Listen Up

Friday, August 16, 2013

The Height of Idiocy and Incompetence

 

HIMSS Says Start Stage 2 On Time And Give It Time To Work

Adopting an approach that encourages continued progress while simultaneously acknowledging short-term obstacles, HIMSS recommends launching Stage 2 Meaningful Use on-schedule and extending Year 1 of the Meaningful Use Stage 2 attestation period through April 2015 and June 2015 for EHs and EPs, respectively.  This would encompass 18 months in which EHs and EPs can attest to Meaningful Use requirements for one quarter.

Data from the more than 5,400 hospitals in the HIMSS Analytics database indicate clear challenges for eligible hospitals and tethered ambulatory care facilities preparing for Meaningful Use Stage 2.  These data show:

  • Up to 68 percent of eligible hospitals, and
  • 41 percent of tethered ambulatory facilities

have purchased the necessary software to attest to the 2014 Certification requirements, but there are concerns that many may still be waiting for the necessary upgrade to the certified version.

HIMSS shared its position on extending the deadline for Meaningful Use Stage 2 attestation in an Aug. 15 letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius; Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner; and, National Coordinator for Health IT Dr. Farzad Mostashari, MD, ScM.

Farzad Mostashari is now a lame duck, having resigned leaving the rest of us with “Hope and Change’.  While I can praise him for devotion to an IT cause he has bailed out for unknown reasons.

 

 

HHS mandated Meaningful use implementation in an unrealistic schedule. Unfortunately it is interwoven with other mandates such as physicians and hospitals qualifying for EMR and HIT incentives. HHS does not even guarantee it will work as predicted, but they still require implementation to receive incentives. 

Medical practices will be required to submit  MU stage II and not know if it even works or if they will receive incentives as promised.  Submissions will probably be lost and/or improperly processed. Again pass the buck to providers, who will be fined and not receive incentives after already investing hundreds of millions of dollars in Health IT.  The only ones who gained were HIT vendors, and insurance companies and Medicare who will maybe reap data, that probably will sit on a server in Utah to be analyzed by non-existing analytic software

If this is an indication of how the Affordable Care Act will work health care is in for a not so big surprise.  Physicians and Hospitals already realize this, and there is much being written about it for the past 12 months, building now to a sense of total frustration and almost an apathetic approach to letting the plan go on, break down, cause financial losses and worsen care for patients..

We are now told, don’t worry we don’t know how or if it works, but we should progress and find out , after the fact.  This  sound much like the proclamation of the highest democratic leaders  in congress. We heard this before……we won’t know what is in it until we pass it.

Basically the Affordable Care Act was passed on a hope and a dream as a  political expediency and with an unrealistic goal and approved by our President with that in  mind.  President Obama's campaign rhetoric of “Hope and Change” was largely an empty promise. Yes, it promised change for the less fortunate in America…..at the expense of the nations overall financial health. Regardless of how the Supreme court ruled on the constitutional validity of the employer and individual mandate, Justice Roberts and his band of cronies voted that it was constitutional throwing it back to Congress to correct their incompetence.  Basically he refused to have the judicial system correct congressional incompetence.

Almost all of us want to provide a social health system that cares for everyone. It affects everyone to see a parent or family member and themselves  neglected by a broken health system, and fantasize that the whole of the ACA will be better than the parts.

This parallels the false and delusional analysis and refusal to deal with the national debt other than print more money.  In fact the Global dependency on the US Dollar underwriting of the financial  system is about to cease, being inherited by other countries such as the Chinese Yuan, the Euro-dollar (which is even weaker.  Perhaps this fact will evolve into banks refusing us credit completely very soon. 

The Affordable Care Act must be put on indefinite hold until it is totally reviewed by competent professionals without financial interest and those not involved with it’s passage in the first place.

The Affordable Care Act will worsen our credit worthiness. President Obama’s plan appeals to those who need hope and change (which may or may not occur, depending upon who you talk to.  A vast majority of Americans are more than uneasy with the plan.

Why were the Democrats in such a hurry to pass a bill they did not read? Political gain !!

Health Train Express and Digital Health Space will continue the message.

Wake up, stop drinking the ‘Kool Aid’, stop believing the  utter and absolute truth that our government has completely broken down.

