Last Friday I'm doing the usual research about what is going on in the world and come across "Argonauts Navigate Between Heavy-weight and Light-weight Standards," posted by Andy Oram (Actually it was Thursday, but the second part was published on Friday). Part of the article states
Congress’s recent MACRA bill, follow-up HHS regulations, and pronouncements from government leaders make it clear that hospitals and their suppliers won’t be off the hook till they solve this problem of data exchange, which was licked decades ago by most other industries. It was by dire necessity, therefore, that an impressive array of well-known EHR vendors announced the maverick Argonaut project in December 2014.
Let's be clear: health information exchange (HIE)is not like that any other kind of industry. This is a departure from what we normally espouse. Normally we would say that 'your problem is not unique and we have solved the various pieces of your problem for someone else previously.' This time, I'm going to side with the doctors. If you are a bank, all you care about is what the balance is. Literally the only question becomes "can the current resources cover the intended action?" If you build cars the questions are a little more complex: "do I have enough widgets and labor to complete the car?" in addition to the financial part "does the customer have enough resources to cover the intended purchase?"
In healthcare, we don't have the luxury of having a commodity level service, like the financial industry does (yes, you all do it the same) or a commodity level manufacturing service (yes you all do it the same) where all questions have a concrete response. Either the check will bounce or it won't. Either you have enough camshafts or you don't. In healthcare the product is both more esoteric, that is, How do you feel?" and more subjective, or, "What are the symptoms?" that said, we need a complete history of what has been done to any particular patient making this kind of information exchange unique in the world. Sure your bank can show you all the activity in a particular account (My idiot bank can show me nine months anyway, so I only get back to June or July of the previous year at tax time making it wholly ineffective) but we don't have a medical 'bank.' I don't want those financial idiots having control of my medical information anyway.
A new protocol is simply going to further muddy the waters, cause confusion and be done worse than about anything that has come before. Swinging back to the side of the tech guys, we have SOAP, REST, Web API, WCF and any of a hundred XML based web services. We don't need a new protocol, we have more than we know how to use now. Further, imagine the what the backlash would be if every other industry wanted to come up with it own communications protocol. The Arrogance! Even worse, the last time the medical industry got it's hands on a 'protocol' they came up with HL7, which is an unmitigated train wreck with documentation three inches thick and a standard so complex that nobody can follow it. Let's assume FHIR is completely successful for a minute. Let's assume the powers that be have belled this particular cat and there is a clear, concise question that generates a clear, concise answer. They haven't been able to do this so far, but let's assume they do. To whom do you ask this clear, concise question?
Aye, but there's the rub. You have a brand new shiny language to ask questions in, and you don't know who to use it on. Let's ignore for a moment the fact that having the data out in the world somewhere, where ever it sits means that we can't find trends and perform analytical analysis on the entirety of the data, let's just do the absolute minimum and simply get the medical records for one patient who has an accident or an incident away from this primary care physician. You guessed it, that can't be done. Is your doctor in Chicago Medical Center East or Chicago Medical Center West? Is she Jane P. Doe, MD or Jane Q. Doe, MD?
How do you peel this particular orange then? The only way to satisfy the requirements set forth above is to have a central repository, an history of record, stating this procedure was performed for this patient by this particular practitioner/practice at this date and time at this location and described by a set of terminology that we can all agree on. We have the database, and we (collectively) have the terminology. Another benefit would be the analytics we could perform on this database to look at things like population health and maybe identify emerging trends.
I am appalled and aghast that nobody seems to look at the overall problem we are trying to solve and that anyone who crows about ANY solution in the correct place gets accolades heaped upon his or her shoulders regardless of the obvious (to us only apparently) flaws of said solution.
A couple of weeks ago we had a discussion about FHIR and came to the same conclusions. Take a minute and share this article with your the members of your networks so we can get healthcare fixed. Take a look at our other articles and blogs and share them too.
We are Sentia Health.
This post also appeared at http://sentiahealth.com/WebLog/Details/26 today, 8/29/2016, and on linked in.
Monday, August 29, 2016
Wednesday, August 24, 2016
EPIC Developers 'Shadowing' Clinicians and Hundred Million Dollar Installations: EPIC FAIL
This morning, doing the daily, I run across this from HealthITNews talking about How Epic sends teams of developers into the field to 'shadow' clinicians as they go about their daily routine. Man that sounds like a great, warm, fuzzy, user engagement kind of deal doesn't it? We are all happy and want to go out and give Epic a hundred million per hospital for an installation and training that takes a year or more to complete and fails regularly.
