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Friday, February 24, 2012

HIMSS 2012 Final Day

Still plenty more to witness. Wish they'd have let me shoot inside the Exhibit Halls. I'd have shot the stew out of it.

I spent some time at the SAS Institute booth, and got a copy of their "healthinsights" publication. More on this later.

Very nice. Reading through it has led me to a lot of great additional material. I've been an on-and-off SAS user since undergrad school (along with SPSS and Stata). Wish I could afford my own copy of SAS-JMP.

I will reflect on my myriad thoughts at length after the conference is over -- from my iMac at home, which, unlike my company laptop, doesn't spew irritating random useless html formatting code into my posts, which I then have to go in
and laboriously locate and remove. Gotta be a Windoze problem. Same browser for editing. Mac snobbery has its rational reasons.

Off to the last day shortly. More to come... Oh, yeah, BTW, the Meaningful Use Stage Two NPRM can be found here (PDF).

Wow, 8:45 a.m. Friday, just off the conference hall. Eerie quiet. Lot of people have left.

Final day Keynote panel: Terry Moran, Donna Brazile, and Dana Perino. They were great.

Man, was she ever funny. As good as any pro stand-up comic.
"I'm not the President, so I can't sing. But, I can dance, yeah I can dance...I can put a serious Hurt on the pole, at age 52..."

Quickly off down to the HIPAA OCR session.

Below, "The Man You Don't Want To See," OCR head Leon Rodriguez. He just exudes the "Federal Prosecutor" aura. "Mr. Gladd, may we remind you that you are under Oath..."

This session was a high point for me. I have 4 pages of notes to follow up with.

Above, left, James B. Wieland, Esq, Ober/Kaler, PC, right, Leon Rodriguez, Director, HHS Office of Civil Rights.
A major takeaway, in three words: "Business Associates, Beware." Four more: "Do Your Risk Analysis."
Dr. Rodriguez also announced the launch of the new HHS OCR YouTube channel (below).

Above, the awesome HIMSS/ShiftComm Press Office folks (these aren't all of them, but I grabbed this shot as those present were preparing to shut down the press Office). Thank you all so much.

Regarding my shots: I just take what the camera gives me (I shoot AWB 12.3 mpix jpeg, not .raw, mostly in program mode owing to time and opportunity constraints; I also then downsize them for the blog).

I refuse to use flash (ugh), I rarely ever crop, and my pics get maybe 5-15 seconds of post in iPhoto where they indeed need tweaking. I could spend time doing saturation and color balance and exposure finery in Photoshop, but I don't, because this is what it looked like (and I don't really have time to do any serious post).

My Sony Alpha 500 is pretty honest. Works for me on the fly.

Amateur's prerogative.

UPDATE: after posting shots from the set of "official HMSS12 photos" above (Feb 26th post), mine look like they need to be dipped in Clorox. I'd toyed with desaturating and color-balancing a couple of mine. But, no, that is how the places looked. Nonetheless, I may mess with going off AWB in the future in venues like this one, just to compare.

Below, swag from The Department of Is Our Children Learning?

Common law "trademarked," no less...

"You can’t win with data. When you use it as a singular noun—e.g., this data is, which might sound more natural to nonscientists—you might lose credibility with some readers. When you use it as a plural noun—e.g., these data are—it might sound odd to readers who are used to hearing data as a singular noun.

In Latin, data is the plural of of datum, which means a thing given. But of course, data is an English word when English speakers use it, and we generally don’t let Latin hold sway over our language. The trouble with data is that it’s still relatively new to English—having emerged in its modern sense during the late 19th century—so we haven’t had much time to fully absorb it into English. Plus, data is a scientific word, and scientists are especially wont to honor Latin language conventions.

Outside science, fighting to preserve proper Latin grammar in modern English is a lost cause..."
Color me Quixotic nonetheless. Mainstream health care, recall, aspires fervently to be included in "science."

