As Records Go Digital, Cultures Clash - Part 2

At "As Records Go Digital, Cultures Clash, Bringing to Life Secrets the Health IT Companies Don't Want You to Know" I wrote of the used-car nature of the healthcare IT market, where lemon laws do not seem to exist and "physician buyer beware" seems a defining characteristic.The Huffington Post Investigative Fund now has a report of their own on this phenomenon:Shopping for Health Software, Some Doctors Get Buyer�s RemorseBy Emma SchwartzHuffington Post Investigative FundJan. 29, 2010Computerizing American medical records within five years is a key goal of federal health policymakers, but disputes between some doctors and their technology vendors highlight the many challenges for individual medical practices making the conversion.Bankrupt vendors leaving orphan software and inaccessible data,...

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A Fire Burning

Its official, I just had my first shoot for A Fire Burning, my new film about my comeback into whitewater kayaking, and training for the 2011 World Freestyle Kayak Championships.It was a little weird at first filming myself, but after awhile I got into it and feel like I am talking directly to the viewer. Being the camera operator and the subject adds a whole new twist and I think I like it. I think it will make the film a lot more intimate and I think the viewer is going to get sucked in and involved. Plus it was fun, which is my main goal.We are having our first pre-production meeting on Monday and begin the official shoot 10 Feb up on the...

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What Happens When "We'll Manage it the Way We Damn Well Want"

Back in the early days of Health Care Renewal (2005, to be exact), we first wrote about some very strange actions by the management of Phoebe Putney Health System.  At first, we noted that the Phoebe Putney responded to a reporter's inquiry about lavish travel expenses pertaining to the system's Cayman Islands health insurance subsidiary by saying, "We own it. We'll manage it the way we damn well want."Then the story got far more convoluted.  In 2006, we wrote about the over the top response to anonymous faxes challenged hospital management's commitment to the institution's mission.  The system CEO compared the fax senders to "terrorists."  After the local district attorney handed over his investigative records to hospital system private investigators, the...

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Why The Apple iPad Will Not Revolutionize, Change the Game, Transform or Create New Paradigms in Medicine Anytime Soon

The announcement of the Apple iPad has been accompanied by the usual irrationally exuberant, buzzword-laden statements and bellicose grandiosity from the IT punditry about how it will "revolutionize" or "transform" medicine.However, this will not occur anytime soon, for in medicine, the device may help solve a portability and visibility problem (compared to PDA's), but it will not solve this problem: the mission hostile user experience.The solution to that problem will require significant human magic.--...

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The iPad and Healthcare

Several folks have asked - will the iPad revolutionize healthcare?The answer is Yes and No.My ideal clinical device is*Less than a pound and fits in white coat pocket*Has a battery life of 8-12 hours (a full shift)*Can be dropped without major damage*Has a built in full keyboard, voice recognition, or very robust touch screen input*Provides a platform for a variety of healthcare applications hosted on the device or in the cloudNetbooks and laptops are too heavy, too large, and do not meet my battery life requirements.The iPhone is too small for reliable data entry.The Kindle is a great device but not a flexible application platform.The iPad...

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Food Allergy Molecule Discovered

So why do some people have an allergic response to something like peanuts and milk, while others have no such response. Researchers are a step closer to answering that question. In a recent study led by Yong-Jun Liu, M.D., Ph.D., at the University of Texas M.D. Anderson Cancer Center, Houston, scientists singled out the molecule that specifically directs immune cells to develop the capability to produce an allergic response. It's called thymic stromal lymphopoietin (TSLP), and these researchers believe it is the key to why food allergies develop in some people. Information from this study may allow scientists to target this molecule in their efforts to treat and cure food allergy. Here's the abstract for those with a scientific brain.This research is being conducted with a grant through the...