Start writing your democratic leaders and overwhelm them with public opinion.

Perhaps we need a ‘Million Man March’ in D.C. and fill the Capital Mall, shut down Washington D.C. and maybe, just maybe President Obama and our worthless congress will get the message.

 

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Saturday, August 10, 2013

#ABC News

 

Today thus far has been an extremely active day for health care social media #hcsm .

Tweet chat, #abcdrbchat from ABC news is  number six on the twitter trend list this AM at 10:30 AM Pacific time. It appears that there were  many tweeps  from non health related sites in this chat.

And here is how to join any tweetchat.

Anyone who thinks #social media is not relevant to #medicine is about to become a  #dinosaur.

Some of the most popular hash tags revolve around #emr #hitsm #hcsm #d4pc #mhealth  Check the web site  Symplur for all the tags relating to health care and medicine.

During the past year physicians have engaged in social media with increasing frequency.

Despite these positive upticks there are those who are reticent to engage in social media.

Here are some things you may have experienced:

In the past year have you experienced:

          Nausea, due to keeping up with the rapid changes in the social media space ?

Y or N

Anxiety, due to the looming threat of an online flare up surrounding your organization?  Y or N

Frustration, due hospital exec rejecting your social media ideas?

Familiarize yourself with three targeted tracks in healthcare communications

1. PR and Marketing

2. Employee Communications

3. Social Media for Medical Professionals

 

Paul Sonnier at Digital Health lists the growing number of Digital Health Events between June 20113-June 2016 which number more than sixty.

During August;

HIMSS ASIAPAC13 Greater China eHealth Forum

National Forum on Data & Analytics in Healthcare @ Gaylord National R

Mobile Healthcare: Innovations in Telemedicine @ The George Washin

Digital Health Days – Stockholm

Digital Health Days - Stockholm @ Stockholm | Sweden

Aug 21 – Aug 22 all-day Conference Digital Health Europe

August 26, 2013 (Monday)

NIH-UCLA Summer Institute on Mobile Health (mHealth) Technology Research

NIH-UCLA Summer Institute on Mobile Health (mHealth) Technology Research @ Los Angeles | California | United States

Aug 26 – Aug 30 all-day California Course Los Angeles United States

August 27, 2013 (Tuesday)

BIOCOM’s 7th annual DeviceFest Conference @ Sheraton Carlsbad

BIOCOM's 7th annual DeviceFest Conference @ Sheraton Carlsbad | Carlsbad | California | United States

Aug 27 @ 8:00 am – 6:30 pm California Conference Diagnostic Medical Device San Diego United States

August 28, 2013 (Wednesday)

The Quantified Patient @ athenahealth's Visitor Center (Building 400)

The Quantified Patient @ athenahealth's Visitor Center (Building 400) | Watertown | Massachusetts | United States

Aug 28 @ 6:00 pm – 9:00 pm Big Data Consumer Digital Health Health IT Healthcare Massachusetts Medical Device United States Wearable Tech Wellness big data HealthcareSocialMedia healthstartup mobile Wearables

This unique event will feature forward thinking entrepreneurs, researchers and companies who are redefining healthcare through the use of self-tracking systems, behavior change psychology, and [...]

August 29, 2013 (Thursday)

Seattle Health Innovators Meetup @ SURF Incubator

Seattle Health Innovators Meetup @ SURF Incubator | Seattle | Washington | United States

Aug 29 @ 5:30 pm – 8:15 pm Accelerator Digital Health Healthcare Life Sciences Meetup Precision Medicine United States Wasghington Wellness

The purpose of the Seattle Health Innovation Forum is to support the individuals actively making health innovation happen. This community draws on entrepreneurs in businesses, [...]

 

For the Schedule for the remaining portion of 2013 and beyond […….] events.

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Thursday, August 8, 2013

Does The Open Letter have a place in Health Care?

 

Wrong !                                              Correct !

             

Hospital mergers, acquisitions and the development of integrated hospitals systems is one of the results of the Affordable Care Act’s model for Accountable Care Organizations.  It will become a fundamental business practice.

An ongoing themes of  mergers, acquisitions and cooperative agreements will create different organizational culture clash.

