CMIOChat: 4th Thursday of Month at 7PM Eastern/4PM Pacific


@UConnHealth appoints Dirk Stanley, MD as First CMIO

by Gregg A. Masters, MPH

Dirk Stanley MD CMIO Uconn HealthA first at UConn Health aka @Uconnhealth, maybe first ‘win’ is to get Twitter handle on home page?

Per Healthcare IT News:

We are pleased to have Dr. Stanley on our team, given his high-level of experience and success in a similar role,” Jon Carroll, CIO at UConn Health said in a statement. “What he has accomplished, and experienced, in his eight years at Cooley Dickenson will be vital to us on our EMR journey.”

In his role as CMIO, Stanley will play an important role implementing the Epic EHR and also will head the health system’s Epic Physician Steering Committee.

Bravo to one of our founding members and supporters at #CMIOchat!

Blab the Blockchain: Healthcare Implications?

by Gregg A. Masters, MPH

 

Today, at 4PM Pacific/7PM Eastern we gather to deploy another innovative platform that enables collaboration via the Blab Beta platform.

For an overview of ‘Blockchain’ see: ‘Understand the Blockchain in Two Minutes‘.

Join your peers and colleagues as we dive into this distributed system of secure transactional accountability.

For full screen and social streams, click here.

 

 

The Identity Problem

by Nick van Terheyden, MD aka @DrNic1

Dr Nick Dell HealthI struggle to keep my contacts in order and synchronized, not just across devices but across ecosystems and channels. How do you keep your old style digitized version of the “rolodex” in sync with your twitter followers and LinkedIn connections? How do you know when your friends join a new social media channel that you are member of so you can connect there?

I’ve tried many tools and techniques and had been using Brewster (which recently was acquired by FullContact) and the transition offered me 3 months of premium access to their service. The free version offers backup and some syncing across limited accounts – the premium version expands to multiple accounts and includes business card scanning.

The early results were surprising – in my contact database the system was offering me updates to over 40% of my contacts. I was suspicious but as I investigated I discovered that using some clever back end algorithms it was revealing updates too many of my connections including some I validated manually that good friends revealed were early forays into social media including a blog on Ice Cream and a corresponding Pinterest account.

So in social media and the commercial world we can link data and people. In fact the commercial organizations do this very effectively that Target collected enough information on individuals linked through a unique identifier to identify a high school student was pregnant and mail her maternity adverts before the “news” had leaked to her father:

“Target assigns every customer a Guest ID number, tied to their credit card, name, or email address that becomes a bucket that stores a history of everything they’ve bought and any demographic information Target has collected from them or bought from other sources”

The healthcare system is rife with enough challenges – why is it we have one that is of our own making? Why is there so much resistance to the idea of uniquely identifying a patient so we can attach the correct medical data to the correct person and deliver the correct medical treatment to that same individual?cmiochat_ patientID

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law and it specifically called for:

“a standard unique health identifier for each individual”

But in 1998, Congress eliminated that requirement and even prohibited the use of federal funds to develop a unique identifier. Anyone who knows me will know my passion for privacy and individual rights but in this instance the harm and cost foisted on the system, providers, payers and ultimately the patients is gargantuan!

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Figure: The Percentage of Waste by country spent on Healthcare Administrative and Insurance

The Social Security number has become the de facto universal (and most valued) US national identifier. Created in 1935 for the purposes of tracking social security benefits it has been hijacked and subsumed into multiple other uses. The gathering and use of this placed a large target on the back of healthcare data and as of the end of last year over 112 Million healthcare records were breached.

As far back as 2009 HIMSS issued a Patient Identity Integrity White Paper making the case for identity management and in 2010 the recently retired Gartner Analyst and Research Director Barry Hieb and now Chief Scientist at Global Patient Identifiers wrote this piece in e-Journal of Health Informatics: A Cost Effective Method to Create a Universal Healthcare Identifier System (full PDF here) advocating the need and a path to the creation of a universal patient identifier:

“The prohibitive cost associated with creating a universal healthcare identifier has been one of the primary barriers to the creation of such a system. The Voluntary Universal Healthcare Identifier (VUHID) project takes a radically different approach to solving this problem compared to previous proposals. This article examines the economic impact of this approach and discusses why the unique VUHID approach permits implementation of the system at a small fraction of previously estimated costs”

Despite a rational approach that enabled individualized control and security it has not taken off. We continue to waste resources, duplicate tests, decrease the overall safety and increase errors in our healthcare system that according to the RAND study: Identity Crisis; An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System could offer a saving of $77 billion per year if implemented with sufficient penetration – they cite 90% level of adoption.