Let's jump in the way back machine to 1962 When about 20 talented Ford engineers got together and built the Mustang I, a small, mid-engine, open cockpit, two seater with a V4 and a manual transaxle. In short, they built what they thought the American Consumer wanted. They didn't wait for all this warm and fuzzy BS, they solved the problem. They took this solution to Lee Iacocca, the President of Ford at the time, and he loved it. He said, and I paraphrase 'your hearts and heads are in the right spot, make it from existing parts, and make it four seats. Using the new Fairlaine floorpan and the new light weight V8, those same 20 or so guys produced the Mustang we all know and love that debuted in 1964 (1/2) and created the Pony car market.
In 1970 Mr. Iacocca commissioned a new Mustang to debut in 1974 built on the new Maverick platform. These plans were scrapped by Henry Ford II in favor of the Pinto platform based on market research. Ford II called and mailed literally thousands of people with surveys of what they want in a new car, held dozens focus groups and generally got bogged down asking people what they want. A month before the launch, they didn't have any running prototypes and the engine hadn't even been successfully mated with the body. The engine mount problem was solved with a large rubber donut dubbed 'the toilet seat' for its looks. and the Mustang II went to showrooms and sat. And Sat. The Mustang II was a miserable failure, and I personally haven't seen one in years, though I see the '64-'73 cruising around town and at car shows regularly.
This wasn't a problem of big corporate bungling either. Ford could still produce a home run. In 1977 20 engineers at Ford of Europe got together and designed and built the new for '79 Mustang, code named 'The Fox.' That car sold close to two million copies in all its forms between 1979 and 1993, making it one of the most popular cars of all time.
What do we learn from all of this? First, solve the problem. No amount of focus groups and surveys and asking questions and lipstick makes a pig attractive. We can not achieve great things by committee. I've heard it said that we couldn't put a man on the moon in 2016, and I believe it. this is the reason. Second, keep it simple. Epic (and Cerner and everyone else in this space besides Sentia Health) has an amazingly complex ... well everything. The installation and training takes over a year and costs tens or hundreds of millions of dollars. Yes, people are complex. Yes, the way they act is complex. How do you account for all of that complexity? You develop a database that is indexed and searchable and corrects for bad spelling and has all the structures of the body, all the procedures you can perform on it and all the modifiers and situations you might accidentally get into. Then you can both document the patient encounter with this database, AND by assigning dollar values to procedures pay the practitioners as well without having to do the stupid medical coding that goes on now. But who makes a database like that? Well, the National Institutes of Health does and it's free. They will give it to anyone with an internet connection and half a brain.
Since we have an internet connection and half a brain, we downloaded it and built our EMR around it. Our EMR requires NO installation, fifteen minutes worth of training, and can be used for $10 per user per month. I don't know how math works in your world but one hundred million divided by 10 = 10 million months to the break even point. If you have one hundred million lying around for an EMR, keep it and pay us out of the interest. That makes our EMR not only orders of magnitude better, orders of magnitude more simple but fricken' free. for all intents and purposes. The conclusion is that yes, we want end user/customer input, but AFTER the solution is designed and built. We can add cupholders and gold paint and a better stereo after the 'car' is designed and built and works amazingly well and you decide you want it.
We Provide
Let's jump in the way back machine to 1962 When about 20 talented Ford engineers got together and built the Mustang I, a small, mid-engine, open cockpit, two seater with a V4 and a manual transaxle. In short, they built what they thought the American Consumer wanted. They didn't wait for all this warm and fuzzy BS, they solved the problem. They took this solution to Lee Iacocca, the President of Ford at the time, and he loved it. He said, and I paraphrase 'your hearts and heads are in the right spot, make it from existing parts, and make it four seats. Using the new Fairlaine floorpan and the new light weight V8, those same 20 or so guys produced the Mustang we all know and love that debuted in 1964 (1/2) and created the Pony car market.
In 1970 Mr. Iacocca commissioned a new Mustang to debut in 1974 built on the new Maverick platform. These plans were scrapped by Henry Ford II in favor of the Pinto platform based on market research. Ford II called and mailed literally thousands of people with surveys of what they want in a new car, held dozens focus groups and generally got bogged down asking people what they want. A month before the launch, they didn't have any running prototypes and the engine hadn't even been successfully mated with the body. The engine mount problem was solved with a large rubber donut dubbed 'the toilet seat' for its looks. and the Mustang II went to showrooms and sat. And Sat. The Mustang II was a miserable failure, and I personally haven't seen one in years, though I see the '64-'73 cruising around town and at car shows regularly.
This wasn't a problem of big corporate bungling either. Ford could still produce a home run. In 1977 20 engineers at Ford of Europe got together and designed and built the new for '79 Mustang, code named 'The Fox.' That car sold close to two million copies in all its forms between 1979 and 1993, making it one of the most popular cars of all time.
