Looking back, taking stock

The REC Blog is nearly 4 years old. A labor of love. The name will soon be changing.

I just screen-scraped my "Blog Archive" links column to take a quick look back. It's about 2 books worth of content. Dang. One of my REC colleagues once asked "dude, when do you sleep?" 

I hope I've added some value to the #Health IT and #healthcare ferment. Sometimes, the more I study, the more I'm aware of how little I know. There is just so much to learn.

Eyeballs deep in several books these days. Working on finishing my own book. Working on some other stuff I'm not prepared to announce just yet. Woodshedding my guitar with a vengeance. That is great fun.

Itching to actually build some stuff, too. Been a "knowledge worker" for my entire white collar career. Building some physical products would be a nice change. I have several ideas.

Loving just living, too, being back with my amazing wife, my best friend of 40 years, after 5 difficult years of work separation. I am one lucky man.

Thanks to all of you that keep stopping by my little pro bono lone-wolf shop. Lots more to come.
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The Blog archive to date.

▼  2014 (34)
▼  March (11)

• Mapping EHR penetration, 2013
• Excellent new paper from Nuance
• Issues with Comparative Effectiveness Research
• Aye...
• 'An EHR should not be a federally-subsidized “hard...
• #HealthIT 2014?
• Chuck Webster's "Pragmatic Interoperability," cont...
• “Predictalytics”?
• "Transparency" games? Are heart surgeons cherry-pi...
• "Your smartphone will see you now"
• This is brilliant

▼  February (14)

• #HIMSS14 Day Four
• #HIMSS14 Day Three
• #HIMSS14 Day Two
• #HIMSS14 Day One. And, off we go...
• “We should not prescribe specific functionality fo...
• #HIMSS14 - Let's ROLL!
• ONC - REC Spin Cycle 101?
• ROI - Health IT Return On Investment 101
• Up next: #HIMSS14
• “In wellness, you don’t have to challenge the data...
• īˈkänəˌklast
• Meaningful Use 2013 review, ONC Working Group Stag...
• Health Affairs TeleHealth Conference
• KatrinaCare.gov update

▼  January (9)

• "There is no way to survive the coming rise in Med...
• "The SOTU is ____________________________."
• BREAKING: Nevada State Health Information Exchange...
• “When it comes to health, your zip code matters mo...
• Meaningful Use Stage 2 is off to a bumpy start
• Next up...
• The Society for Science Based Medicine
• Meaningful Use Stage 2 now fully underway
• Happy New Year to everyone in Health IT

▼  2013 (127)
▼  December (10)

• Holiday respite
• ICD-10: W6142XA, Struck by turkey, initial encount...
• More #IHI25Forum
• A sad anniversary
• #IHI25Forum Updates
• #IHI25Forum Monday Dec 9th
• #IHI25Forum Day One - Preconference
• Off to #IHI25Forum
• Philosophia sana in ars medica sana
• December 2013: a busy month ahead

▼  November (13)

• A Thanksgiving weekend blogging respite
• Buckshot: the continuing randomness of U.S. health...
• "He never met a vegetable he didn't hate"
• Let's Go Nuts!
• Healthcare "Big Data" will not be a panacea
• NYeC 2013 Digital Health Conference Day Two
• NYeC 2013 Digital Health Conference Day One
• Off to the Big Apple
• One in Three
• Next up: the NYeC Annual Digital Health Conference...
• The ASC X12 834 005010X220/005010X220A1 Lonesome H...
• HealthCare.gov: Nobody Got The 2010 PPACA Memo?
• (404)^n, the upshot of dirty data

▼  October (11)

• KatrinaCare?
• HealthCare.gov in the Congressional crosshairs
• DATA: Meaningful Use Attestation and 2014 CEHRT up...
• Federal default averted for now, time to fix the H...
• Shower the people
• Cusp of Convergence?
• ObamaCare HIX: let the Sticker Shock and Benefits ...
• Farzad's next chapter
• Health 2.0 2013 final day
• Health 2.0 2013, Day Two
• Health 2.0 2013 Day One. Lights, cameras, action!