Have a I raised your heckles advocating for a unique identifier – is it as Adrian Gropper Chief Technology Officer for Patient Privacy Rights stated (@agropper):

“Implementing a unique patient identifier would add nothing to our health care system beyond coercive surveillance”

Or, as Twila Brase, RN, Co-founder and President of Citizens’ Council for Health Freedom, says its important not to have it to prevent the creation of a “nationalized” healthcare system (I’d interpret this as a single payer system like the VA and Medicare?):

“The most important reason is our opposition to building a national health care system. Without a national identification card for patients, it would be difficult to nationalize health care”

Or do you side with Douglas Fridsma, MD, PhD, is President and CEO of the American Medical Informatics Association who says people care a lot about the privacy and security of their medical data but want immediate access and transferability with control over who can see and use their medical data and believes that:

“Giving every American a unique patient ID could help address all of those issues”

Join me and your clinical informaticist colleagues this Thursday April 28 at 7pm Eastern/4PM Pacific for #CMIOChat.

Here are the topics we’ll be considering:

T1 Why does the US not have a Unique Patient Identifier?

T2 Is it possible we can come up with agree and use a Unique National Patient Identifier and if so how?

T3 What alternatives are practical and cost effective to a Unique patient identifier?

T4 How do we protect patient confidentiality and privacy in a world with a unique patient identifier?

 

HiMSS16: Separating the Wheat from the Chaff

by Dirk Stanley, MD MPH

Very happy to report that I’m back from HIMSS16 in Las Vegas this year, renewed and re-energized with new information!

Dirk Stanley MD MPH HiMSS13
Dirk Stanley MD MPH HiMSS 2013

What a great learning experience HIMSS always is – And not just at the conference! This year, I even learned a lot about what HIMSS really means when a non-healthcare, non-technology person sitting next to me in the plane asked me, curiously: “What is your conference all about? What can 40 thousand people possibly have to talk about for five days?”

For many healthcare technology and Informatics professionals, HIMSS is not only a great showcase of what’s going on in the industry, but it’s a great opportunity to connect with other people who are facing the same challenge : How to make technology work to successfully help improve patient careHIMSS16_home

In general terms, some technologies focus on improving clinical operations for the doctors, nurses, pharmacists, and other ancillary staff providing care on the front-line. Other technologies focus on harnessing quality data and analytics to streamline care and reduce costs, or connecting patients with their care and caregivers. And finally, some vendors are looking to improve all of these areas, together.

But when budgets are tight, and the clinical stakes are high, it can be very challenging to predict the success of a investment in a new technology or human capital. How exactly does one best do this? What factors should a health technology professional look for to know if the investment will be both helpful and cost-effective?

And so I’m very happy to report that in addition to the new technology and talent showcases, HIMSS also attracts a priceless group of real-world healthcare IT, Informatics, and patient care advocates and professionals who are faced with the same challenges, and asking the same questions.  Many of them can be found on Twitter following the #HealthIT and #HITsm hashtags.

So when I was trying to explain my purpose for attending HIMSS to this curious person sitting next to me on the plane to Vegas, it dawned upon me that one of my major reasons for going was not only to better understand the answers, but also to better understand the questions.

So now after returning from HIMSS16, I’m glad to say that I learned a tremendous amount from the vendor showcases, education sessions, and the after-hours conversations with these other HealthIT, Informatics, and patient engagement advocates. Together, they help me develop clarity through better questions about investments in technology and/or human capital. It’s that clarity and deeper understanding that helps to effectively separate the wheat from the chaff. After all, if at the end of the day, it doesn’t help improve patient care, provider satisfaction, or efficiency – or all three – why make the investment?