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More California Medical Centers Plagued by Quality Problems While Their Executives Get Bonuses for "Improved Patient Care"

Earlier this week, we noted that while executives at one University of California medical center were getting large bonuses supposedly for "improved patient health," the hospital was being cited for serious health care quality deficiencies.  Now, more stories have appeared that raise questions about the rationale for the generous bonuses handed out to multiple top hospital executives at University of California hospitals.  University of California - San DiegoFirst, in alphabetical order by city, the San Diego Union-Tribune reported on penalties for poor quality care announced by the California Department of Public Health: UCSD Medical Center in San Diego was fined $50,000.... The state said the hospital staff failed to follow its surgical policies and procedures, which resulted in...

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Vegan Pizza

At home, our vegan cooking is based on seasonally fresh fruits and vegetables, homemade tofu, and the basic idea that every ingredient should be savored for its special qualities.Our vegan pizzas are freshly baked crusts topped with pesto, tomatoes, broccoli, and mushrooms.Recently, we discovered a remarkable Vegan Pizza restaurant close to Boston - Peace O'Pie, Gourmet Vegan Pizza in Allston.This is not a pizza joint with a veggie pizza. It's an entirely Vegan restaurant owned and operated by vegans. Fresh, organic produce is the core of every Pizza. There are no refined sugars. Even the whole wheat crust and pizza sauce are organic.We...

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A Privacy Breach

Today, Beth Israel Deaconess and UCSF issued press releases about a complex situation. Over a year ago, an employee of BIDMC who had authorized access to data for quality improvement activities placed clinical data (not financial or social security number data) for approximately 2,900 patients on a thumb drive. The employee left BIDMC and went to work in California for UCSF. While at UCSF, the employee copied the thumb drive to a UCSF owned laptop in order to demonstrate quality improvement reporting. The laptop was stolen, then recovered. There is no evidence that the data on the laptop was accessed. BIDMC takes this situation very seriously and notified the patients, Health and Human Services, and the media. As with other challenging situations I've discussed such as the CareGroup...

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The Grant Programs from ONC

How do you spend $2 billion dollars wisely and quickly on Healthcare IT?Here's ONC's complete grant funding planRegional extension centers (RECs) $643 millionHealth Information Exchange $564 millionWorkforce Training Programs $118 millionBeacon Communities $235 millionStrategic Health Advanced Research Projects (SHARP) $60 millionNationwide Health Information Network/Standards and Certification $64.3 million (details are pending)These are the major initiative but there are are other smaller contracts and projects, hence the total above is less than $2 billion.Regional extension center and Health Information Exchange funding will be announced before the end of January.Beacon Community applications are due February 1 and work will begin in March.SHARP grants were due January 25.The FOA...

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Allergy Friendly Food Banks

I got a disturbing e-mail last week that a Boy Scout troop had been turned down when they offered to help organize food at our local food bank. Why?The food bank was out of food. There wasn't anything to organize. Our community rallied and many of us shopped in our cupboards and grocery stores and sent food over to the food pantry.I do think sometimes about families in need who may also deal with food allergies. Our jars of peanut butter and boxes of macaroni and cheese may not help those folks.That's why I love what Dee Valdez has done. She's on a mission to open gluten free food banks across the country. She started with one in Loveland, Colorado. Dee, also known as "Gluten-Free Dee", has partnered with companies, including Pamela's Products, to provide gluten free products to those in need.Don't...

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Drowning our Sorrows in Ketchup: Novartis Settles, Appoints Former Heinz Executive CEO

Here's the latest corporate health care marcher in the legal settlement parade, as reported in the Wall Street Journal.Swiss drug giant Novartis AG said its U.S. subsidiary struck a plea agreement with U.S. investigators to resolve criminal allegations regarding the company's promotion of the epilepsy drug Trileptal, and agreed to pay a $185 million fine.Federal investigators have been carrying out civil and criminal investigations of Novartis' marketing of the drug, including allegations that it promoted the drug for uses for which it is not approved by the Food and Drug Administration, an illegal practice known as 'off-label' marketing, Novartis said in a statement Tuesday as it announced fourth-quarter results. To resolve criminal allegations, Novartis said it agreed to plead guilty to...

