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Monday, March 11, 2013


I obviously Photoshopped this shot I took at their booth. We are in fact in a "boom" period in Health IT. Is a "bust" to follow? What would it look like? A HIMSS13 reflection (and more), starting with my interesting conversation with MedSys Group President Steven Heck.

Steve's company does HIT staffing and consultation to improve HIT management and operations effectiveness.

e.g., from their website:

Applying a simple approach, MedSys Group Consulting delivers professional, highly skilled healthcare information technology consultants to drive efficiency and performance for your organization. MedSys applies nearly two decades of HIT experience to help improve care by delivering scalable and economical solutions using a rapidly deployable model.

Simply put, MedSys makes consulting easy!


  • Project Management
  • Operational Consulting
  • System Implementation
  • System Conversion
  • System Integration
  • Multiple Systems Interface
  • Project Cost Containment
  • Increased Quality Consulting Talent on Project
  • Deliverable Assurance
  • Increased ROI
  • Reduced Project Time
  • Project Consultants Complete On-time and Within Budget
A quick look at the platforms for which they provide expertise.

Pretty clear from that list that they operate primarily in the more complex inpatient and larger group practice settings.

Again, from their website:

MedSys Group’s Advisory Services Division will not only assist providers’ Healthcare leadership with more effective IT Governance, but it will also assist providers in extracting value from the technology they have deployed over the last 5 years. The team consists of a select group of industry experts with executive level healthcare information technology experience. This includes consulting and sourcing experience in the provider, payer, and life sciences segments of the healthcare industry.

The team has worked with many of the country’s leading healthcare organizations who have sought their leadership and advice with investment, planning, and deployment strategies.


  • Best Practices to achieve the efficient use of IT resources
  • Practice Redesign and Optimization to dramatically improve returns from IT investments of the last five years
  • IT Planning

The "practice redesign and optimization" thing was the phrase that had originally attracted my interest -- and, of course toward the end of "the efficient use if IT resources."

Recall, though, my 2nd post back back in July 2010:


The cut-to-the-chase core take-away from this very worthy book is pretty straightforward:

  1. The truly difficult work begins after EHR go-live implementation. This is NOT about "IT" per se;
  2. You simply must have HIT physician champions;
  3. And, you must devote extended post go-live resources to function-based training, delivered via simulators and Adult Learner modeled content -- i.e., constrained, didactic, classroom-based (and "train-the-trainer") methods simply do not suffice.
Anything less is a recipe for failure (regarding which they enumerate some painfully honest examples from within their own organization). PDF sample here.

This is simply the finest book I have yet to run across on the topic of healthcare QI (one going beyond the topic of mere HIT deployment). Had I the money personally, I'd buy a copy for everyone in my company, and every member of my family and all of my friends. It is replete with examples of care delivery across a gamut of outpatient to inpatient settings from the patients' points-of-view, perspectives that put you right in the midst of the chronic chaos that too frequently charaacterizes our wasteful, error-hobbled healthcare processes.

The publisher graciously provides some extended excerpt PDF samples:

"...Governments can tweak payment systems and probably get some temporary fiscal relief. But until we focus reform efforts on where most of the money goes, which is healthcare delivery, we will remain stuck in a revolving door of near disaster and narrow escapes.To get to the point where all people have access to high-quality healthcare, affordably, we must focus our attention on how the healthcare delivery system determines costs and quality. Then we need to change that delivery model entirely.

In fact, hospitals, physicians, and nurses—all of healthcare—must change. First, we must emphasize the science of medicine over the art. This means turning to evidence-based medicine, which is already underway in some sectors. But we are also talking about evidence- based delivery, work that has barely begun..."

"...By starting with the value being delivered to patients and thinking carefully about the delivery process for creating this value, we have proved that it is possible to enhance patient experiences while dramatically improving medical outcomes and lowering costs. Finally, we have distilled our experiments into an action plan that the senior management team of any healthcare organization can follow to achieve similar results..."

"...We do not mean to suggest, however, that the external environment of healthcare—payment systems, insurance coverage, and regulations—does not need to be overhauled. It is a badly broken system requiring major surgery. But we are convinced that the healthcare debate needs to start from a deep understanding of how healthcare value is actually delivered.

This is an understanding we all need—policy makers and patients, as well as medical professionals.We all have a role to play in reforming healthcare. Caregivers need to rethink their priorities and remake their working environments. Lawmakers need to rewrite the rules to ensure that value is rewarded instead of waste. And patients must understand how healthcare works in order to demand truly effective change..."
[from the Introduction, pp. 2 - 4]
Highly, highly recommended -- for the healthcare professional and layperson alike. You should also spend some time at the ThedaCare Center for Healthcare Value website. A rich environment of resources.

More on the Steve Heck interview shortly.


Just saw this over on The Incidental Economist blog.

Wow. Hence, the "boom." Hence the need for "efficiency" if we are to "bend" that "cost curve" (down). All of these "providers" need to hop on the "productivity treadmill."