T1 : What factors do you consider in a technology to know if the investment will be helpful?

T2 : What factors do you consider in a vendor to know if the investment will be helpful?

T3 : What factors do you consider in human capital to know if the investment will be helpful?

T4 : What factors help you determine whether an organization will see a good return on investment from their investments in technology or human capital?

T5: What are your sources of research when exploring & vetting products, services & solutions? Why?

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Dirk Stanley, MD, MPH  is a board-certified hospitalist, informaticist, workflow designer, and former CMIO who lives in Northampton, MA. For more information, click here.

A HiMSS16 Primer

by Rasu Shresthra, MD, MBA 

 

rasu_headshot_cmiochatThe annual HIMSS conference is seen as the “Superbowl” of the Health IT industry. The conference brings together over 40,000 health IT professionals, clinicians, executives and vendors from around the world, hungry to learn from one another, with an appetite to connect, collaborate and learn. The conference is seen as an annual pilgrimage for many – a “must attend” event due primarily to the high value that can be attained in a condensed period of time. Whether this is your first HIMSS conference or whether you are a regular, the one hallmark of a successful conference is planning.

 

So let’s chat about what you may expect from #HIMSS16. And let’s together plan to make this a particularly meaningful one.

 HIMSS16_home

HIMSS promises to offer a showcase of cutting-edge health IT products and services, remarkable networking opportunities and world class educational content with an inspiring line up of sessions, talks, keynotes and workshops.

 

And then, there are the announcements and press releases, each trying to one up the other. The news of the demise of Meaningful Use may have been premature. This was sparked by a comment last month at the JP Morgan Conference made by a top CMS official (Andy Slavitt) when he said that “the meaningful use program as it has existed will now effectively be replaced by something better.” Will HIMSS16 attendees be able to get more clarity around what this “something better” really means for them? Or will we come back with an alphabet soup of questions on how MU will be integrated with PQRS (Physician Quality Reporting System) and MACRA (the Medicare Access and CHIP Reauthorization Act), which in turn will be based on the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs)?

 

Will we see large strides in vendors and providers scaling the interoperability mountain? What about patient engagement? Is cloud, analytics or information security going to be top of mind for most? Will there be interesting innovations around wearables, sensors, big data and the IoT?

 

Keynotes are always a big draw at HIMSS. The secretary of the U.S. Department of Health and Human Services, Sylvia Mathews Burwell, and Michael Dell, chairman and CEO of Dell, are both set to deliver keynote speeches at the HIMSS 2016 conference. Super Bowl Winning Quarterback & Five-Time NFL MVP Payton Manning will be coming in fresh off of a real SuperBowl 50 win and will be providing the closing keynote. I wonder if this will be a touchdown of a keynote!

 

Also featured, amongst many other things will be the HIMSS Interoperability Showcase, and the HX360 Innovation Pavilion. The Intelligent Health Pavilion is also always a big draw.

 

With all this and more, HIMSS16 promises to be busy. So let’s fire up your favorite Twitter application (TweetDeck, Tweetchat, Tweetchat.io) and let’s get chatting! Here are the topics:

 

T1:  Why are you attending #HIMSS16? What are your priorities for the conference?

T2:  What ONE thing are you most excited about for #HIMSS16?

T3:  Do you fear that we will be blinded by buzzwords? How do you separate the wheat from the chaff?

T4:  Population Health means many things to many people. What does this mean to you?

T5:  What tips do you have for fellow HIMSS attendees?

 

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Rasu Shrestha MD MBAChief Innovation Officer

UPMC & EVP UPMC Enterprises

#HiMSS16: The CMIO Then and Now

by Gregg A. Masters, MPH

I love this quote:

Leadership has always been a complex calculus and is specific to the domain/environment/population being led. – William F. Bria, MD, FCCP ‘The CMIO Survival Guide

So are we willing to be led? And by whom?

