entering the depths of EMR software, this little very thin client would serve that end well. It is an early design and could be duplicated by many other hardware manufacturers well.
Cool, huh ?
Now I know there will be hundreds and perhaps thousand of ‘experts who will offer why it cannot be done… And I will offer the fact when there is a will there is a way. Especially if you know where you are going and have a do-able end point. This is unlike where we are and with a vague, expensive complex goal.
Thursday, December 9, 2010
Important News About Health Care Today
The Institute of Medicine of the National Academies has released several reports at the beginning of December.
For the Public’s Health: The Role of Measurement in Action and Accountability Released: December 8, 2010
Despite having the costliest medical care delivery system in the world, Americans are not particularly healthy. While this information is alarming, the bigger problem is that we do not know how to reverse this trend. Our lack of knowledge is due in large part to significant inadequacies in the system for gathering, analyzing, and communicating health information about the population. In this report, the IOM reviews current approaches for measuring the health of individuals and communities and creates a roadmap for future development.
The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010
Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.
Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches - Workshop Summary Released: December 6, 2010
Currently, a substantial gap exists between the knowledge needed and that available for medical care decisions. The IOM Roundtable on Value & Science-Driven Health Care sponsored a meeting to explore the methods, data resources, tools, and techniques that are emerging in the new generation of accelerated clinical research approaches.
The Science of Adolescent Risk-Taking - Workshop Summary Released: December 1, 2010
Adolescence is a time when youth make decisions, both good and bad, that have consequences for the rest of their lives. Some of these decisions put them at risk of lifelong health problems, injury, or death. The IOM held three public workshops between 2008 and 2009 to provide a venue for researchers, health care providers, and community leaders to discuss strategies to improve adolescent health.
The Safe Use Initiative and Health Literacy: A Workshop - Workshop Summary Released: December 1, 2010
Every year at least 1.5 million people suffer adverse effects from medication. These problems occur because people misunderstand labels, are unaware of drug interactions, or otherwise use medication improperly. The Food and Drug Administration’s Safe Use Initiative seeks to identify preventable medication risks and develop solutions to them. The IOM held a workshop to discuss the FDA’s Safe Use Initiative and other efforts to improve drug labeling and safety.
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