▼  September (8)

• Health 2.0 EDU Day
• Amid the increasing din of negativity, a Singular ...
• HIPAA Omnibus: no more excuses, compliance date is...
• Back online in California
• 12 years ago today
• Headlines and deadlines
• California, here I come...
• Meaningful Use payments update through July

▼  August (10)

• "Medical High School"? What?
• Health IT down the drain
• Are you ready to board the Omnibus?
• HIX Update: here come the Oscars
• "Start Spreading The News..."
• Meaningful Use to become a "political football"?
• The future of the PPACA explained in one small jpe...
• ONC Chief Dr. Mostashari calls it quits
• The "Do Nothing Congress" heads home for six weeks...
• 54 Days and counting. Time to get on the Omnibus

▼  July (10)

• Meaningful Use Payments Update
• An EPIC Tale. Portending an EPIC Fail?
• Delay Stage 2?
• "20%" MU dropout rate? "17% dropout rate"?
• "RECs are well positioned to continue to assist pr...
• The Progress Principle and Meaningful "Use"
• Whither/"Wither" Meaningful Use?
• Happy Birthday, America
• Summer reading list
• July 1st, always a sad day

▼  June (8)

• Bad news for the Meaningful Use initiative
• Hiatus, briefly
• " It's not one-size-fits-all"
• Whither?
• SPC for Lean Newbies
• "Data flowing at the speed of trust"?
• Lean Healthcare Transformation Summit 2013
• Speaking of "Health Information Technology"...

▼  May (15)

• Massachusetts Law 2012.224.108
• If I knew then what I know now... pondering the Na...
• "If I knew then what I know now, what would I do ...
• How Fragile We Are
• Courage
• California State HIT Day
• Refactored Day 2
• "Refactored" - a jam-packed two days in Mountain V...
• Happy Mother's Day
• The Red
• "Transforming" Health Care?
• Reporting from Reindeer Mountain
• Health 2.0 Refactored 2013
• REC progress data release update from ONC
• Home again

▼  April (11)

• The fundamental problem facing health care policy
• Sweet
• "What happens when an eligible provider or eligibl...
• "REBOOT" report, continued
• Meaningful Use news update
• Aghast
• A new Day. BobbyG's REC campaign is moving to KHIT...
• Meaningful Use attestations thus far by vendor
• LYBBAVERSE: Repost by request
• Weekend update
• Blood on the tracks in Reno

▼  March (12)

• Hello from Walnut Creek
• HIT, meet HIX
• Figliozzi strikes again
• Health data flowing "at the speed of trust"
• HIE - "Bank" on it?
• "BOOM!"
• HIMSS13 Thursday March 7th
• HIMSS13 Wednesday March 6th
• HIMSS13 Tuesday March 5th
• Monday at HIMSS13
• WHAT? "Boil Water order" for NOLA?
• Off to NOLA!

▼  February (10)

• Austerity
• Obesity
• Countdown to HIMSS13 in NOLA
• #EHRbacklash?
• "Interoperability" - soon to be the #1 cliche of t...
• Flow, meet ebb?
• Cane toads and kudzu
• "The stage 1 criteria were theory-based. Stage 3 n...
• The REC Cafe du Monde Caucus in NOLA at HIMSS13
• Clinical workflow

▼  January (9)

• Hats off to Qualis' WIREC
• Meaningless Auditing of Meaningful Use
• Update from Walnut Creek
• HIPAA Omnibus Final Rule FINALLY released
• HIMSS13 New Orleans: March 3 - 7!
• Wiki Doc Resource: "The Living Textbook of Medicin...
• ARCH-IT website launched
• The Curious Case of the Missing Final Rule
• A 2013 Happy New Year to the HIT sector

▼  2012 (85)
▼  December (8)

• From the REC Blog, adieu 2012
• December 22nd updates
• Grief
• Ready, [bleep], Triple AIM!
• #ONC2012 #HealthIT #RegionalExtensionCenters
• G-A-T-C, meet SCOTUS
• December 7th, 71 years ago
• O HIPAA, Where Art Thou?

▼  November (9)

• HIT and the "Fiscal Cliff"
• Happy Thanksgiving to all
• RECs: don't get run over; you won't make the local...
• HealthInsight REC retreat
• "Big Data"? How about REALLY Big Data? "Personaliz...
• SERIOUSLY?
• Congratulations, President Obama
• The Future of Health IT
• "Obama Administration Sits on Key Regulations"?