Unless we just want to turn the job over to Congressman Paul Ryan.

50% reduction in federal Medicaid spending across the next decade? Along with "Repeal ObamaCare?



Apparently likes me...


From one of Dr. Mostashari's Keynote Address slides (pdf source material). No mention of Basic and Intermediate Directives.


Farzard also made a claim for which I am not finding any slides or tables -- that successful Attesting EPs are not just barely meeting the numerator/denominator criteria, they're crushing them. I have searched in vain on and for these types of drill-down numbers. I would love to know which num/denom measures are being "crushed," by how much (and how they distribute statistically), and how they stratify by vendor/product and medical specialty. Such information might well comprise a sort of "usability" proxy indicator.
HIMSS Review: Technology Priorities and Realities
Scott Mace, for HealthLeaders Media , March 12, 2013

Another HIMSS conference is history. The technology cart, however, may be getting ahead of the horse. Everywhere I turned, vendors touted their technology solutions to transform existing healthcare providers into ACOs. Many of these solutions tackle the worthy challenge of correlating claims data coming from payers with clinical data coming from providers, in an effort to create longitudinal records of care for any patient who walks through the provider's doors. In this way, providers will catch comorbidities they are missing today, eliminate duplicative tests, reduce readmissions, and increase patient satisfaction, all in one fell swoop.

At least, that's the theory. But wait—if the brave new technology future is at hand, why are the Pioneer ACOs petitioning CMS to ease up on demanding early results?

I think I now understand why the pioneers are freaking out.

The ACO concept only works if health information exchange between providers is mature enough to handle what the ACOs require. And I'm here to report that health information exchange still has a long way to go.

That's why, in the midst of a HIMSS packed with innovations that I will describe in future columns, the National Coordinator for Health Information Technology, Farzad Mostashari, sees the maturation of HIE as the biggest challenge of 2013. (Mostashari views the HIE acronym as a verb and a desired state of being, rather than as only a description of HIE/HIO organizations.)

"There are technical challenges," Mostashari told a packed HIE town hall on the final day of HIMSS. "There are governance and trust challenges to information being exchanged. And there are business practices and a business case for information exchange, all of which need to be addressed in order for information to move. We intend to act on all of them this year to create a context where we get to the goal and the 'why' of all this, which is that information follows the patient wherever they need it to go, across organizational boundaries, across vendor boundaries, across geographic boundaries."...

[But] Without clear consent, some patients will freak out when they see their healthcare data following them around. What providers see as their ticket to ACO nirvana may appear to some patients as a kind of Big Brother, if they haven't been fully educated about all the consent forms they normally sign without reading.

Then there's what I consider the elephant in the room: what the technologists, including Mostashari, describe as a lack of digital key distribution that continues to prevent easy verification of patient identity as patients travel from provider to provider.

The federal government is prohibited by law from being the provider of digital keys that would establish a national patient identification system in the U.S.

This puts us at odds with practically every other industrialized nation on the planet, and hampers our efforts to implement not only ACOs but all manner of population health and public health innovations, not to mention to greatly reduce fraud and waste.

The distant goal of interoperability

Private industry is starting to step up, but slowly...

[And] with the ongoing sequestration of funds from government programs hampering the ONC itself, vendors who until now have been prospering from government HIT incentives must turn to the hard work of getting that tech cart behind the horse, and keeping it there, by cooperating in ways they never imagined.
Heads in the cloud
Health IT's failure to achieve interoperability invites congressional scrutiny
By Merrill Goozner, March 9, 2013

Though the U.S. has already spent more than half the $22.5 billion earmarked for computerizing medical records, there has been achingly slow progress in creating an accessible, interoperable system that works for patients. It didn't take long walking around the trade show floor at last week's Healthcare Information and Management Systems Society's annual conference to understand some of the roadblocks.

I come at this issue first and foremost as a medical consumer. I can access my bank records, pay my bills, look at yesterday's performance of my retirement assets and review my daughter's grades at college with a few clicks of a computer mouse—or do it all on my smartphone while at lunch. How many Americans can say the same thing about their medical records?

More than two decades into the Internet revolution, the answer to that question remains precious few. Primary-care physician practices are beginning to offer their patients computer portals where can they can access their most recent records and even send their doctors e-mails. But if their experience is like mine, those records have little or no information from the last physician who had responsibility for their care—unless they verbally reported it...

Since healthcare delivery is inherently local and most Americans still get their health insurance through their place of work, this occupational and geographic mobility translates into multiple changes in insurers and providers over the course of a lifetime. Without complete and seamless interoperability, the grand promise of electronic medical records—that it will empower patients, lead to better and better-coordinated care and lower costs—will never be achieved.

So why is it taking so long? The fragmentation among suppliers is one reason. The field is dominated by a handful of relatively large players with proprietary systems aimed at specialized audiences. Some cater to large hospital systems; others to physician practices. Literally hundreds of software providers surround these major players by filling niches in the market, which in turn spawned another set of firms that specialize in building pipes to connect the cacophony of electronic data.