These clashes apply to group practices and hospitals.  Executives of these entities are faced with a myriad of tasks, not the least of which is human interaction with can be unpredictable if not guided with introductory process as well as implementation guidelines.

Perhaps medicine can take a lesson from mergers such as Amazon and the Washington Post, as well as Tony Hseih of  Zappos.  The common theme was their guiding hand.

Likewise the pen of Jeff Bezos on the Post purchase outlined openly the acquisition  and his goals.

Mergers or acquisitions often take place in the setting of economic changes, anxiety and fear. The number one concern for employees is whether they will have a job.  Fear and anxiety can lead to a loss of productivity, loss of faith, trust and loyalty. The Open Letter should address all of these factually and honestly.

Frequently health care organizations merge or acquire to accomplish one of the following;

1. Increase market share

2. Consolidate many administrative functions, with a possible reduction in work force.

3. Provide complimentary services, or add a center of excellence

4. Improve asset/liability ratio, to acquire financing or to expand physically.

5. Close a competing facility or expand physical locations.

 

 

An Effective Open Letter

So what does a great open letter take? If you are looking to use this form of communication as a leader to offer your point of view in a more powerful and emotional way, there are three elements that should to be at the top of the list:

  1. Humanity – Great open letters have a human tone of voice. They don’t use corporate speak and actually sound like something that a leader might say in a conversation as opposed to an investor presentation. They express emotion and feelings, and share a personal point of view.
  2. Timeliness – An open letter is usually delivered in response to a piece of news or announcement. As a result, the timing of getting that letter out is often vital. Having it completed and published early ensures that conversation and media attention will incorporate the views shared in the letter. Also, having it done early is essential to demonstrate that the viewpoint is a proactive one, and not in response to some sort of crisis or criticism.
  3. Visibility – The final element is making sure the letter is published in a place where it is highly likely to be seen and shared. Bezos publishing on the homepage of Amazon or on  Washingtonpost.com are obvious choices … but sharing your open letter through an op-ed piece on another website, or on a highly visible corporate blog that is easily found from your company homepage can both be good choices.

As more companies use the Internet and social media to communicate a corporate point of view directly to their audiences, using the open letter will become a more and more important element of corporate communications. There may be a time soon when any communicators developing a media engagement and public relations strategy for corporate announcements or product launches will need to consider an “open letter strategy” as a part of their efforts.

Social media strategy will be an important vehicle for these ‘open letters’.

 

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Monday, August 5, 2013

October Residency Approved for AMA PRA Category 1 Credits™

 

This amazes even me. The original skeptic and cynic whose attitudes and social media mores and ethics carefully developed an honed after 40 years of practicing medicine.  God bless the United Social Media of Medicine (U.S.S.M). 

The goal for Social Media Residency is that participants will develop a plan for strategically applying social media tools in their work. Download Sample Agenda/Curriculum, and see the Social Media Residency page for more background on the program.

See the Social Media Week page for an overview of the entire week's events, and for links to where you can register.

How relevant is social media to physicians?   The title speaks to it all.  This amazes even me. I mean I have been working at this for years, and I never imagined I would earn CME courses.  Will I be ‘grandfathered’ as a certified social butterfly?

Will I have to meet CME requirements annually to participate on twitter, Facebook or Google plus, as well  ?  Since I have about ten years of experience on social media I want to nominate myself to be on the     ‘Board’ of the Joint Commission of Social Media in Medicine’. My credentials include a self-nomination’ as expert in social media, SEO, semantics, entrepreneur, one of the original founding users of Google plus and a pioneer of Hangout heavens.

Mayo Clinic

Social Media Week

Mayo Clinic designates this live activity for a maximum of 11.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: To applicants:

There are two parts to this examination:

1.Written: Participant will converse on four social media sites simultaneously.

2.Oral examination: Google  hangout with 9 other social media (all certified by the board.) (meaning me !) Participants will have the option of choosing  Zoom.US Google Hangouts, Skype or Facebook for this portion of the examination. Note: All participants are bound by the EULA of the host media.

There is a fee, REGISTER HERE

choose your method of payment.

Requirements are broadband internet and a modern computer capable of video, a webcam and either a Mac, any brand of tablet, or Window PC. Note Windows Vista or above.

