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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).


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…

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,

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"?

They were touting a new book. Looks interesting.

Available in Kindle edition for about $16.


Drought? What drought? LOL.


More to come...

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