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BIDMC Data Marts

At BIDMC, our clinical systems are written in a hierarchical database called Cache - a very fast transactional system with great reliability and disaster recovery features.However, for population health, quality, and performance analysis, we export our clinical care data into over 80 data marts build with SQL Server 2008.These data marts are focused on specific reporting areas such as pharmacy, radiology, lab, and O.R. They are designed and maintained by an IS team within Clinical Information Systems. Updates generally occur daily and are managed via SSIS packages. BIDMC data marts are used to support ad hoc queries by analysts as well as standard...

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As Records Go Digital, Cultures Clash, Bringing to Life Secrets the Health IT Companies Don't Want You to Know

Yes, as records go digital, cultures clash: the culture of medicine, and the culture of the Barbary pirates.The following story perhaps brings to life much of the advice from a candid HIT vendor (who happens to also be a physician) in my post "10 Secrets the EHR Companies Don't Want You to Know":As Records Go Digital, Cultures ClashBy Sammy Mack, Health News FloridaJan 22, 2010A group of Broward County doctors looking to switch to electronic medical records say the result has been a massive headache: surprise charges, inadequate training and even blocked access to patient files.... Experts say a culture clash between mid-career physicians and...

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Soft Power Health Official selection NY International Film Festival and Jury Prize Mammoth Mountian Film

Soft Power Health has just been announced as an official selection in the New York International Film Festival and has received the Jury Prize in Action Sports at the Mammoth Mountain Film festival in California.SOFT POWER HEALTHWhat an incredible and inspiring documentary! Dr Jessie Stone should win a humanitarian award for her efforts. Dr Stone helps people in Uganda receive mosquito prevention sleeping nets to prevent malaria, contraceptive education and much more. Polly Green has done an excellent job with professional videography & editing as well as some amazing shots. Very informative and a must see documentary!Anoo CottoorExecutive...

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UCI Medical Center Fails Inspection, UCI Executives Get Bonuses

Back in the early days of Health Care Renewal, we had many occasions to write about problems with the leadership of the University of California - Irvine (UCI) medical school.  Starting in late 2005, we posted  about various management problems at the institution, involving its liver transplant service, cardiology division, and bone marrow transplant service, (see posts here and here) which lead the new chancellor of the campus to "acknowledge a failure of leadership and accountability" (see post here.) Slightly more recently, we noted the almost 20 year history of questionable financial relationships that involved one of UCI's "biggest stars" in clinical researach and several pharmaceutical companies (see post here).  Then, in 2007, we wrote about some strange contracting...

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The January Meeting of the HIT Standards Committee

At the January 20, 2010 meeting of the HIT Standards Committee, we had an important discussion of the Interim Final Rule and Notice of Proposed Rulemaking.Doug Fridsma presented this powerpoint about the Interim Final Rule. Slide 3 illustrates the linkage between Meaningful Use objectives, Certification criteria and standards. It's a 1:1 mapping - every objective has certification criteria. Every certification criteria has standard(s) requirements. Slides 5-8 document the differences between the HIT Standards Committee recommendations and the IFR. You'll see that most of the base standards recommendations from the HIT Standards Committee (based on a foundation of HITSP work) were included in the IFR.We discussed several key questions.Why does the IFR lack detailed implementation guidance?The...

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Information From Food Allergy Assistant Readers

I've gotten some requests from readers to post their items of interest to the food allergy community. I wanted to pass these along:Teresa posted a quirky, but fascinating article called “20 Weird Allergies That Actually Exist”.Leeanne is giving away some allergy friendly candy on her blog. The offer is only available until Jan. 26, so hop on over for the chance to win.I wrote a blog for Peanut Allergy.com recently about new peanut allergic mice which should help researchers with treatment and a cure for peanut allergy.Don't forget the FAAN and Divvies Cookie Recipe Contest. The deadline is Feb. 15. Grand prize is a trip to Great Wolf Lodge.Cooking Allergy Free has released an iPhone app to help those who need to prepare allergy friendly food.Anyone in the market for a new grill? Reader Joseph...

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The Price is What?