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Monday, July 29, 2013

Concierge or Direct Pay Care

 

Some say that Concierge medicine and Direct Pay are two different forms of payment.  Not so.

This should not be complicated.

Medical Access USA is an old and well established method for patients to access quality health care and were discussing how to build a system.

Accountability is a trust relationship and is a one-on-one transaction. Our goal at Medical Access is to restore the relationship between patient and provider to ensure that connection. Our mechanism is a fee-for-service model. Despite recent moves to discourage and eliminate this mechanism for many reasons unrelated to practicing quality health care, it should not disappear.  It provides a simplicity without complex indecipherable regulations.  It also reduces the overhead of billing (64% for an individual primary care physician )according to some sources)

How do we go about changing health reimbursement in a meaningful way for many patients. Notice I did not say all patients.  That would be as foolhardy as what the Democrats and President Obama accomplished with the Affordable Care Act.

The prime directive for our plan is patient welfare and the ability to access primary care easily and affordably.  It does not take a rocket scientist to analyze what needs to be done.  The Affordable Care Act favors a medical home. This used to be called a family or general medical practice.  The name changed but the core premise remains the same. Another term would be ‘holistic medical practice’.  Patients do well and favor having a physician who can manage most of their issues.  Many health related  problems have an underlying psycho-social component and requires a transference between patient and physician. This is reinforced by visiting with the same physician.

The basic care unit is one doctor and one patient. Patient pays doctor for services, a one-on-one contract with no intermediary.

Dave deBronkart (e-Patient Dave) well known patient advocate, frequent keynote speaker for advocacy groups, and TEDMED.

Much of medicine has been misdirected, fixing ‘train wrecks’ rather than taking care of early disease.

 

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Wednesday, July 24, 2013

The Real Price of Incentives: Loss of Trust

 

Are Incentives a bribe ?

 

Incentives, rewards, penalties, fines, deadlines. Are they counterproductive? Probably so,  amongst professionals.

Many of these issues also apply to healthcare and medicine. Rushing to satisfy requirements for new technology and unproven organizational models often leads to loss of productivity, inappropriate expenditures, and disaster for organizations.

You might be thinking “why else would people work if not to enrich themselves?” This is certainly the view of human nature that dominates economics. In The Wealth of Nations, the father of modern economics, Adam Smith wrote:

 

It is in the inherent interest of every man to live as much at his ease as he can; and if his emoluments are to be precisely the same whether he does or does not perform some very laborious duty, to perform it in as careless and slovenly a manner that authority will permit.


Thus, for Smith, if you wanted people to do an honest day’s work, you had to make it pay. The discipline of economics has been guided by this assumption ever since. And the management practices of organizations in all areas of life have borne the mark of this view. But even within this framework, people realized that there was more to work and life than instrumental incentives. For example, Goldman Sachs, the investment bank that was one of the villains of the financial collapse, was guided in its earlier days by “service to client” as its touchstone. It was only after Goldman Sachs became a public company that it evolved into a money-making machine.

Does this sound like health care ? The cost of doing business, health or otherwise increases with bureaucracy, and like “teaching to the test” creates more efficiency to produce more income and incentivizes the wrong goals.

Yes, “what’s in it for me” was a part of human nature, but so were virtues like honesty, integrity, loyalty, pride, responsibility, duty, commitment, and courage. Indeed, even Adam Smith made it clear in The Theory of Moral Sentiments, that he didn’t think the economic side of human beings told the whole story. But nowadays, we tend to see human motivation as uni-dimensional, at least when it comes to designing our institutions. What is odd is that although we seem readily to accept this view when it comes to other people, we reject it completely when we’re thinking about ourselves.

There is no doubt that some incentives are smarter than others. But incentives are, by their nature, limited in what they can accomplish, and thus not the right tool for every objective. Worse yet, incentives can have perverse effects, undermining the moral commitments people might otherwise have to pursue the telos of their chosen profession.