▼  October (13)

• In the Federal Register Oct 31st: yet another heat...
• Fred Trotter at Strata Rx 2012
• Hurricane Sandy
• REC Blog post number 1100111
• Stayin' with the numbers: REC Brew 102
• REC Blog Milepost 101
• REC blog post 100
• Health 2.0 SF Final Day: From DC to VC
• Day 2 Health 2.0
• Day One Health 2.0, full on
• Sunday registration and pre-conference events
• Up next...
• Time for procrastinating is over, folks

▼  September (10)

• Au revoir, FY 2012. Bonjour FY2013
• Time to play nice
• The 2014 CEHRT 3rd Wave
• Weekend Updates
• "Savings promised by the government and vendors of...
• “Federal funding of IT was a step in the right dir...
• A sad anniversary
• Draft 2014 CEHRT Certification Testing Stds Issued...
• 45 CFR 164.308 and HIT vendors
• One month to go before risking missing the 2012 At...

▼  August (5)

• Single Source of Truth
• Stage 2 Final Rule and 2014 CEHRT Final Rule
• 2012 Meaningful Use Year One Attestation deadline ...
• Dog Days errata
• M&M's...?

▼  July (6)

• MCC Hammer
• Post MU incubation
• "The Health Care Handbook" considered
• Analytics - SAS, R, SQL, EHR database schema. An o...
• Primary care: renewal or exodus?
• A sad anniversary for me

▼  June (6)

• PPACA Upheld
• Tick, tick, tick...
• The Association of Regional Centers for Health Inf...
• ObamaScare Section 5405
• "Pruh-SEE-jer"
• Tangent: PPACA at the precipice

▼  May (4)

• 45.CFR.164.3, 45.CFR.164.5, and 42.CFR.2
• Two Years on...
• My first guest cross-post: "Personalized Preventio...
• Let a Thousand Flowers Bloom

▼  April (6)

• Policies and Procedures
• Just in case you thought OCR wasn't serious
• Oink
• Barriers and Brickbats and Opportunities
• Attestation money thus far
• The Imminent Storm?

▼  March (6)

• Three days of PPACA Orals
• The Jennings Moot Court tees up the PPACA
• PPACA Orals at SCOTUS, March 26-28
• Yet another federal public comment period announce...
• MU Stage 2 and 2014 CEHRT Public Comment Period th...
• Two years on...

▼  February (8)

• HIMSS 2012 reflections
• HIMSS 2012 Final Day
• Stage 2 and CEHRT 2014 announcements
• HIMSS 2012 Day 2
• HIMSS Day 1 quick random photo essay
• Welcome to Las Vegas, HIMSS12
• Greed? Ego?
• Back down in the Weeds'

▼  January (4)

• Oops
• Down in the Weeds'
• Shovel Ready
• 2012: ruminating on the year ahead in HIT

▼  2011 (32)
▼  December (3)

• The twisty politics of HIT
• Facts © ™ ®
• Meaningful Use Reimbursements Update

▼  November (2)

• So many topics and issues, so little time
• Blog Hiatus for a bit

▼  October (6)

• ACOs? "Another Crock of, uh, Government"?
• Telemetry (and other stuff)
• 2011 Nevada Health Care Forum, Oct 11th
• IF AIR TRAVEL WORKED LIKE HEALTH CARE
• My heart goes out to Steve Jobs' family and friend...
• National Health IT Hype Week, Sept 27th

▼  September (4)

• The only person who enjoys change is a baby with a...
• National Health IT Week, Sept 12 - 16
• September 11, 2001
• Another "Use Case"

▼  August (2)

• Talk Dirty to Me
• 2011 ONC Regional Conference in Hollywood
• ▼  July (2)
• What does "obtain consent" mean with respect to HI...
• Nevada HIE kickoff event

▼  June (3)

• Meaningful Manual Labor
• Use Case
• Meaningful Use ePHI Privacy and Security complianc...

▼  May (4)

• Meaningful Use, or meaningless "hoopla"?
• Health Policy Research: a promising new resource
• A year of REC blogging
• Athena Health CEO Jonathan Bush on the RECs

▼  April (2)

• Meaningful Use Attestation Day One, April 18th
• Springtime for Meaningful Use

▼  March (1)

• The Ides of our forced REC March

▼  February (2)

• Poof! Where did THAT year just go?
• Bottlenecks, bugs, barriers...

▼  January (1)

• 2011, Meaningful Use Stage I, Year I Showtime. Opp...

▼  2010 (6)
▼  December (1)

• My Excellent Adventure into the Mecca of Quality

▼  November (2)

• First, Do No "Hold Harmless"
• November 2010 updates

▼  October (1)

• Mulligan: 7.5 months into my REC adventure

▼  July (1)

• Game ON - Meaningful Use Final Rule issued

▼  May (1)

• Opportunity for collaboration? ASQ and the RECs

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More to come...