What do we learn from all of this? First, solve the problem. No amount of focus groups and surveys and asking questions and lipstick makes a pig attractive. We can not achieve great things by committee. I've heard it said that we couldn't put a man on the moon in 2016, and I believe it. this is the reason. Second, keep it simple. Epic (and Cerner and everyone else in this space besides Sentia Health) has an amazingly complex ... well everything. The installation and training takes over a year and costs tens or hundreds of millions of dollars. Yes, people are complex. Yes, the way they act is complex. How do you account for all of that complexity? You develop a database that is indexed and searchable and corrects for bad spelling and has all the structures of the body, all the procedures you can perform on it and all the modifiers and situations you might accidentally get into. Then you can both document the patient encounter with this database, AND by assigning dollar values to procedures pay the practitioners as well without having to do the stupid medical coding that goes on now. But who makes a database like that? Well, the National Institutes of Health does and it's free. They will give it to anyone with an internet connection and half a brain.
Since we have an internet connection and half a brain, we downloaded it and built our EMR around it. Our EMR requires NO installation, fifteen minutes worth of training, and can be used for $10 per user per month. I don't know how math works in your world but one hundred million divided by 10 = 10 million months to the break even point. If you have one hundred million lying around for an EMR, keep it and pay us out of the interest. That makes our EMR not only orders of magnitude better, orders of magnitude more simple but fricken' free. for all intents and purposes. The conclusion is that yes, we want end user/customer input, but AFTER the solution is designed and built. We can add cupholders and gold paint and a better stereo after the 'car' is designed and built and works amazingly well and you decide you want it.
We Provide
Real Solutions
Monday, August 22, 2016
HealthITAnalytics.com: Silos Prevent Delivery of Coordinated Care
On August 19, Brent Clough published Healthcare Big Data Silos Prevent Delivery of Coordinated Care, detailing why we aren't working together to keep the population of the United States healthy. He states
"Typically, the proposed solution is to increase communication or integrate different departments. It's an issue that many have cited as something that is holding back efficiency in healthcare."
We addressed this very issue on July 18th, 2016 (on this site) and came to the conclusion that the only way to integrate healthcare is to have ONE data store of record and have all others feed into it. Since Sentia Health is the one provider of an electronic medical records system that can house all that data and automate the entire insurance industry thusly cutting out approximately 1/3 of the total cost of healthcare, I self nominated us. Our system is patient centric, not doctor based and therefore details what goes on with a patient, not a department.
Out of necessity, practitioners can't provide healthcare on an assembly line. It is too specialized and we don't want every sniffle and cough to go through surgery. What we can do, however, is not model our software systems on doctor- and hospital-centric thinking. The patient in our example from July 18, 2016 broke his leg skiing in Switzerland. No amount of API integration is going to help that patient find his own medical records to show the doctor in Switzerland. The data MUST follow the patient. Since Sentia has a patient portal with assigned reading to engage the patient, we not only have the central repository necessary to make truly coordinated care work, the patient already knows how to access his or her own information.
The only other problem we haven't addressed it how to get the information from where it sits to its permanent home with us. We discussed this exact problem in the July 18, 2016 post on this very site. Sentia Systems, one of Sentia Health's sister companies, provides a product called the Information Integrator that has the ability to access any data source, transform it according to a graphical, user defined specification and then insert it into any data destination. It is done, has been done for years, and best of all works.
It sounds to me like most people are fumbling around trying to get SOMETHING accomplished while there are better, even great solutions available.
We provide
"Typically, the proposed solution is to increase communication or integrate different departments. It's an issue that many have cited as something that is holding back efficiency in healthcare."
We addressed this very issue on July 18th, 2016 (on this site) and came to the conclusion that the only way to integrate healthcare is to have ONE data store of record and have all others feed into it. Since Sentia Health is the one provider of an electronic medical records system that can house all that data and automate the entire insurance industry thusly cutting out approximately 1/3 of the total cost of healthcare, I self nominated us. Our system is patient centric, not doctor based and therefore details what goes on with a patient, not a department.
Out of necessity, practitioners can't provide healthcare on an assembly line. It is too specialized and we don't want every sniffle and cough to go through surgery. What we can do, however, is not model our software systems on doctor- and hospital-centric thinking. The patient in our example from July 18, 2016 broke his leg skiing in Switzerland. No amount of API integration is going to help that patient find his own medical records to show the doctor in Switzerland. The data MUST follow the patient. Since Sentia has a patient portal with assigned reading to engage the patient, we not only have the central repository necessary to make truly coordinated care work, the patient already knows how to access his or her own information.
The only other problem we haven't addressed it how to get the information from where it sits to its permanent home with us. We discussed this exact problem in the July 18, 2016 post on this very site. Sentia Systems, one of Sentia Health's sister companies, provides a product called the Information Integrator that has the ability to access any data source, transform it according to a graphical, user defined specification and then insert it into any data destination. It is done, has been done for years, and best of all works.
