The KHIT Blog: Health 2.0 SF Final Day: From DC to VC

Wednesday, October 10, 2012

Health 2.0 SF Final Day: From DC to VC

This was fabulous. I'd been only mildly interested in this post-Health 2.0 SF event (the Venture Capital part; I'm not looking for VC money -- yet, lol), and, after the packed, celebratory open bar reception last night, I was moving a little slow this morning (I copped a bit of a Pinot buzz, though mostly I was just tired), but DC to VC admission came with my comp press pass, so felt I obligated to show up. I am so glad I did. So much to report on. Many holes to fill in from the week. Stay tuned.


NudgeRx CEO David Schuster, voicing concerns that a Romney election -- the fatuous "I'll Repeal Obamacare on Day One" aside -- could throw major sand in the gears for HIT, primarily at the hospital level.

ONC HIE Chief Claudia Williams and Congressman Murphy

Above: former Congressman Patrick Murphy. He blew me away Tuesday night and again on Wednesday with his passionate defense of health policy reform (and repeal of DADT). He's now running for Pennsylvania Attorney General. From his campaign site:

Patrick Murphy is a husband. A father. The son of a police officer. A native Pennsylvanian. And his lifetime of experience has made him ready to be our state’s next Attorney General.

Patrick has law enforcement in his blood. He grew up in a row house in Northeast Philadelphia, where he learned the importance of public service at an early age from his father Jack Murphy, who was a Philadelphia police officer for more than 22 years after serving in the Navy.

Patrick has dedicated his life to protecting American families. After 9/11, he volunteered for combat to bring those who would harm Americans to justice. And whether it was prosecuting terrorists and leading convoys in Iraq, enacting tougher consumer protection laws at home, or putting dangerous criminals behind bars, Patrick has been committed to doing what it takes to keep our families safe and our neighborhoods secure.

After serving first in Bosnia, Patrick deployed to Iraq in 2003 as a paratrooper in the Army’s elite 82nd Airborne Division. In Baghdad, Patrick successfully prosecuted three Central Criminal Court cases, two of which convicted terrorists bent on killing Americans. Patrick was awarded the Bronze Star for his service...

After it was over, I trucked back down to the Powell Street BART station. Stopped to take a shot as I descended into the turnstiles. Beautiful day. Beautiful city.

Did an OJ at the airport and just barely made the earlier Virgin America flight back to Vegas. As we climbed out into an initial west turn, the fog was rolling it below. No ground hold for me this time.

Went to the kennel and picked up my dogs, which I'd not expected to do until the morning. They were thrilled to see me.
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I have just spent most of the week in the company of quite an assemblage of highly intelligent, technically amazing, and morally committed people. This old REC grunt is pretty humbled, overall.

Much more to come. Thanks to everyone for being so nice to me.

Thanks, Matthew Holt and Health 2.0.
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Below: a "Make Lemonade" photo.

What do you do with a shot that was off-center (she was moving, and I was trying to catch the backlight on her hair) and not quite sharp enough, given the relatively dim available light? (I was shooting ISO 6400, 'cause I can't afford a $6,000 300 mm lens. And, I will not bail out to flash.) Couple of minutes in Photoshop to the rescue, take out the chroma, add a bit of text.

Wish I had a portrait studio. And $20k worth of gear. I'd be competitive.
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Booming thunderstorms with lightning here in Vegas tonight (we had widespread street floods today). Blogging, watching the VP debate. Fixin' to go to bed. Tired.

Much more to come...

BACK IN THE TRENCHES

The lawmakers have risen high; Camp is chair of the Ways and Means Committee and Upton chairs the Energy and Commerce Committee, two of the most expansive and powerful committees in Congress. They recently co-authored a letter with their health subcommittee chairs, Rep. Wally Herger at Ways and Means and Rep. Joe Pitts at Energy and Commerce, calling on HHS Secretary Kathleen Sebelius to halt--and then rehaul--the electronic health records meaningful use program.

Read that letter and you’ll wonder how much the two committee chairs know about the health care industry. You’ll be amazed at how little the subcommittee chairs know. They contend that 4 1/2 years into the meaningful use program (actually about 3 1/2 from the time the law was signed for those who know basic math) “it is safe to say that we are no closer to interoperability in spite of the nearly $10 billion spent.”

They actually expected the nation’s largest, most fragmented and complex industry to fully automate, integrate and share data within a few years--faster than most other industries, if not all of them, were able to do the same. And they have no idea what meaningful use has done to change the entire mindset of an industry toward information exchange...

Ouch. Article link here.

In other MU news:

National Library of Medicine Sets Meaningful Use Standards
NLM, in collaboration with the Office of National Coordinator for Health Information Technology, will provide vocabulary sets for clinical measures found in MU Stage 2

By Michelle McNickle InformationWeek October 11, 2012 05:07 PM

The National Library of Medicine (NLM) announced it will launch the NLM Value Set Authority Center (VSAC) in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and theCenter for Medicare & Medicaid Services. VSAC will provide downloadable access to all official versions of vocabulary value sets contained in clinical quality measures that support Meaningful Use Stage 2...

CODA

Apropos of Health 2.0., from InformationWeek Healthcare:

Meaningful Use Needs Mobile Magic
Mobile technology could play a huge role in meeting the federal MU regulations, but the Stage 2 rulebook virtually ignores this potential.
Paul Cerrato | October 09, 2012 08:28 AM

Mobile apps and devices have taken the healthcare industry by storm. So why is the word "mobile" mentioned only once in the 672 pages of Meaningful Use Stage 2 regulations? One can only guess the rationale behind that decision, but several experts see the need for more emphasis in this arena...

Interesting. This past week I've seen a plethora of mobile apps spanning the gamut of health care data gathering, transmission, and analysis, right down to post-op care-continuity wound healing assessment via secure mobile phone photo transmission.

It's pretty clear to me that the cutting edge developers are way out ahead of the feds. How that will reconcile is an open question, I guess.

OK...

HIE Expert: ‘Most State HIEs Won’t Survive’
October 11, 2012 by Jennifer Prestigiacomo

Yeah, like Nevada's. Just give us the money. What have you got to show for the ~$3 million you've spent to date?
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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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Wednesday, October 10, 2012

Health 2.0 SF Final Day: From DC to VC

National Library of Medicine Sets Meaningful Use Standards

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