Psychologists have known this for years, but policy makers have not been paying attention. In this connection, it is interesting to note that the “normalization” of incentives is a relatively recent historical phenomenon. In earlier eras, they were regarded with distaste as nothing more than bribes. They were not the same as rewards and punishments, because rewards and punishments imply merit or desert. They were just levers that one could use to make people do what you wanted them to do. Owing, I think, to the pervasive influence of economics, and to developments in the discipline of management science, incentives slowly evolved into morally neutral management tools. One consequence is that questions about what the right thing to do is were less and less commonly asked.


If people aren’t asking themselves what’s the right thing to do, they are not likely to do the right thing. And as a result, the public will stop trusting them, as indeed, it should.

 

Digg This

The Real Price of Incentives: Loss of Trust

 

Are Incentives a bribe ?

 

Incentives, rewards, penalties, fines, deadlines. Are they counterproductive? Probably so,  amongst professionals.

Many of these issues also apply to healthcare and medicine. Rushing to satisfy requirements for new technology and unproven organizational models often leads to loss of productivity, inappropriate expenditures, and disaster for organizations.

You might be thinking “why else would people work if not to enrich themselves?” This is certainly the view of human nature that dominates economics. In The Wealth of Nations, the father of modern economics, Adam Smith wrote:

 

It is in the inherent interest of every man to live as much at his ease as he can; and if his emoluments are to be precisely the same whether he does or does not perform some very laborious duty, to perform it in as careless and slovenly a manner that authority will permit.


Thus, for Smith, if you wanted people to do an honest day’s work, you had to make it pay. The discipline of economics has been guided by this assumption ever since. And the management practices of organizations in all areas of life have borne the mark of this view. But even within this framework, people realized that there was more to work and life than instrumental incentives. For example, Goldman Sachs, the investment bank that was one of the villains of the financial collapse, was guided in its earlier days by “service to client” as its touchstone. It was only after Goldman Sachs became a public company that it evolved into a money-making machine.

Does this sound like health care ? The cost of doing business, health or otherwise increases with bureaucracy, and like “teaching to the test” creates more efficiency to produce more income and incentivizes the wrong goals.

Yes, “what’s in it for me” was a part of human nature, but so were virtues like honesty, integrity, loyalty, pride, responsibility, duty, commitment, and courage. Indeed, even Adam Smith made it clear in The Theory of Moral Sentiments, that he didn’t think the economic side of human beings told the whole story. But nowadays, we tend to see human motivation as uni-dimensional, at least when it comes to designing our institutions. What is odd is that although we seem readily to accept this view when it comes to other people, we reject it completely when we’re thinking about ourselves.

There is no doubt that some incentives are smarter than others. But incentives are, by their nature, limited in what they can accomplish, and thus not the right tool for every objective. Worse yet, incentives can have perverse effects, undermining the moral commitments people might otherwise have to pursue the telos of their chosen profession.

Psychologists have known this for years, but policy makers have not been paying attention. In this connection, it is interesting to note that the “normalization” of incentives is a relatively recent historical phenomenon. In earlier eras, they were regarded with distaste as nothing more than bribes. They were not the same as rewards and punishments, because rewards and punishments imply merit or desert. They were just levers that one could use to make people do what you wanted them to do. Owing, I think, to the pervasive influence of economics, and to developments in the discipline of management science, incentives slowly evolved into morally neutral management tools. One consequence is that questions about what the right thing to do is were less and less commonly asked.


If people aren’t asking themselves what’s the right thing to do, they are not likely to do the right thing. And as a result, the public will stop trusting them, as indeed, it should.

 

Digg This

Saturday, July 20, 2013

Culture of Disrespect

 

 

In a Culture of Disrespect, Patients Lose Out

 

When doctors tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine.

Part II

 

Disrespect goes far beyond the nurse-doctor patient interface with patients. We are leaving out the most disrespectful aspects of our present system. 

These are the under-insured and uninsured patients. 

The middle level managers with cookbook guidelines to denials and authorizations for diagnostic procedures, treatments and access to expensive pharmaceuticals.

The insurance company unreasonably denying treatments, the endless waiting in a phone queue only to be answered by a robot.

The informed consent written by attorneys that are unintelligible. The Medicaid system which treats recipients with disdain and rules that are byzantine, with addendums and empty promises of a safety net, obsolete and irrelevant poverty figures as well as month to month eligibility which obviates any form of managed care or case management.

The incompetent legislatures who rule from above with no concept of safe and/or effective healthcare.