Yeah, call me pedantic. And, it increasingly does look to be a lost cause.

(requires mp3 embed code plugin)

KNPR interview with Dr. Paul C. Tang this week (Dr. Tang was here attending HIMSS12):

The Obama Administration has been pushing for standardized electronic medical records. It would help doctors provide better and more effective treatments and it would save money because it would prevent repetitive and unnecessary testing. There was even money in the stimulus law to pay medical records to go digital. But there's a problem: most providers do not want to make the electronic records available and particularly do not want them to be available to patients. So what can be done to fix this problem? And who really does own your medical records?

Yeah, I know, "...right access this data...who 'owns' this data..."

That aside, I am not nearly finished considering the "ownership" issues pertaining to PHI. They are hardly settled, neither legislatively nor in case law.

Just in:

Feb. 24, 2012, 5:45 p.m. EST
HIMSS12 Breaks Previous Attendance Records
LAS VEGAS, Feb 24, 2012 (BUSINESS WIRE) -- The record-breaking trend continues for the 2012 Annual HIMSS Conference & Exhibition, held in Las Vegas at the Venetian Sands Expo Center from Feb. 20-24. As of Friday morning, Feb. 24, attendance at HIMSS12 reached 37,032 attendees, surpassing the HIMSS11 attendance figure of 31,500 attendees...

Nice. Very nice.


Supercomputer 'Watson' Tries Hand at Medicine
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: February 24, 2012

LAS VEGAS -- IBM's supercomputer Watson -- the formidable Jeopardy! contestant who beat two humans by answering trivia questions at record speed -- may be able to apply the same technology in a clinical setting and arrive at a diagnosis faster than a doctor can.

"It's a bit like House, but for real," said Nick van Terheyden, MD, chief medical information officer for speech technology company Nuance Communications, during a presentation at the Healthcare Information and Management Systems Society (HIMSS) conference here...

...Watson can sift through an equivalent of about a million books or roughly 200 million pages of data, analyze the information, and provide an answer in less than three seconds.

Unlike Google, Watson isn't a simple search engine that presents the top hundred most reliable answers. Instead, it homes in on the most important parts of a query and responds with an answer in the way a human brain would.

For instance, if Watson is given the query: "This hormone deficiency is associated with Kallmann's syndrome," it would rapidly locate a passage in medical literature that read, in part "Isolated deficiency of GnRH or its receptor causes failure of normal pubertal development and amenorrhea in women. This disorder is termed Kallmann syndrome when it is accompanied by anosmia and has also been termed idiopathic hypogonadotropic hypogonadism."

Rather than latching on to a random noun in that passage, such as "amenorrhea" or "anosmia," it knows that GnRH is a hormone so it selects GnRH as the correct answer...


Apropos, we shall soon be going again

The massive scope and intricacy of our increasing knowledge, and its infinitely variable applicability to individuals, make it increasingly obvious that the minds of highly educated physicians cannot be relied upon to recognize the patterns that define unique individuals and their medical needs. In that environment, we will heed Bacon’s warning not to “falsely admire and extol the powers of the human mind,” and we will embrace the use of external tools to empower the mind. Both the mind and external tools use language to reference clinical concepts. Lack of precision and consistency in the use of language has long been recognized as an obstacle to semantic interoperability among disparate health information technologies, particularly electronic health records. Accordingly, major efforts have been underway for many years to develop standardized medical terminology, taxonomies of medical concepts and corresponding coding systems. These efforts, however, valuable as they are, leave unresolved the problem of unstructured clinical judgment by physicians. For example, using standardized terminology to record the results of an initial workup does not assure that the contents of the initial workup will be complete or accurately coupled with medical knowledge. Assuring those goals requires some form of knowledge coupling tools as described above. Standardized terminology and coding is pursued most fruitfully when it is driven by needs that arise in developing knowledge coupling tools and using those tools in medical practice. [Medicine in Denial, pg 192]

More to come...

