The KHIT Blog: #HIMSS16 Day 3

Thursday, March 3, 2016

#HIMSS16 Day 3

BREAKING! In my email inbox today!

Lucky me! I may have to leave the conference early! (Love the "tommorrow" spelling.)

But, first, a bit of snark.

I searched "Uber" on the Conference website. No match. Thank you.

Attended the #HITsm panel / interactive discussion. Excellent.

Mandi Bishop moderating

The panelist on the right is Drew DeFord. He brought up "Lean." BobbyG was all smiles. Color me an Evangelistic Believer. See my coverage of last year's Lean Healthcare Transformation Summit in Dallas. The 2016 Summit will be in Miami this June. A tremendous value. Highly recommend you go if you can. Interact with the leaders in progressive, science-based health care process QI.

In response to a question asked of the panel and audience regarding "what you you think will be the innovation that will have the most significant impact of the health care industry going forward?" my response was "that of 'AI' or 'IA' (artificial intelligence / intelligence augmentation)." See my prior posts on the topic.

It's somewhat of a close call, But, overall, with respect to the "health care industry" writ large, that would be my view.

Below, at #HITsm, Chuck Workflow Man Webster, commenting while doing a Periscope live stream.

INTEROPERABILITY

Shlepped down to the rear of Level 1 to area 11954.

Sequoia Project presentation.

"In 2012, The Sequoia Project, previously Healtheway, was chartered as a non-profit 501(c)(3) to advance the implementation of secure, interoperable nationwide health information exchange. The Office of the National Coordinator for Health Information Technology, part of the US Department of Health and Human Services, transitioned management of its eHealth Exchange to The Sequoia Project for maintenance. Since 2012, the Exchange has grown to become the largest health information exchange network in the country. In 2014, we began to support additional interoperability initiatives beginning with Carequality.

We have assembled, through these initiatives, and our engagement with government and industry, experts who can identify the barriers to interoperability and pioneer processes to make health information exchange work on a national level. We are a neutral body, inclusive of diverse participants, which allows us to create practical solutions to data exchange problems. As a nonprofit operating in the public interest, our governance process insures transparent oversight of this work.

Our vision is to make the right health information accessible at the right place and time to improve the health and welfare of all Americans."

Yeah. Good a time as any to review some of Fred Trotter's 2011 book "Hacking Healthcare."

Chapter 11. Interoperability

The first thing to keep in mind when thinking about interoperability is not a particular standard or technology, but motivations for instituting data exchange. Widescale interoperability has been technically possible for more than 20 years, and major hospitals have had data worth exchanging for at least that long. But as with EHRs, exchanging health data has stalled due to conflicting and backward incentives.

Historically (with a few notable exceptions) most healthcare institutions have found little motivation for interoperability. There is a lot of motivation to profess interest in healthcare interoperability, which costs nothing. This creates confusion among those outside the healthcare industry. For example, if the hospital CEO says that interoperability is “critical,” why is there no health data being exchanged?

For most clinics and hospitals, making patient data portable makes the patient portable. Why would anyone invest in a technology that makes it easier for patients to migrate to competitors? For any healthcare provider, a patient represents a financial asset that is expensive to replace. And the easy exchange of records lowers one of the main barriers to patients leaving— information about their medical histories. For centuries, a doctor-patient relationship was something very difficult to replicate. Patients understood that their current doctor was familiar with their health story, and moving would mean losing that familiarity. In a world without portable healthcare records, that relationship is priceless to the patient and difficult to rebuild. Changing doctors will still be hard, even when the health record is movable, but it will become a tractable problem.

Similarly, health IT vendors lack motivation to properly support interoperability standards. If the data for a single patient can easily be exported from an EHR, then the data for every patient can also be exported easily. True interoperability means that it is much simpler for one EHR to replace another, and therefore one EHR vendor to be replaced by another. As it stands, without widespread interoperability, it is almost impossible to migrate from one EHR to another. Again, interoperability will not make migration between EHR systems easy, but it will make it possible. EHR vendors know this, and have a similarly mixed motivation regarding interoperability. Most EHR vendors claim that they are interoperable because they provide tools to migrate data into their EHR system. Generally, the motivation for interoperability drops for vendors substantially when they see that it creates a path away from the vendor.

Many EHR vendors charge extra for modules designed to export data, and this fee often becomes a kind of “severance pay” for EHR vendors. When purchasing an EHR, it is critical to request that any modules required for data exchange be included in up-front pricing. Neglecting this often ensures that you have to pay your vendor for the privilege of firing them...

Trotter, Fred; Uhlman, David (2011-10-07). Hacking Healthcare (pp. 167-168). OReilly Media - A. Kindle Edition.

That was five years ago. (I first reviewed Fred's book in March 2012). Are we still stuck largely with "Free Beer Tomorrow?" "Interoperababble?" (See all of my "Interoperababble" rants here.)

Or, are we on the cusp of a beneficent, "transformative" exponential Hockey Stick Function interop uptick?

One hopes.

"HOCKEY STICK?"

OK, quick analogy (of sorts). Say you're some penny-ante geezer who comes to Vegas in flip-up shades, Hawaiian shirt, cargo shorts, sandals, and black knee socks. You play the penny slots, and maybe bet a penny on an NBA game with your friend (absurd; bear with me). Your strategy? Double your bet if you lose to get your money back.

What would be the consequence of a 24-game losing streak? I quickly drop some stuff into an Excel sheet to illustrate.

After 12 losses you're only out about 41 bucks. No biggie. But, as you can see, the upslope really gets going thereafter. Hockey Stick neck really cranes up around loss #19. Hard to believe that final number. Don't take my word for it, screen-scrape and paste this exponential expression into Google: ".01*2^24="

Consider that the longest NBA team losing streak is 28 games (76'ers). Longest NFL losing streak, 26 games (Tampa Bay). Consider had you started out wagering not with a penny, but $100.

LOL.

I used to play street hoops in Vegas at a NW side city park with these low-life degenerate sports book gambler dudes (the ones who weren't in iterative jail repose at the time). This guy "Doc" explained his "double-down" M.O. to me. I thought, "yeah, bro', that's why you're habitually on the verge of being homeless."

So (flipping the analogy from losses to wins), in terms of significant interop progress, maybe we're getting close to the Hockey Stick neck.

One hopes.
___________

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
___

"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
___

"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
___

"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
___

"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
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"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
___

"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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Thursday, March 3, 2016

#HIMSS16 Day 3

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