The autocratic and dictatorial methods of the Department of Health and Human Services.

Friday, July 19, 2013

CAeHQ---The Status of Health Information Exchanges in California

 

California is large enough to be called a ‘nation-state’ with 35 million citizens, it is larger than many sovereign states in the world.  The diversity of it’s demographic is challenging not only for health systems and providers, and with social engineers as well.

The development of health information exchanges in California is a microcosm for what must take place nationally in regard to health reform and ObamaCare.

California HIOs

Early study and planning for HIX began in 2004 with a major impetus by the newly formed Office of the National Coordinator for Health Information Technology (ONCHIT). Rather than forming one monolithic organization a model for regional information exchanges evolved over time.

Simultaneous interoperability standards were developed to ensure a common system of harmony between disparate EMR system, laboratory systems, pharmacy systems and more.

Federal incentives in the form of the HITECH Act has fueled significant growth in HIT since 2009.

The most recent meeting of the CAeHQ nicely summarizes the progress of health information exchanges, and it’s relationship to the national plan. It is anticipated that as the system matures individual HIOs may vanish to be replaced by the national HIE.

NationWide Framework and CA HIO

The development of each individual health information exchange has been sporadic and dependent upon local interests and the development of sustainable business models. Other items include trust agreements among the users of the exchanges.

Whilst some HIXs are working well, each one delivers different data fields and the comprehensiveness of it’s data. Some are simple messaging functionality, some allow transmission of continuity of care records, while  others are more complete.

As yet there is little if any transparency from an electronic medical record. Rather than true integration of the data into a trusted partner’s EMR a separate portal must be engaged to retrieve patient data.

The ONCHIT Direct program remains a national infrastructure, while each region has it’s own network.  There is no uniformity of size.  The current size appears to be guided by the hospital systems and the individual state. Few cross state jurisdictions except for a few.

The CAeHQC recent stakeholder meeting took place on July 18,2013 via a webinar.

The slide deck of the meeting (24 slides) is linked here. (may take a moment to load)

Stakeholder meeting  Next

ref: CAeHC Webinar July 18,2013  Recorded TBA available at www.ehealth.ca.gov

 

CAeHQ---The Status of Health Information Exchanges in California

 

California is large enough to be called a ‘nation-state’ with 35 million citizens, it is larger than many sovereign states in the world.  The diversity of it’s demographic is challenging not only for health systems and providers, and with social engineers as well.

The development of health information exchanges in California is a microcosm for what must take place nationally in regard to health reform and ObamaCare.

California HIOs

Early study and planning for HIX began in 2004 with a major impetus by the newly formed Office of the National Coordinator for Health Information Technology (ONCHIT). Rather than forming one monolithic organization a model for regional information exchanges evolved over time.

Simultaneous interoperability standards were developed to ensure a common system of harmony between disparate EMR system, laboratory systems, pharmacy systems and more.

Federal incentives in the form of the HITECH Act has fueled significant growth in HIT since 2009.

The most recent meeting of the CAeHQ nicely summarizes the progress of health information exchanges, and it’s relationship to the national plan. It is anticipated that as the system matures individual HIOs may vanish to be replaced by the national HIE.

NationWide Framework and CA HIO

The development of each individual health information exchange has been sporadic and dependent upon local interests and the development of sustainable business models. Other items include trust agreements among the users of the exchanges.

Whilst some HIXs are working well, each one delivers different data fields and the comprehensiveness of it’s data. Some are simple messaging functionality, some allow transmission of continuity of care records, while  others are more complete.

As yet there is little if any transparency from an electronic medical record. Rather than true integration of the data into a trusted partner’s EMR a separate portal must be engaged to retrieve patient data.

The ONCHIT Direct program remains a national infrastructure, while each region has it’s own network.  There is no uniformity of size.  The current size appears to be guided by the hospital systems and the individual state. Few cross state jurisdictions except for a few.

The CAeHQC recent stakeholder meeting took place on July 18,2013 via a webinar.

The slide deck of the meeting (24 slides) is linked here. (may take a moment to load)

Stakeholder meeting  Next

ref: CAeHC Webinar July 18,2013  Recorded TBA available at www.ehealth.ca.gov