We hooked up in the Press Room today. Very nice guy. Great, busy, reliable blogger. See Political Keynote at HIMSS 2012 and #HIMSS12 Recovery.

Aneesh Chopra & Farzad Mostashari at TEDMED 2011

I can't yet find any videos for Dr. Mostashari's HIMSS12 talks, but here's Farzard recently at TEDMED:

Dr. Mostashari @ 3:10:

So, government does innovation? No.

The innovation comes from out there. Right? Government sets the infrastructure, the rules of the road, and the conditions for innovation. But, ultimately, health care is going to be changed by the 5,000 hospitals, by the 600,000 doctors, the 3.1 million nurses, and the 300 million people in this country. That's what's gonna change health care...

...(@ 5:39) So, he had help from a non-profit local organization that was funded by ARRA funds, to help him make that transition, in a way to keep his records secure. Local solutions, local problems. There are a HUNDRED THOUSAND primary care providers across the country who have now signed up with one of these Regional Extension Centers established..."
OK. I will have a lot to say to this. But, continue listening to the argument. The man does in fact inspire (but, we don't have a REC timesheet "direct project" code for "inspired").

I wish I had a transcript of his ONC Town Hall session at HIMSS12 (I have my notes, but I have a ton of notes to review and reflect upon yet).

So, it's 6:45 pm on a Saturday night in Vegas, and what is Mr. No Life doing?
Reading and blogging in my study, what else? And, yes, I'm a Messy Marvin.

I did, though, knock out some Honey-do List items today, replete with two Tim Taylor Tool Time forays to Home Depot. Were Cheryl home, though, we'd now be at Lindo Michoacan, workin' on some Top Shelf Margaritas.
Yeah, I shot that. Of course.

JUST IN, from the HITRC

There are challenges to integrating health information exchanges into EHRs.


The proprietary nature of vendor systems complicates the task of interfacing and exchanging health information. A standard format that could be consumed by HIEs would address this issue. Direct is has also been offered as a possible solution, however not all vendors have adopted Direct messaging protocols. RECs have provided potential mitigation strategies to address the risk of not being able to integrate EHRs with HIEs and Direct.

Mitigation Strategies
RECs have offered a number of mitigation strategies to address this problem, including the following:
  1. Demonstrate (Direct) secure messaging to show how patient records can be delivered safely and how it can reduce staff time spent faxing and calling on the telephone.
  2. Plan for HIE interfaces back into a providers EHR.
  3. Contract language will include accountability to the declared interoperable capabilities.
  4. Include language in vendor agreements that commit the vendor/VAR to meeting interoperability requirements.
  5. Determine which model of HIE integration is preferred, identify alternatives if that is not an option, and use integration as one of EHR evaluation technical points.
  6. Engage practices to influence their vendors to cooperate. Consider engaging negotiation consultant.
  7. Work with vendors willing to put HIE as a major factor and build the necessary interfaces up front without passing on all costs to each provider.
  8. Work with lab vendors and hospitals to build open source interfaces.
  9. Build HIE requirements into the vendor selection and include in any vendor contractual obligations. All selected vendors have agreed to interface with the HIE.
  10. The HIE confirmed that all pre-qualified EHR vendors are capable of interoperability. Interoperability is a part of the contract negotiations.
  11. Assess existing EHRs for HIE capability and communicate a list of "non-functioning" EHRs to field staff.
  12. Build demand and leverage vendor relationships. Work collaboratively with the HIE and vendors to assure that vendors can certify with the HIE.
RECs must summarize and assess implementation of the suggested mitigation strategies and their utility in mitigating risk of not being able to integrate EHRs with HIEs and Direct.

Some of that will really go down swell with the vendors. After all, in the conventional (short-sighted) thinking, "proprietary" = "product differentiation" = "market share" = profitability.