Many in the US believe that a free market in health care is a good idea.  Some actually assert that the US health care system amounts to a free market.  More evidence against that assertion was provided this week by an article in our local paper, the Providence Journal, by Felice Freyer. For the first time ever, the Rhode Island state health insurance commissioner published a report comparing what insurers pay different hospitals for the same services:If you had surgery at Kent Hospital, your insurer would pay Kent significantly more than if you had the exact same procedure at South County Hospital �� even if the same doctor did the work. On average, Kent is getting paid nearly twice as much as South County for inpatient care, according to a new report from the health insurance commissioner...

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Many Diagnosed With Peanut Allergy may Not Be Allergic

A study was recently conducted to determine if those patients who test positive for peanut allergy through a blood or skin test could really tolerate peanut. Of the 933 children who tested positive for peanut allergy, the majority didn't have a peanut allergy when orally challenged. Isn't that something????Now, this is not something to be tried at home; however, it may be something worth discussing with your allergist. I know that my peanut allergic child has never had peanuts, nor has he been orally challenged to peanuts. We're just going with the allergy on the basis of blood and skin test results. In the same study in The Journal of Allergy and Immunology also used component-resolved diagnostics (a more sophisticated blood test) to determine if they could find differences between the children...

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Cool Technology of the Week

As the home CIO, I need to manage our household IT infrastructure - iMacs, MacBooks, wireless, archival storage, printers, and Internet connections. We're an intense user of bandwidth internally and externally. In an effort to reduce travel, I use video conferencing technologies - Cisco Telepresence, iChat, and H323 via Polycom software. I do large file transfers.My wife, who teaches digital photography at the Boston Museum of Fine Arts School and Bentley University, manages all her courseware and photography assignment review via the Web. My daughter uses bandwidth extensively for school research projects, media (music/video), and social networking.I've been an early adopter of FiOS and the 20 megabit down/20 megabit up service as part of my teleconferencing pilots.My cool technology of...

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Operation Aurora And a Widespread Reluctance to Discuss IT Flaws: Is Universal Healthcare IT Really a Good Idea in 2010?

In an essay that ties together recent expos�s of serious IT security flaws (starting with Operation Aurora) and a culture of secrecy that pervades the IT industry and industries who use IT, I ask the question:Is universal healthcare IT really a good idea in 2010?The complete essay is at my academic site at this link.Operation Aurora was a cyber attack, conducted in mid-December 2009 and apparently originating in China, against Google and more than 20 other companies, including Adobe Systems, Juniper Networks, Rackspace, Yahoo, Symantec, Northrop Grumman and Dow Chemical.The attack used "0-day" vulnerabilities (newly discovered and unknown to the software vendor, i.e., "day zero" of the vendor's knowledge of the defect) in Microsoft's Internet Explorer. One target was Google's email service,...

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Stress Acceleration

When I think back on my high school experience, I remember an 8am-3pm school day, a cross country/track workout from 3p-5p, a snack until 6pm, and an hour of reading or problem sets. After that, my time was my own to experiment with early microprocessor circuits, tinker with building a hovercraft (powered by a used vacuum cleaner motor) or do personal writing (I entered dozens of essay contents as a teen). Weekends were filled with bike riding up and down the coast of California, SCUBA/snorkeling in local marine preserves, or helping around the house. Summers were filled with outdoor pursuits and low key internships.My daughter is 16 and is experiencing the typical modern public high school schedule - classes from 7:30 or 8:30am to 2:30pm, a bit of after school community service or...

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Senator Grassley asks hospitals about experiences with federal health information technology program

At a brief Oct. 24, 2009 posting "Washington Post: EMR's No Cure-All; Sen. Grassley Sends Letter of Inquiry to health IT vendors" (link) I mentioned an Oct. 16, 2009 letter to major healthcare IT vendors from Senator Charles E. Grassley (ranking member of the United States Senate Committee on Finance) initiating a Senate investigation of corporate practices. That letter is here (PDF).A followup investigation has now begun by Sen. Grassley of hospitals themselves. Here is a link to his Senate website and a copy of the new letter dated Jan. 20, 2010.This followup letter is being sent to:Banner Health, Brigham & Women's Hospital Case Western Reserve University Hospital Health System, Catholic Healthcare West, Cedars Sinai Children�s National Medical Center, Geisinger Medical Center, Hackensack...

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