The KHIT Blog: Day One Health 2.0, full on

Monday, October 8, 2012

Day One Health 2.0, full on

First thing we saw this morning at daybreak as Cheryl was taking me to the BART station. The view up the hill from her back yard. And, the day has gotten even better from there.

Jean Luc Neptune MD MBA, Sr. VP Health 2.0 Con

Co-Chair and CEO Indu Sabaiya

Matthew Holt, Co-Chair

Kaiser Permanente Chief Communications Officer Diane Gage Lofgren: "Let's welcome our first Keynote Speaker Jim Flower." Chief Communications Officer Diane Gage Lofgren.

Keynoter Joe Flower, awesome.

Aetna CEO Mark Bertolini, keynoter. Very interesting presentation as well.

More shortly. I have had a great, great, busy day, and have more to report on than I can get to tonight.

UPDATE

I hit the trifecta and then some yesterday. I was sitting in the press room working on some of my shots, when who walks in and plops down next to me?

Doc Gurley!

OMG! Dr. Jan Gurley, one of my total heroes! Click her name, read up on her.

"Doc Gurley is a Board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing."

This year’s Health 2.0 codeathon was markedly different from last year’s because the global competition judging was up first – the first ever Developers World Cup. Teams from as far away as Fukushima and Stockholm had flown in for this final judging. My fellow judges include Sastry Nanduri, Gretchen Wustrack, Forrest King from Novartis, Michelle Snyder, and Unity Stoakes. Many people have been here since yesterday morning. Indu Subaiya (CEO of Health 2.0) remarked on how far things have come since the very first codeathon on the Google campus. The room was full of milling stress. People sat, then stood, then twitched as they waited for their mere 5 minutes to explain all the work, and heart and sleepless creativity they’d shoved into a brand new piece of life-changing technology.

We have corresponded by email every now and then, but I have always read her articles in the Chronicle assiduously. I have always just been a soon-forgotten name in her in-box.

Lordy Mercy! I am blessed.

My day kept on. J.D. Kleinke? What?!!

He saw me coming and shouted "BobbyGEEE" when he saw my badge. Nice. Recall my post "Use Case"? See also my September 30th post.

A few more random shots.

The exhibit hall is buzzing.

My "Big Boss," ONC head Dr. Farzad Mostashari. He smiled and told me he follows my tweets (I'd thought he might have been irritated with me). He fielded some hard shots during the Q and A, but handled them all with grace and enthusiasm.

Above, Dr. Pat Salber of HealthTechHatch.com

Personal health monitoring and meds compliance apps are all the rage.

OK, now we've outsourced Happy Hour. A shot from the press room window.

The only disappointment of the day was a session entitled "The Digital Doctors Lounge: Tools for Provider Workflow and Collaboration."

Seriously? Had zero to do with "workflow" and was a pretty fair stretch on the "collaboration" thing.

Did see a quick demo of an app, though, that purportedly uses "NLP" (Natural Language Processing) to data mine progress note narratives for billable items that may not have made it to the claims, for subsequent re-billing.

So, we now have EHRs that take in structured data and convert some of them to fake progress note open-ended text "narratives," but we'll now add an app that converts the stuff back to structured dx and px codes?

OK.
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MORE SHOTS

I'll be catching up all weekend filling in my narrative reflections. Had to be back at the office today.

Allscripts is here.

One of the better booths. The exhibits generally were not up to HIMSS, CES, (and the old COMDEX) snuff. Insufficient lighting was the norm.

Lygeia Ricciardi, ONC consumer eHealth Director

ONC State HIE Director Claudia Williams

Above: I am remiss. I have no notes on who this is. My Bad.

Jodi Daniels, Director, ONC Office of Policy and Planning

Much more to come...
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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Monday, October 8, 2012

Day One Health 2.0, full on

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