From a comment on The Health Care Blog.
A fairly common gripe. One that can't be simply summarily shrugged off as Luddite naysaying. Not that I buy all of that, by any means. Here's another just in.
"Rest assured that HIT is not the solution"? Must be nice to be so all-knowing. What might Messrs Weed say in reply?
Patients must be educated in the use of tools such as the problem-oriented record and computerized POMR so that there is some concrete instrument for expressing and capitalizing upon their own motivation. If the patients are not motivated enough to use the tools effectively, then we should get over the illusion that those same patients are accomplishing much with twenty minute visits to providers or that they are complying very precisely with directions from those providers, except in those instances where a normally healthy individual gets specialized care for a self-limited problem from the appropriate specialist, e.g. a broken leg. The Power Of The Right Tools: Tools extend our muscles, our senses, our memories, and our analytical capacities. Extending our muscles and our senses with automobiles, power tools, telescopes, etc. are commonplace. Extending our basically chemical and electronic minds with electronic computers is becoming more commonplace. For patients who, up until now, have had little exposure in school or elsewhere to the use of the medical record as a powerful tool in their own health care, the particular form of this tool will be of little consequence so long as it is clear to them and usable by them. A computerized problem-oriented record will not be any newer or more confusing to them than traditional paper records since they never had either record in the past. Physicians, nurses, and other providers have been trained with a whole set of habits and notions about medical records and their availability to patients. It is difficult for some of them to switch to electronic tools that provide specific guidance for solving problems within the context of patients’ other problems. Some not only do not want to switch to an electronic record system, they still do not recognize that the record should be a tool the patient’s use as much as a tool for their own use. Therefore: In health care, patients and very inexpensive paramedical people who are already a permanent part of a community must be taught to use the problem solving guidance in their own records and eventually in computers. After all, rescue squads with remarkable skill in heart and lung disease have been developed all over the country, and people with only a high school education or less have been taught to do sophisticated medical work. Surely we all can learn to deal with many of the less life-threatening disorders such as sore throats and body aches if we have our records and the right guidance tools. Expensively trained medical professionals should be reserved for specialized tasks that we cannot master and cannot do for ourselves. They also should be used to build the guidance in the tools and to monitor occasionally our records and behaviors to make sure that we are behaving in a disciplined and reliable manner...

...Physicians and other providers often make time the constant and achievement the variable with patients. They try to do everything for the patient themselves and even keep all the records to themselves and instruct the patients hurriedly over a series of timed appointments. They do not have the time or money to give the necessary time to those who need it; on the other hand, they also have patients who return for repeated office visits that are unnecessary because those patients understood their situation at the first visit and can manage their own affairs. In such medical practices the patient is not only being denied his essential role as an informed participant. in his care, he is also being denied the basis to form an accurate judgment about the quality of health care he is purchasing. [pp 261-2, 264]
Get the book. It contains a thought-provoking whack upside the head on every page. Not that I need lean exclusively on the Weeds' book, compelling as it may be. Consider as well

Just got this on my Kindle and have started studying it. Click the cover graphic above for the link.


In the mid-twentieth century Joseph Schumpeter, the noted Austrian economist, popularized the term “creative destruction” to denote transformation that accompanies radical innovation. In recent years, our world has been “Schumpetered.” By virtue of the intensive infiltration of digital devices into our daily lives, we have radically altered how we communicate with one another and with our entire social network at once. We can rapidly turn to our prosthetic brain, the search engine, at any moment to find information or compensate for a senior moment. Everywhere we go we take pictures and videos with our cell phone, the one precious object that never leaves our side. Can we even remember the old days of getting film developed? No longer is there such a thing as a record album that we buy as a whole—instead we just pick the song or songs we want and download them anytime and anywhere. Forget about going to a video store to rent a movie and finding out it is not in stock. Just download it at home and watch it on television, a computer monitor, a tablet, or even your phone. If we’re not interested in getting a newspaper delivered and accumulating enormous loads of paper to recycle, or having our hands smudged by newsprint, we can simply click to pick the stories that interest us. Even clicking is starting to get old, since we can just tap a tablet or cell phone in virtual silence. The Web lets us sample nearly all books in print without even making a purchase and efficiently download the whole book in a flash. We have both a digital, virtual identity and a real one. This profile just scratches the surface of the way our lives have been radically transformed through digital innovation. Radically transformed. Creatively destroyed.

