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Saturday, October 20, 2012

Stayin' with the numbers: REC Brew 102

Runnin' with a riff a bit longer. Post no. 102. The Power of Photoshop Compels me, The Power of Photoshop Compels me, The Power of Photoshop Compels me...

Post number 102. Lots to update and discuss this weekend.
Mostashari: Paper records are great ... if you're Harry Potter
Health IT coordinator talks to CHIME members about accountable care, national patient identifiers, EMR certification and more
October 18, 2012 | By Gienna Shaw

I'm optimistic. I think we're going to do it by tapping into innovation. We're going to create disruptive innovation … evolutionary innovation. And we're going to do it through the one thing known to create reliably faster, better and cheaper [healthcare], which is technology," he said. "The idea that we would bring the same brilliance, the same power, that has transformed everything else and bring that to healthcare."
Technology is just a tool, he said, but what a tool it is, he added. "Data," he said. "Wow! I Love data."

On paper records

Once you close a paper file it's dead. "You can't use it for anything. You can't move it, you can't learn from it," Mostashari said.

"In a Muggle world, the world we live in, the provider can't go into the room of paper charts and flourish their wand and say 'All the patients with diabetes!' and the charts fly out and hover in the air. 'All those who didn't come back to see me, over here!' Send in an owl. We can't do that on paper. But that is the essence of population health management."
Gotta love the guy.

I Photoshop quickie. I can do better. It'd be funny to put other ONC execs' faces in as well.

More to come. Gotta go vote.

Done. I'm back. a quick rant in the comments on THCB before heading out to a wounded Veteran benefit.
BobbyG says:
October 20, 2012 at 11:45 am
“Finally, individuals who insist that corporations should be beacons of social progress are bound to be disappointed”
Straw man.
The aggregate moral purpose of markets should properly be to advance the human condition, net (which includes not fouling the nest) -– maddeningly difficult to achieve ongoing as it may be. Markets properly exist to serve humanity, not the other way around. That this requires rational regulation ought be self-evident. That such is a never-ending pain in the ass ought also be self-evident.
If you disavow that, you are disavowing our system of law. It has been a long, painful climb up out of the Tooth and Claw muck.
See Gresham’s Dynamic, for one thing. A Winners vs Losers economy will not sustain. How many times must we re-learn that lesson?
Corollary: Not all markets are equally morally consequential. Markets for cheap trinkets and crass entertainments can come and go without appreciable socioeconomic/moral impact. The “markets” in health care or other life necessities are quite another matter at core.
We continue to live through the adverse upshot of an inadequately regulated financial sector.
Short memories are a bane. They simply re-enable the rapacious.
I, for one, will continue to insist that corporations be beacons of social progress, notwithstanding that I will be guaranteed of my numerous disappointments. Settling for a net win/win would suffice for me. Declaring “stymie” in the face of the difficulties of the requisite hard work ahead is no excuse for making excuses.

"I use the EMR every day, and I am old enough to have trained and practiced when everything was on paper. While overall, I am happy to have electronic records, there is a problem: The EMR is trying to serve too many masters. The needs of these various masters are different, and sometimes they are incompatible, even hostile to one another."
Christopher Johnson, MD, "The EMR and the Case of the Disappearing Patient"

That is so true, and comprises the fundamental problem HIT must confront.


apropos of nothing. Just some the cool stuff you find on Twitter.


Sir! May I have another, Sir?!

At HealthInsight, we're the "health improvement" people. Saw this in the kitchen at work the other day.

Can I get an a1c test with those?
Preparing IT for Mobile Forensic Investigations
By Thor Olavsrud, 19-Oct-2012

If your IT security team must comply with regulations like PCI-DSS or HIPAA, you need to know who accesses your data and what they do with it, even if they're using a mobile device to do it. But performing forensic investigations on mobile devices is trickier than it is on PCs.

As mobile devices proliferate in the enterprise, whether corporate-owned or part of a bring-your-own-device (BYOD) strategy, security organizations need to ensure they're prepared for the unique challenges of mobile forensic investigations.

This is especially true of organizations subject to compliance with regulations like PCI-DSS or HIPAA, but any organization could find itself in trouble if it can't get its hands on emails and SMS messages during an ediscovery process.

"If a company faces litigation or some other incident, do they have the capabilities to get the answers that these devices potentially hold inside them, whether through insourcing or outsourcing? That preparation is often an afterthought," says David Nardoni, a director in Pricewaterhousecooper's Forensic Services practice. "It has to be part of the implementation of your mobile policy."...
Good article. PCI-DSS refers to "Payment Card Industry Data Security Standard."
 See Requirements and Security Assessment Procedures Version 2.0 (pdf).
PCI DSS represents a minimum set of control objectives which may be enhanced by local, regional and sector laws and regulations. Additionally, legislation or regulatory requirements may require specific protection of personally identifiable information or other data elements (for example, cardholder name), or define an entity’s disclosure practices related to consumer information. Examples include legislation related to consumer data protection, privacy, identity theft, or data security. PCI DSS does not supersede local or regional laws, government regulations, or other legal requirements.
Interesting article on the topic of Mobile Forensics here:
by kstrzempka | in iPhone Forensics | October 3, 2012

The release of iOS 5 came with many new features, one of which was iMessage.  iMessage allows for sending text, photos, videos, group messages, and more over a cellular or Wi-Fi network from an iOS device (i.e. iPhone, Mac, iPad). From a user’s perspective, there isn’t a major difference from the looks of an iMessage compared to a standard text. Using iMessage, the user can see when another is typing, and the message appears in a blue text bubble instead of green.