#HIMSS14 Day One. And, off we go...

Above: HIMSS Board Chair Scott MacLean opens up the 2014 event

Above, the Mayor welcomes HIMSS14

Above and below, Aetna CEO Mark Bertolini opens HIMSS14 with his Keynote address

Sitting in the Media health IT Leadership Survey brunch and panel discussion at the moment. In sum, CIOs are worried about financial sustainability, and finding competent IT staff. Most report having already done Meaningful Use Stage 1 attestations.

EXHIBIT HALL OPENS

A quick random ramble. All the Big Players are in place, as usual.

Everyone's getting into healthcare:
You want a 3/8th cordless drill with that CABG px?

"Strategic Interoperability"?

I put in to win this guitar at the Peer 60 booth. My wife will kill me,
I have axes and amps all over the house, and a P.A.
and stage lights piled up in the garage.

Below: in addition to the Big Dawgs, HIMSS14 features a
Startup Showcase competition.

BTW: Links to my coverage of HIMSS13 and HIMSS12. While I can and do write dense copy with the best of them, I love doing "photojournalism" as well. I do this mostly for the vast majority of people unable to attend in person. Try to convey a sense of what it's like to attend. I did a lot of that in Vegas covering my many friends in the music industry there.

I attended a 4 pm HIMSS policy briefly featuring Tom Leary, HIMSS VP of Government Relations. It was interesting. HIMSS' Beltway lobb... -- uh -- "advocacy" operation is very astute and energetic. Seems to me that the legislative and regulatory interests of the Health IT space are quite well represented on the Hill and amid the agencies.

Your Daily Downer

"Patient matching is the healthcare cousin of NSA surveillance." - Adrian Gropper

Really?
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More to come, as always...

HIMSS13 Tuesday March 5th

Dr. Eric Topol's morning Keynote was "off the hook." I hope they publish it to YouTube. An inspiring man. He is all over the cutting edge, and a serious critic of the status quo. I wrote about his new book last year while reporting on the last day of HIMSS12 (scroll down).

He had all the cool toys. Right down to ICU telemetry-capable.

Dr. Topol on YouTube recently

He posed the rhetorical question this morning "why go to the hospital, when you can do all of this from the comfort and convenience of your own home?"

Well, yeah, but how do we pay for the hospital to be there when we really need it?

QUICK POST-KEYNOTE AMBLE THROUGH THE EXHIBITS

Interesting.

Epic looks like they have the most real estate at HIMSS13.

Nice that IHC is here. HealthInsight has long had a lot of interaction with them.

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A SHOUT-OUT TO LOUISIANA HEALTH CARE QUALITY FORUM

Had a nice chat with Nadine Robin, Health IT Program Manager for the Louisiana Health Care Quality Forum. Her organization is both the REC and HIE for Louisiana. She has a great story to tell. I asked if she might like to do a guest post to tell it in the way she'd like to have it told. Hope she takes me up on the offer. Delightful person.

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"THE OPERATOR"

Dr. Topol flashed a quick slide and made a passing remark about a recent article about Dr. Oz:

Is the most trusted doctor in America doing more harm than good?
Michael  Specter, The New Yorker, February 4th, 2013

Oprah Winfrey first referred to Mehmet Oz as “America’s doctor” in 2004, during one of his earliest appearances on her television show. The label stuck. Oz was a rare find: so eloquent and telegenic that people are often surprised to learn that he is a highly credentialled member of the medical establishment. Oz graduated from Harvard University in 1982. Four years later, he received joint medical and M.B.A. degrees from the University of Pennsylvania. He then moved to Columbia and New York-Presbyterian Hospital, where, as a surgeon specializing in heart transplants, he has served as vice-chairman and professor in the department of surgery for more than twenty years. (He still performs operations there each Thursday.) Oz also directs Columbia’s Cardiovascular Institute and Integrative Medicine Program, which he established in 1994, and has published scores of articles on technical issues, such as how to preserve muscle tissue during mitral-valve replacements. He holds a patent on a solution that can preserve organs and one on an aortic valve that can be implanted without highly invasive open-heart surgery.