Some will argue the predigital era was a better and simpler one. We were not connected and distracted all the time—even when driving a car. We wrote handwritten notes to one another and communicated much more deeply and effectively, albeit less frequently. We spoke on the phone to each other and did not rely on texting and instant responses. We had much more privacy, and there was no digital, immutable archive of our lives for everyone to peer at via a few clicks. We used maps to find our way from place to place instead of global positioning systems. But those days are truly past tense, and our world has irrevocably changed. The cumulative effect of extraordinary innovation that exploits digital information has turned our world upside down. Essentially, there is no turning back.

But the most precious part of our existence—our health—has thus far been largely unaffected, insulated, and almost compartmentalized from this digital revolution. How could this be? Medicine is remarkably conservative to the point of being properly characterized as sclerotic, even ossified. Beyond the reluctance and resistance of physicians to change, the life science industry (companies that develop and commercialize drugs, devices, or diagnostic tests) and government regulatory agencies are in a near paralyzed state, unable to break out of a broken model of how their products are developed or commercially approved. We need a jailbreak. We live in a time of economic crisis because of the relentless and exponentially escalating costs of health care, but we’ve done virtually nothing to embrace or leverage the progress of the digital era. That is about to change. Medicine is about to go through its biggest shakeup in history.

This book is about the creative destruction of medicine, of how medicine will inevitably be Schumpetered in the coming years, and why it is vital for consumers to be fully engaged. Without the active participation of consumers in this revolution, the process will be inexorably slowed. All the other forces that could come to bear—doctors, the life science industry, government, and health insurers—are incapable of catalyzing this transformation. At the same time, the democratization of medicine is taking off. You, the consumer, are going to be needed to make it happen.

Topol, Eric (2011-12-02). The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care (Kindle Locations 184-189). Perseus Books Group. Kindle Edition.
"[G]overnment regulatory agencies are in a near paralyzed state, unable to break out of a broken model of how their products are developed or commercially approved."
OK, Medicine in Denial, page 37:
Policymakers recognize that transformation requires more than technology. Accordingly, certification and “meaningful use” of electronic health records (EHRs) are required to receive subsidies to purchase EHRs under the 2009 economic stimulus legislation. But the requirements for certification and meaningful use as currently conceived are primitive. They fail to incorporate or even consider most elements of the problem-oriented medical record (POMR) standard (the subject of part VI), which became prominent four decades ago. Since that time, the quality of medical records has declined. Use of the POMR standard has receded, and the clinical purpose of the medical record has been compromised
___Above, cool, eh? (I stole that from the Scripps website). OK, how about your telemetry source is a RFID enabled undershirt?

Below. Kaiser Permanente is throwin' down the mobile tech. HIMSS12 Interview with the CEO here (don't let the annoying Nausea Cam off-center shot framing distract you. Matthew, seriously?)


Remote 'eye in the sky' keeping tabs on VA hospital patients
Dr. Matthew Goede, an intensive-care specialist, monitored VA patients in Minnesota, Omaha, and South Dakota Wednesday afternoon from his workstation in the Tele-ICU hub at the Minneapolis VA Medical Center.
"There are three words to describe what I do. I’m a doctor. This comes from the Latin docere, teacher. I’m a physician, which comes from the Latin, physica, science. I’m a medicine man, which means healer. To help someone else, you have to have science, you have to be able to heal, and you have to be able to teach. They all work together. In Western medicine, we put a disproportionate emphasis on the science part."

- Dr. Oz

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