As we all know perhaps all too well, ‘healthcare is local‘, in fact hyper-local as the case often is, and not immune from indigenous geo-political and market structural considerations. Whether from a market dominance or top of mind share perspective, healthcare infrastructure carries a considerable amount of political currency – if not outright ideology driving the organization, governance and equity (business model) considerations of local operators. For instance, the State of Texas and it’s commitment to the preservation of independent physician practice is a stark contrast to the practice of Medicine (risk tolerance) in the State of Florida (no Corporate practice of medicine doctrine) or even California for that matter.

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Yet in the still emerging space of ‘applied medical informatics‘ whether informed purely by market or even organic forces, before factoring in the material incentives presented legislatively via ARRA/HITECH and it’s aftermath, the space has been in a constant state of dis-equilibrium if not sector chaos as we look for and settle on some market or industry homeostasis if you will.

This narrative has been developing for some time. In 2006 JAMA published: The CMIO—A New Leader for Health Systems wherein it posited physician:

leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined

IT and teh Executive Team (CMIO)
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While a tad dated, this perspective was further informed last year when HiMSS released its Annual Leadership Survey (see: ‘About‘ post for results). What this author found of interest then and perhaps still so today with the degree to which the CMIO role penetrated the C-suite culture particularly given the importance of the role as acknowledged by both references above. In 2015 the CMIO was considered part of the ‘executive team’ in only 39% of the sample.

While this is a static picture and therefore not instructive on the relative growth rate of this participation (and standing) in the health system enterprise, it none-the-less follows on the heels of the rise of the CIO as a full fledged member of the C-suite team. Here the evolution from DP Manager or Director (often seen as staff position with an overhead label) to the CIO of a materially staffed operation tasked (or co-tasked) with revenue, market share and business intelligence objectives may offer some insight.

In 2016 the CIO role is well established. Yet, can the same be said of the CMIO? For an excellent post by one of our founding colleagues Nick van Terheyden, MD (@DrNic1), see: ‘Process matters as much as technology, especially when treading new ground‘.

And ‘treading new ground’ is arguably a constant for our colleagues and the vendors who hope to engineer their enterprise success!

Follow the action from HiMSS 2016 via the hashtag #HiMSS16. The digital dashboard is here.

 

 

AMDIS 2015: A Look Back and Peek Forward?

by Gregg A. Masters, MPH

In this non-stop 24/7/365 tsunami of data overload, taking time to look back and see where we’ve been is often a rewarding if not grounding experience.AMDIS15

In June the Association of Medical Directors of Information Systems (AMDIS) met in the awesome surroundings of Ojai, California to consider their agenda for the year.

AMDIS describes itself as:

..the premier professional organization for physicians interested in and responsible for healthcare information technology.

AMDIS Members are the thought leaders, decision makers and opinion influencers dedicated to advancing the field of Applied Medical Informatics and thereby improving the practice of medicine.

With our symposia, blogs, on-line forum, journal, presentations, sponsored and co-sponsored programs, and networking opportunities, AMDIS truly is the home for the “connected” CMIO.

[Editor’s Note: AMDIS 2016 information and registration page is here.]

Here is a list of and access to symposium presentations from the June gathering, while a twitter transcript of the meeting is available here.

Always ground zero for clinical informatics innovation, best practices and real world experience beyond vendor marketing hype, AMDIS sessions are rich and current. Here are the titles and presenting faculty at the event:

As we continue down the merry path of HealthIT or tech fueled if not enabled accountable care or better yet the holy grail of the triple aim, may we continue to be mindful of the limits of technology to make up for tired if not mis-aligned business models in healthcare delivery today.

Bridging the volume to value gap is a complex task. Enterprises and health systems navigating a mid-flight transformation need operate in a sea of conflicting incentives. As one of our colleagues John Mattison, MD opines on occasion: ‘we get what we incent’.

Today we have toes in the ‘risk water’ via a complex mix and range of government and privately fueled change initiatives mostly codified in drawers of healthcare contracts and/or service agreement ranging from bundled payments to global (PMPM) capitation.

While some health plans or their host integrated delivery systems (IDNs) have been in the value space for quite some time, most remain in a production oriented fee-for-service operating mindset and culture.

Yet as Don Berwick opined some time ago, we’re in an ‘all hands on deck, full court press’ to meet the challenges of the triple aim. Clearly absent the tech central spine enabling many to act as one, we can not get there. So, let’s get on with and get this done!

