The KHIT Blog: #HIMSS16 Day 1

Monday, February 29, 2016

#HIMSS16 Day 1

Got my badge, tried to login to the conference website to review my calendar.

"The website that you're trying to reach
is having technical difficulties and
is currently unavailable.
We are aware of the issue and are working hard to fix it.
Thank you for your patience."

Lordy. We're the IT people...

OK. one core thing I will be looking for this week, apropos of my recent review of Dr. Nortin Hadler's book, are affirmative responses to this Hadler cite:

"If there is a role for computers in decision making, it is to facilitate dialogue between patient and physician, not to supplant the input from either or to cut health-care costs."

Now, obviously, the physician and her patient are not the only "stakeholders" in the health care space, but if all of our cherubic talk of "patient-centered care" is more than just Suit talk, then I'm looking for affirmative evidence of the foregoing. The salient question: "how does what you do/sell 'facilitate physician-patient dialogue'?"

Good a time as any for a bit more Hadler by the Bedside. Keyword search "EHR."

At the beginning of this chapter, I pointed out that the transformation of “medicine” into a “health-care industry” required first creating a different setting for caring. That is fait accompli. Next, it had to intrude into the examining room itself. The coup de grâce is the commandeering of the doctor-patient relationship itself, the topic of the next chapter. The health-care industry took ownership of the examining room by computerizing the clinical interview. This required convincing the country and the federal government that an Electronic Medical Record (EMR) was much more than a confusing, expensive way to garner fees for services. Furthermore, EMR was to be replaced by another acronym, EHR, to denote that matters of “health” were to be recorded, not just “medical” matters... [pg 120]

The Affordable Care Act does not assault the Babel of invoicing. To the contrary. The solution currently being offered is buried in the Electronic Health Record, which is already mandatory for larger institutions and will be universal before long if the federal government has its way. These are computer programs that require providers to enter actions and codes leading to large data sets with the “granularity” that is considered the secret to efficient invoicing. The ICD-10 appeals to this mindset, but even with the ICD-9, a patient encounter or admission can send myriad data points into the maw of invoicing. I’m not surprised that it has proved difficult to demonstrate that the implementation of the EHR leads to a reduction in costs or any other impressive utility, even in outpatient settings. But the EHR has its stakeholders; some are wonks with their policy prowess at risk, and others are stockholders with deep pockets. All are crying “wait and see,” even the current crop of RAND Corporation thought leaders... [pg 125]

Perhaps the most evil example of propaganda masquerading as clinical pedagogy is the insidious introduction of contentious clinical guidance into the Electronic Health Record. Not only are various guidelines and reviews linked to the EHR, but adherence to them also can be monitored digitally— with the assumption that adherence is a measure of “quality of care.” [pg 137]

Plenty more where those came from. Buy the book (I am not pimping it; I get nothing for these cites).

JUST IN: EHR SCIENCE UPDATE

I really admire Dr. Carter's work.

Diagnostic Error, Results Management, and Software Design
by Jerome Carter on February 29, 2016

As I have spent more time thinking about clinical software design, my ruminations have become more problem-focused. I have begun to look at specific care delivery problems and how changes in software designs might help or hinder clinical work. Lately, the problem of diagnostic error as it relates to results management has captured my attention. Having dealt with results management headaches in practice, this is an issue that resonates with me.

When approaching a software design challenge, I like to start with high-level concepts before jumping into detailed design issues. Here, the question is: What is the optimal way to manage test results? When designing software for clinical work, it is helpful to pose two questions. The first question: What is it about managing results that is common (or should be) across all clinicians within a specific domain? The second question: What necessarily varies among clinicians within a domain? Creating software that helps and doesn’t hinder requires answers to all three questions...

EHR systems are data-centric, and as such, they can be great for event-based support of clinical work, but if process support is needed, they have serious shortcomings. Current EHR systems lack workflow capability, so do not expect sophisticated process support to appear anytime soon.

Improving diagnostic decision support for test results requires moving beyond alerts. It requires process-centric software designs that make use of tools that fit into the workflows of busy clinicians. Results management is a process, not an event…

MONDAY PM 11TH ANNUAL AUPHA ACADEMIC FORUM

Had not heard of them.

"The Association of University Programs in Health Administration (AUPHA) is a global network of colleges, universities, faculty, individuals and organizations dedicated to the improvement of health and healthcare delivery through excellence in healthcare management and policy education. Its mission is to foster excellence and drive innovation in health management and policy education, and promote the value of university-based management education for leadership roles in the health sector. It is the only non-profit entity of its kind that works to improve the delivery of health services – and thus the health of citizens – throughout the world by educating professional managers. AUPHA's membership includes the premier baccalaureate, master's and doctoral degree programs in health administration education in the United States, Canada, and around the world. Its faculty and individual members represent more than 400 colleges and universities...

The association continues to provide forums for discussion where leaders from the field can gather to share information on educational methods and research. The association continues to serve as an effective advocate for the health administration education community before various legislative and executive bodies. Most importantly, AUPHA continues to focus on providing its members with the tools, research, venues, support, and forums that enable each program, as well as healthcare administration education as a whole, to evolve and thrive in a constantly changing industry."

I was expecting to hear (perhaps overlapping) broad stuff about developing and nurturing effective curricula -- pedagogy. e.g., say,

Management: incl, the MBA paradigm vs Effectual/Entreprenurial/Startup

Leadership

Process QI (e.g., Lean)

Organizational dynamics (e.g., apropos of "Just Culture")

InfoTech

Analytics (including Ops)

Law and Regulation

Ethics

Clinical Cognition (e.g., "How Doctors Think")

I was pretty disappointed. They lost me with the first two presentations: "Characterizing Pioneer Hospital ACOs" and "The HIPAA Privacy Rule: Regulatory Success and Legacy Technology." The 3rd, "Learning Health IT Management Using Data Visualization," though, was a bit more on point.

I didn't stay for the ensuing session following the break, "eHealth Use by Mature Adults -- Does One Size Fit All."

"foster excellence and drive innovation in health management and policy education"?

Huh?

They were touting a new book. Looks interesting.

Available in Kindle edition for about $16.

SOME RANDOM DAY 1 PHOTOS

Drought? What drought? LOL.

___________

More to come...

No comments:

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
___

"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
___

"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
___

"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
___

"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
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"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
___

"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, February 29, 2016

#HIMSS16 Day 1

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