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Tuesday, March 5, 2013

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...

Monday, March 4, 2013

Monday at HIMSS13

I need to plan to leave a lot earlier. Inbound I-10 traffic is extremely heavy. Still, I made it to the morning keynote. Nice welcoming speech by Mayor Mitch.

A couple of shots.

 



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More to come... It will no doubt be a long day extolling Innovative Collaboration for Healthcare Transformation.

Meanwhile, the cynicism is running as thick as the NOLA sewage system over on THCB comments under the Millenson piece.

UPDATE
For Stage 2 MU, don't assume vendors have you covered
March 04, 2013 | Diana Manos, Healthcare IT News


A packed house at the Meaningful Use Symposium held March 3 at the 2013 HIMSS Annual Conference & Exhibition couldn't help but inspire awe and possibly conjure a little concern in the hearts of those attending.

How could an incentive program, issued just a few short years ago, have as many nuances and intricacies as federal tax code? Yet that's what came to mind as extremely adept speaker Robin Raiford, research director on meaningful use for the Advisory Board Company, disseminated rapid-fire information at rapt attendees of her section of the symposium, titled "Meaningful Use Stage 2–Ready or Not, Here it Comes!"

One of her messages was, "don't procrastinate," deadlines are looming. This was closely followed by "talk to your vendors." Don't just assume your vendor is preparing you for compliance with Stage 2, Raiford said. Get the checklists, ask questions, be closely involved, lest you are caught unaware...
And, also be aware that there will likely be no Regional Extension Centers around to help, unless you're prepared to pay market consulting rates for those few that "survive" into "sustainable" offspring.

All of which assumes that the MU incentive monies survive further 2013 budget cutting.
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COUPLE MORE SHOTS



The joint is jumpin'. Went to a very interesting "Congressional Affairs Roundtable." More on that later. Took a lot of notes. Very well attended. The Q&A ran well over. There were a lot of good comments / questions, along with a couple of lame tinfoil hat ones -- my fav was some dude's angry whine that the CMS Meaningful Use audits were "Red State / Blue State," i.e., that they were "partisan," punishing docs in the states that went GOP in 2012.

That was pretty stupid.

The exhibit halls just opened. Time to shlep around and see all the new whiz-bang. Release the hounds...

As far as you could see...

Above: Travis Broome of CMS. This was, out the entirety of the 10-tera-kazllion square feet of HIMSS13 exhibition floor space, the total ONC footprint. Wasn't even labeled "ONC." I walked two ZIP codes to get to this. Travis was congenial. Obviously thrilled to see me.


Above: Hey, EPIC shareholders, this is what some of your money paid for.

I'm seein' a Bubble here. Dot.com 3.0

BTW: "Boil Water" remains in effect. Shhhh....h.h...h..h..h...

CODA: ICD-10

Cutting right across the first year of Meaningful Use Stage 2. CMS Link here.


Should be lovely.
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More to come...

Sunday, March 3, 2013

WHAT? "Boil Water order" for NOLA?

OK, I'm here in the press room at HIMSS13, about 10:30 a.m., sitting in a cube and, just saw a tweet:
Boil water order issued for east bank of N.O. after water pressure drops


WWLTV.com

NEW ORLEANS - A precautionary boil water advisory has been issued for all of the east bank of Orleans Parish, after a loss of water pressure Sunday morning, city officials said.
"Sewerage & Water Board officials are still determining the cause of a loss of water pressure at the S&WB Power Plant," said a statement from the city, about two hours after initial reports of the problem from residents.

S&WB recommends that customers boil their water for one minute and let it cool down prior to consumption (including drinking, cooking, brushing teeth, bathing or preparing food).

"This boil water advisory will remain in effect until further notice for customers in the affected area. The Sewerage and Water Board will notify residents when the advisory is lifted." said the city's statement...
Uh, OK... I brushed thoroughly this morning...

Well, if we have to boil water, we might as well boil some crawdads while we're at it.

TRIP TO THE RESTROOM

Lovely.

What about, uh, washing your hands in the lav?

MOVING RIGHT ALONG

Michael L. Millenson is all over it. By way of Maggie Mahar:

The Health IT Scandal the NY Times Didn’t Cover

As health information technology honchos gather for the annual HIMSS trade show and schmoozefest, it’s a safe bet the industry “scandal” the New York Times placed on page one recently will breed more bored yawns than buzz. The real scandal in health IT involves the customers, not just the vendors, but that’s a topic for quiet conversations journalists can’t cover.