Interoperability represents a direct threat to their business models—and raises the specter that at the end of the process, just one or two firms will dominate the field, rendering most of the smaller players extinct...

The government could cut through this Gordian knot by setting a performance standard for interoperability. The payment system would be simple: If your system plays well with others, you get paid. Otherwise, you don't. Instead, it set benchmarks and postponed achievement dates...

Don't be surprised if later this year, healthcare industry leaders and the head of the Office of the National Coordinator for Health Information Technology are called to testify on why things aren't farther along.

Indeed. The next few years will be interesting. Full of severe challenges and contention, including stuff related to things like these (above and below):
Sequester slashes Genesis' Medicare payments
Genesis expects to lose about 1 percent, half likely 2 percent for many hospitals

ZANESVILLE — Thirteen days after the U.S. plunged into sequestration, it’s still unclear exactly what’s coming down the pike — or, in the case of federal funding, what’s not coming.

Federally funded groups know they stand to lose, but just how much or in what form is still a little hazy.

“As soon as we hear more, we’ll know more,” said Genesis HealthCare Systems Chief Financial Officer Paul Masterson.

Genesis stands to lose about $100,000 a month in Medicare reimbursements, Masterson said, but specific details, such as how to administer those cuts, have been scant.

Plus, there’s still the thought there might be a last-minute, retroactive deal to stave off some of the cuts, Masterson said.

“Right now, you know, everyone’s in limbo, kind of waiting for the other shoe to drop,” he said.

The sequester, $85 billion in automatic federal cuts, went into effect March 1 after Congress did not approve an alternative plan in time. The cuts hit multiple areas — education, defense, transportation — but for the health care industry, one of the hardest hits is an $11 billion cut to Medicare. About half that cut, $5.8 billion, will come from cuts to hospitals’ Medicare reimbursements, according to a report from the Advisory Board Company, a global research, technology and consulting firm.

What that boils down to for Genesis is about a $100,000-per-month cut, or $1.2 million annually, Masterson said...


I still think that the MU "Smoking Status" "structured data" requirement is pretty feeble.

But, I found this interesting this morning.

Smoking: The Good News and the Bad News
Published by Harriet Hall under Public Health , SBM
The principles we espouse on Science-Based Medicine are vitally important, but some of the subjects we address are not so important in the big scheme of things. Homeopathy and electrodermal diagnostic devices don’t actually harm very many people. For today’s post, I’m going to follow the Willie Sutton rule and go where the money is, so to speak.

Smoking is the leading preventable cause of death. No prospective double blind randomized controlled studies have been done, or ever could be done; but a mountain of evidence converging from many avenues has established the health dangers of smoking beyond any doubt. Hill’s criteria of causation have been amply fulfilled.  Smoking causes 90% of all deaths from lung cancer and chronic obstructive pulmonary disease (COPD). It increases the risk of coronary heart disease, stroke, several types of cancer, infertility, stillbirth, sudden infant death syndrome (SIDS), osteoporosis, and premature skin aging (wrinkles). The dangers of second-hand smoke have been amply documented, and where smoke-free laws have been passed there has been a drop in the incidence of heart attacks and of emergency room visits for children with asthma.

Two new studies published in The New England Journal of Medicine reinforce what we already knew and offer both good news and bad news...
In the early 1900s, doctors promoted cigarette smoking. Ads featured doctor endorsements like “good for your health” and “more doctors smoke Camels.”  Celebrities, Santa, even babies appeared in tobacco ads....
Smoking is the leading preventable cause of death. What can we do about it? Prohibition wouldn’t work any better than it did for alcohol. But legislation to raise taxes on cigarettes, prohibit sales to minors, and restrict smoking in public places can have an impact. Warning labels on cigarette packages increase public awareness but don’t persuade many smokers to quit. Smoking cessation programs using nicotine replacement, drugs, hypnosis, incentives, and social interventions don’t have a very high long-term success rate. But there is hope: three-quarters of ex-smokers report having quit on their own without assistance of any kind.

Over 68% of smokers say they want to stop. . Advice from a health professional increases quit attempts and increases use of effective medications which can nearly double to triple rates of successful cessation. The US Preventive Services Task Force (USPSTF) recommends (Grade A recommendation) that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.   But less than half of smokers who saw a health professional in the last year reported receiving advice to quit. That’s shameful. It means doctors were treating lesser problems while ignoring the greatest modifiable threat to their patients’ health. Surely we can do better.
Hence the "smoking cessation" Clinical Quality Measures (CQM) that have much more utility than the silly "smoking status" core measure.


Not available in Kindle edition, so I bought the large format paperback textbook. I've taught "Critical Thinking" and the undergrad and Master's levels. It will be quite interesting to see how she applies the principles to her domain (nursing). I will surely learn a lot from this.

Add it to my pile.

My Kindle Runneth Over, too...

It goes on and on. My Cognitive Crack Pipe...



More to come...

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