By 2009, after dozens of appearances on “Oprah,” Oz had become so popular that Winfrey offered him his own show, produced by her company, Harpo. “The Dr. Oz Show” has since won two Emmys and averages nearly four million daily viewers. Certainly, no American physician has greater influence over a larger number of people. Oz has been named one of Esquire’s 75 Most Influential People of the 21st Century, as “the most important and most accomplished celebrity doctor in history.” He ranks consistently in the top ten on the Forbes list of most influential celebrities, and has been included on a similar list of Harvard University alumni. In 2008, Oz received the Ellis Island Medal of Honor...

Oz’s popularity isn’t hard to understand: he speaks to Americans about problems that many find impossible to share, and he talks to them in ways that few other physicians would. Want to know how many orgasms you will require each year to prolong your life? Oz says two hundred—give or take. He also suggests how often we should move our bowels and what they ought to look like when we do (at least every other day, brown with a hint of gold, shaped like an S, he says, and “it should hit the water like a diver from Acapulco”). Oz likes to be in the news; he was on the air with students from the Sandy Hook Elementary School, in Newtown, Connecticut, three days after the shootings there. And you never know who his guests will be. Not long ago, Michelle Obama appeared on the show to talk about her effort to end the epidemic of childhood obesity. A few weeks later, Oz welcomed back Theresa Caputo, a Long Island-based medium who helps people commune with dead family members. “The last time she was here,” Oz told the audience, “her readings blew me away.”

“The Dr. Oz Show” frequently focusses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like “startling,” “breakthrough,” “radical,” “revolutionary,” and “miracle.” There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. Last year, Oz broadcast a show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay-reparation therapy, had recanted. (Spitzer last year apologized to “any gay person who wasted time and energy” on what he conceded were “unproven claims.”) Oz introduced a show on the safety of genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” He also broadcast an episode on whether the apple juice consumed daily by millions of American children contains dangerous levels of arsenic. “Some of the best-known brands in America have arsenic in their apple juice,” he said at the outset, “and today we are naming names.” In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show. Last year, almost as soon as that G.M.O. report was published, in France, it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

Addressing such issues, however, is part of what Oz describes as “the undiscussed conversation—the one we need to have but don’t.” He describes modern medicine as a “civil war” waged between conventional physicians and those who are open to alternative cures for maladies ranging from anxiety to cancer; he considers it his mission to walk the line that divides them. But more often his show seems to erase that line completely, with results that may be less benign than Oz and his many viewers realize. “I want no more barriers between patient and medicine,” he explained to me not long ago, as we sat in one of the show’s production offices, just outside NBC’s Studio 6A, in Rockefeller Center. “I would take us all back a thousand years, when our ancestors lived in small villages and there was always a healer in that village—and his job wasn’t to give you heart surgery or medication but to help find a safe place for conversation.”

Oz went on, “Western medicine has a firm belief that studying human beings is like studying bacteria in petri dishes. Doctors do not want questions from their patients; it’s easier to tell them what to do than to listen to what they say. But people are on a serpentine path through life, and that is the way it is supposed to be. All I am trying to do is put a couple of road signs out there. I sit on that set every day, and that is what I am focussing on. The road signs.”...

This man (along with Dr. Andrew Weil) is fairly despised over at ScienceBasedmedicine.org. Read the entire New Yorker piece. Spend some time hanging at SBM. See what you think.

“My father is passionate about medicine, and he still goes to the hospital every day,” Oz told me the first time we met. “He thinks what I’m doing is very fringe and he’s worried about me. He keeps asking me when I will be done playing around with this stuff and settle back down to medicine.” On another occasion, Oz described his father’s reaction to his growing interest in alternative approaches to health care as “suicidal.”

Interesting. As is this:

“Mehmet is a kind of modern evangelist,” Eric Topol said when I called him at the Scripps Research Institute, where he is a professor of genomics and the director of the Translational Science Institute. Topol, one of the nation’s most prominent cardiologists, founded the medical school at the Cleveland Clinic and led its department of cardiovascular medicine. “He is keenly intelligent and charismatic,” Topol said. “Mehmet was always unique, but now he has morphed into a mega-brand. When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.”

He continued, “It all seems to be in the service of putting on a show. And, when you add it up, that seems like something other than medicine. It’s more like medutainment.”...

I would just caution all true Health IT enthusiasts to not lose sight of the goal: quantifiably improving health by adding timely, comprehensive, accurate, and relevant data to the physicians' arsenals. "Big Data" full of crap, "analyzed" by people having no business doing so, may well make matters worse.
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More to come...