The KHIT Blog: adieu, 2014

Wednesday, December 31, 2014

adieu, 2014

Been an interesting year, and I expect that 2015 will be as well across a variety of health care and Health IT fronts. ObamaCare will again be in the dock before SCOTUS in March and under renewed assault in the Republican-majority Congress, ICD-10 looms (will it yet again be kicked down the road?).

Health IT In 2015: What's In The Cards?

Healthcare IT professionals are in for another busy year in 2015, as medical organizations look for ways to build on the groundwork they've already laid with their investments in electronic health records (EHRs), early big data and analytics trials, and experiments in patient engagement and population health.

They'll also need to address federal mandates including Meaningful Use Stage 2, the push-pull of ICD-10 deadlines, and the government's demand for healthcare systems interoperability. No matter who resides at the White House after the 2016 election, throughout 2015 healthcare organizations should act as though the Affordable Care Act -- aka Obamacare -- will survive, in some form or another, several executives predicted...

Meaningful Use 2014 closes today (with disappointing attestation numbers as of the last ONC reporting), with the future of the program in some doubt (we're now going to be largely into the reimbursement reduction penalty phase, with most of the incentive money having been doled out). 2015 should shed firmer light on the viability of ACOs. Evidence is thus far mixed and too short of duration.

The Interoperababble debate will no doubt continue unabated. To that end, I have invited Australia's Grahame Grieve to do a guest cross-post on the topic (without any editing on my part), in light of his HL7 FHIR API expertise. He politely takes issue with my "Standard Data Dictionary" rant and my questioning of HL7.org: here, and here.

The progress of FHIR initiative bears close watching.

I guess my little blog continues to add something of value to the fray. Just crossed a third of a million hits (since I started tracking them after about a year of posting).

No sponsors, no "monetization" of any kind. Just a semi-retired lone wolf with an attitude and an aching back.

Books on deck for review (to cite just two):

The more I re-read Vik's book, the more I like it. See my Amazon.com review. See also his latest post on THCB. A curmudgeonly caller of bullshit, he is.

I've just started "The Art of Medicine." It will continue the riff I started in a prior post. In 2015 I will also continue to expand on the theme I started with my June 25th "Talking Stick" post and its linked brethren.

I got a totally unexpected invite recently.

Small group private dinner with athenahealth CEO Jonathan Bush. Flattered to be asked (particular given the shot I took at him in 2011 after he dissed the RECs at HIMSS). Definitely going.

Have to say, I'm lovin' this little Christmas gift from my Grandson (below).

Today (New Year's Eve) is my wife's birthday. We've now been together almost 41 years. Meeting her in March of 1974 was by far the best thing that ever happened to me.

Also: congratulations to our son Nick (a.k.a. "Matt") on his December 2014 graduation with distinction from the Smith School of Business at the University of Maryland. B.S. in Operations Management.

I hope everyone has a safe and happy New Year's Eve and a prosperous 2015.

Oh, and, uh, ROLL TIDE!

ERRATUM

My wife's cousin Scotty has had a 130 ft high grain tower erected on the family farm via which to deliver corn and soybeans from the trucks into the grain silos. My first thought was "tornado magnet."

Of course, I climbed to the top.

Bracing ascent. Great view. I wanted to go back up and do a 360 panorama shot, but it rained thereafter until we had to come back home. Next time.
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More to come...

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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, December 31, 2014

adieu, 2014

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