 

 

 

Informatics Domain and Clinical Workflow

by Dirk Stanley, MD, MPH

After my last post, some people asked me if I could put it into a video form, to help share with other people.

I was able to condense it into this 7-minute, 23-second video below:

CMIOchat_dirk_imageFor anyone who has ever struggled to explain the Informatics domain, how it is related to clinical workflow development, and how it can help create smooth, predictable, reliable, and non-disruptive workflows – this is my offer.

Hope it was helpful! Leave your comments and feedback in the comments section below!

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Source of blog post and video originally posted here.

Author’s note: Need a CMIO, temporary CMIO, or physician informaticist? Need someone to help coach your new CMIO or CNIO? Or need someone to help analyze your workflow challenges? I am available for consulting! Feel free to email me at DlRKSTANLEY@GMAlL.COM or look me up on LinkedIn!

2nd CMIO Tweetchat

by Luis Saldana, MD

luis saldana headshotOur inaugural #CMIOchat was a great success, and thoroughly engaging with the skillful facilitation of Dr. Nick van Terhyden aka @DrNic1.  I have the distinct pleasure of facilitating the next #CMIOchat this Thursday October 22nd at 7 PM Eastern Time.

cmiochat_analytics1

So, the ICD-10 ‘GoLive’ date has come and gone without much ruckus, and the Stage 3 Meaningful Use Final Rules were released with a bit more fanfare, and certainly more to come.  So, how do these events impact the journey to the holy grail destination of interoperability.

I think we have all experienced the challenges associated with the current state of interoperability, or lack thereof, of various systems that support our health system.  We want to delve bit in our next #CMIOchat into this and related topics.  We would love to hear all perspectives on this topic and welcome anyone with interest in exploring and discussing this.

So here are the topics for Thursday evening’s Tweetchat.  I look forward to seeing you there,

Luis @lsaldanamd

T1. What are the challenges we encounter as patients and informaticists in the road to interoperability?  Are you optimistic that we will get to true interoperability?

T2. What would a truly inter-operable, unified patient medical record look like from a functionality, user interface and operational perspective?

T3.  How would such a unified medical record support patient engagement or activation, or facilitate self management of one’s own health?

T4.  How would physicians and other clinicians engage with the data from such a record to enable both personalized medicine and population health?

 

CMIOchat Thursday September 24th 2015

by Gregg A. Masters, MPH

We’ve been baking this idea for a while, and at long last here it is!

CMIOchatThe inaugural chat is moderated by social media savvy and clinical informatics thought leader Nick van Terheyden, MD Dell Health and Life Sciences (@DellHealth) Chief Medical Officer aka @DrNic1 on twitter.

For a list of founder members of CMIOchat, click here, and the ‘why’ question is answered here. For context on the chat, checkout ‘Process matters as much as technology, especially when treading new ground‘ proffered by @DrNic1.

The hashtag is #CMIOchat and you have several ways of participating Thursday, September 24th, 2015 at 7PM Eastern/4PM Pacific Time.

Simply find your way to our home page here, or check out the TweetChat room here, or the Twubs page here (enter #CMIOchat). In the later two instances, you need be logged into your twitter account to access the ‘rooms’.

The value of Tweetchat or Twubs participation is you can pause and resume the #CMIOchat tweetstream.

Of course you can also follow on your smart phone, tablet or even Tweetdeck via the hashtag.

The theme is ‘Emerging Technologies’ and the topics to be parsed to the community are as follows:

T1: What technology is critical for near-term and future clinical and financial success? (Analytics? Telehealth? Mobile Apps? Social media listening?)

T2: What factors to consider in prioritizing tech adoption: Impact? Cost? Effectiveness? Ease of adoption? Current tech platform?

T3: How do you ensure that the IT department prepares for future technology?

T4: What ancillary factors should be considered when adopting technology? (Training, support, physician leadership, integration of data, etc.)

The process will begin with a round of introductions, followed by each topic and it’s discussion.

We’ll run for 60 minutes and hopefully engage the health data and clinical informatics community is key issues many of us are  grappling with on a daily basis.

Cheers!