From a forensic analyst’s standpoint, iMessages are stored in the same database as a standard SMS message; however, the format of the record is very different...
Zero percent unemployment rate in the InfoSec sector as far as the eye can see, IMO.


Regional Extension Centers Strive Toward a Sustainable Future
By Kurt Andrews, PhD (pdf)

With a charter that was boldly going where nobody had gone before and limited federal funding through 2014, it was unclear at the creation of regional extension centers (RECs) whether they could succeed and create a sustainable future. Will they do it? With just less than 20 months to go in the RECs’ funding lifecycle, the signs are pointing in the right direction...

RECs recently announced the creation of an REC-specific trade association, the Association of Regional Centers for Health Information Technology (ARCH-IT), which was formed in June 2012. Executive Director David Bergman is a Point-of-Care Partners (POCP) alumnus. (Learn more about the Association, which will soon have its website available at

ARCH-IT’s Bergman remains optimistic about RECs’ future, despite the speed bumps in the road ahead. He believes the providers’ needs and use cases would clearly support RECs’ long-term sustainability...
Were it all of "20 months." It's effectively more like 10, for the reasons I've addressed previously. And, ARCH-IT, well, they have their work cut out for them.

This same POCP consulting outfit has another interesting article circulating:
EHRs and the 2012 Presidential Elections
By Ed Daniels, MSIE (pdf)

It is impossible to know how each of the two presidential candidates would impact the electronic health record (EHR) industry if elected. However, that knowledge would be valuable to all of us who develop market, sell, implement and utilize EHRs. That knowledge would also be of interest to us as patients, whose records are stored in EHRs, and to our physicians who benefit from EHR use. Since we cannot know how these candidates will behave once elected, the best we can do is speculate based on available information.

According to KateAckerman, managing editor of  iHealthBeat, “Given the bipartisanship surrounding health IT for years, it's no surprise that both presidential candidates back the use of IT to improve health care.” A wild card for both candidates is the looming fiscal cliff to which Congress will attend after the election. A lot of what happens depends on the makeup of the Congress, especially since the senate composition is too close to call, according to some pundits. Clearly, some expenditures will be cut. Will the meaningful use (MU) incentives survive? Ackerman’s article reminds us that the MU incentive programs for EHR adoption were created under the Health Information Technology for Economic and Clinical Health Act (HITECH). That legislation is separate from the Affordable Care Act (ACA), which opponents often call Obamacare. Because of the statutory separation, it will be “very difficult to end the incentive program" even if the ACA is repealed or modified, according to the vice president of government relations for the Healthcare Information and Management Systems Society (HIMSS). The meaningful use program is classified as an entitlement, so Congress will have to pass legislation to end or reduce the program. It might be easier to just call it quits at stage 3, which is as far as HITECH goes.

At a high level, we can assume that President Obama, if reelected, will continue to pursue his current approach to EHRs. There is no evidence that he believes any major changes are required. His administration put in place significant, high-dollar programs to promote EHR standards and adoption. If a Republican house is preserved and a Republican senate elected, President Obama may find some of his EHR programs reduced due to the broad impact of budget reductions at the federal level...

It is safe to say that a Romney administration will find a way to limit the billions of dollars of federal spending now going directly to guide development of specific EHR features as well as motivate adoption. More of that is likely to be left to states, payers and private sector...
This is a nice article. Good side-by-side table Obama-vs-Romney comparative table at the conclusion.

Meaningful Use funding aside, I would conclude it to be the safest of bets to predict that there will be no more federal REC money forthcoming, no matter who wins the Presidency.

I take no joy in saying that, either.

We'll have a bit more HIT path forward clarity in 15 days. 

More to come, after the Giants-Cardinals Game 7...

UPDATE: Wow! 9-0 skunk to win the Pennant. Fear the Beard.


Click for programme

ONC seeks approval to collect key data from a relatively small sample of clinical laboratories nationwide for the Evaluation of the State Health Information Exchange Cooperative Agreement Program. The National Survey on Health Information Exchange in Clinical Laboratories will assess and evaluate the electronic transfer of health information from clinical laboratories to ordering physicians. It will focus on two key measures: (1) Percentage of laboratory facilities that are able to send structured lab results electronically to ordering physicians and (2) percentage of lab results that are currently being sent electronically in coded format to ordering physicians.

Need and Proposed Use of the Information: A key goal of the State Health Information Exchange Cooperative Agreement Program is to promote the electronic exchange of structured test results from clinical laboratories to healthcare providers. ONC will use these survey findings to develop a comprehensive understanding of the baseline level of laboratory information exchange in order to inform program activities to promote laboratory information exchange and provide more targeted assistance to states and territories in developing their laboratory information exchange strategies.
Interesting. "1,489 burden hours." Priced at $??? per hour, subbed out to ??? Beltway contractor? (rather than, say, contract mods for the RECs already working this turf?) Stay tuned.


Well, this is interesting.

AirStrip files lawsuit against mVisum for patent infringement
October 22, 2012 | By Greg Slabodkin, FierceMobileHealth
The battle between mHealth providers is heating up. San Antonio-based AirStrip Technologies last week announced that it filed a lawsuit in Federal District Court for the Southern District of New York, arguing that mVisum violated its patented intellectual property rights. The alleged violation involves an "industry-leading" method for remote monitoring of patient medical data on smartphones such as Apple's iPhone, tablets such as Apple's iPad, and other mobile devices.

In its legal complaint for patent infringement, AirStrip argued that its "revolutionary" AppPoint software was the "first FDA-cleared healthcare application for Apple devices to appear in the App Store," and now is found in more than 400 hospitals in the U.S. and internationally...

Safe to say, I think, that there will be a proliferation of this kind of litigation in coming years.

More to come...

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