In case you missed it, the shocking news was that health IT companies that stood to profit from billions of dollars in federal subsidies to potential customers poured in ­– well, actually, poured in not that much money at all when you think about it ­– lobbying for passage of the HITECH Act in 2009. This, putatively, explains why electronic health records (EHRs) have thus far failed to dramatically improve quality and lower cost, with a secondary explanation from athenahealth CEO Jonathan Bush that everything would be much better if the HITECH rules had been written by Jonathan Bush of athenahealth...


Even those hospitals that adopted EHRs rarely bought, or bought and then didn’t turn on, clinical functions related to drug-drug interactions and infection prevention. “Computerized medical records” were used to better document all the small details of care that boosted payment in a fee-for-service world. Salt Lake City’s LDS Hospital used computerization to reduce the adverse drug reaction rate below the theoretical minimum of the Harvard Medical Practice Study and its innovation diffused precisely nowhere. One hindrance, some doctors whispered softly, was that infections resulted in more care, more revenue and more profit for the hospital...

Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; absurd flaws ­– a medical record less searchable than a ten-year-old PC – that were never corrected while piled-on new features created a kluge-job catastrophe.

Then there were the unintended consequences that occur when any innovation is taken to scale. Is it any surprise that academics focusing on efficiency and clinical improvement were blindsided by sharpies who focused, instead, on how EHRs could help game the reimbursement system to make more money?...


The problem with health IT isn’t the politicians and lobbyists, easy targets though they may be. It’s us, in health care. It’s the doctors, hospitals, vendors and researchers among us who are not held accountable when our behavior delays and distorts innovation, hurts patients, costs money and impugns our own industry’s credibility.
THCB has the post as well. The comments are interesting, as always.
 
HEALTH INNOVATION BROADCAST CONSORTIUM

Just ran into Dr. Salber and Gregg Masters. They're doing a cool thing here at HIMSS.

About
We’re an independent association of professional journalists, producers, bloggers and activists who have joined forces to organize and produce coverage of the HIMSS 2013 Conference and Exhibition. We’re laying the foundation to make HIBC.tv a sustainable, independent resource, so we appreciate your support. Founding members include Open Affairs Television, The Doctor Weighs In, ACOwatch (XanateMedia) and crowdfunders Medstartr and Health Tech Hatch. Coverage of the conference and the ‘innovation conversation’ begins on Sunday, March 3 2013 with “HIMSS’13 Highlights” and continues through the end of the conference Friday, March 8th, 2013.

A partial list of the experts we have secured include Pat Salber (@docweighsin), Gregg Masters (2healthguru), Nate DiNiro (@unclenate), Neil Versel (@nversel), Jane Sarasohn-Kahn (@healthythinker), Regina Holliday (@ReginaHolliday), Dave Chase (@ChaseDave), Matthew Holt (@boltyboy), Leah Carey (@thehealthmaven), and others to be announced as they come aboard. Our conservative estimates put potential targeted audience reach at over 250,000 daily viewers...
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WORKSHOP C:
BEST PRACTICE (METHODS AND TOOLS) FOR CLINICAL WORKFLOW ANALYSIS



OK off to Great Hall A. I think it's in a different ZIP code.





CODA: EVENING RECEPTION


Walter Wolfman Washington and his band. Lots more shots. Too tired to post tonight, though. Big day tomorrow.
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Up at 6...



Nice. A good day. The big stir starts today (Monday).

I'll have to have my cognates aligned so I can fully absorb all of the Seamless Sustainable Interoperability Solutions I'm gonna hear about. There will be a plethora of End-to-End Solutions that Span the Medical Device Connectivity and Clinical Informatics Spectrum.
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More to come...

Saturday, March 2, 2013

Off to NOLA!


See y'all there. Les se' Bon Ton' Roulet
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A FEW RANDOM SHOTS AFTER A LATE, BUMPY FLIGHT

Just enough time for a quick trip downtown and to the Quarter. It was cold!





Miss HIMSS13


George Harrison is alive, and gigging on Bourbon Street!





Excellent bass player. Vegas quality.
It was drunk out.

ERRATUM: BIG DATA

 Props to The Incidental Economist blog.
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More to come...