It sounds to me like most people are fumbling around trying to get SOMETHING accomplished while there are better, even great solutions available.
We provide
Real Solutions
Monday, August 15, 2016
A Tale of Two EHRs: The Cerner and Epic Train Wrecks
Today we have a loosely coupled doubleheader for you. In the news this morning Bon Secours, a Richmond Virginia healthcare system exposed 655,000 patient records from Virginia, South Carolina and Kentucky to the internet from its Epic EHR system. Read all about it. According to a press release from Bon Secours:
We here at Sentia (Ok I represent Sentia) (am)are a little confused. Why are there files laying around on some disk or disk array to expose to the internet? A database has two files and you can't get to them because they are locked by the database engine and you can't even copy them while they are in use. If your EHR is designed correctly, or at all, you can't expose this to the internet. Epic is one of two huge companies who vend EMR/EHR systems. Clearly they are doing something wrong.
In related news, the other huge EMR/EHR vendor, Cerner, just allowed its CEO, Neal Patterson, to cash in his stock options for a net $26,900,000 ($26.9 million). Patterson has led Cerner since 1995 when they began with 1095 employees. Today they employ more than 22,200 world wide. Patterson still holds options to buy 1,138,000 more Cerner shares at $3.70 apiece. The stock closed Friday at $66.45. If we do the math, that means that this guy stands to make another $71,000,000 in addition to his salary.
Here are a couple of problems: as a software vendor, you don't need people. Sure, you have to have developers, and you have to have a support team to reset passwords, but 22,200 people??? We have one guy that does bug fixes, support, administration and biling. WE call him the "Maytag Repairman" because outside of clicking the "Go" button to send out bills, he literally doesn't do anything. Everything is automated. With 22,200 people I could describe the universe and give three examples and NOT lose anyone's data. Second, I don't care if this guy is the second coming AND the worlds greatest developer, he isn't, he isn't worth $100,000,000 plus his salary.
How are these stories related? If there are two big vendors, we have to conclude that they have similar offerings. If they didn't, one would shrivel up and die and the other would flourish. Since this isn't happening the obvious conclusion is that they are, for all intents and purposes the same. If they are the same and Epic just exposed 655,000 patient records to the internet, then Cerner either has or will expose thier patient records to the internet. Just do a search for "Cerner Data Breach" I suggest Bing. Go ahead, I'll wait.
So Cerner has data breaches too. The top stories I found were about someone hacking into their data center, not just some hospital out in the world with lax or nonexistent security either. Clearly, obviously, demonstrably we can't trust these huge vendors to secure our data. I don't really want anyone to know I'm getting treated for carbuncles on me bum, but even worse, there is enough information on those servers (think date of birth and social security numbers) to open a credit account in my name and start buying things.
At Sentia, we don't have files laying around and honestly can't figure out why anyone would. All our data (images included) reside in our database, as it should, that has a resting encryption so that even if the database itself is stolen, (it can't be) the hackers couldn't get into it. That isn't even the double security layer. First, all data transfer is done over secure sockets. That means the data is encrypted before being transmitted across the internet. That wasn't enough for us. The NSA can break that encryption, in real time and look for my carbuncles. The second layer is an ever changing Globally Unique IDentifier (GUID) that identifies both the user and the session. This GUID is never transmitted across the internet and is required to authenticate both the user and the session for each database call. We literally CAN NOT have an Epic style data breach.
Meanwhile, these numbskulls are charging hundreds of millions of dollars per installation and paying idiot CEOs hundreds of millions of dollars when they clearly, obviously and demonstrably do not know what they are doing. And who do you suppose, dear reader is paying for all of this? You are..
Here is a simple question: would you rather pay hundreds of millions per installation and tens or hundreds of thousands per month for support and infrastructure, plus hundreds of millions to dunderheaded CEOs (I'm aiming squarely at you Neal Patterson and Judy Faulkner), or would you rather have a secure, well written EMR provided for free by your insurance company who also charges 1/3 less than your current health insurance provider?
If I were you, dear reader, I would start calling and writing my senators and representatives and the administrators of my local hospital right now and demanding better. Heck, the VA is looking at Cerner and Epic and that installation will cost billions and both have completely failed installations that had to be rolled back to paper records. Sentia will do it better and faster than they can and do it for 1/100th of whatever price they quote.
99% discount sounds pretty good, doesn't it? We provide:
Visit https://sentiahealth.com or email us at info@sentiahealth.com
| "...R-C Healthcare Management, a company doing work for Bon Secours, inadvertently left files containing patient information accessible on the internet while attempting to adjust their network settings from April 18th to April 21st." |
We here at Sentia (Ok I represent Sentia) (am)are a little confused. Why are there files laying around on some disk or disk array to expose to the internet? A database has two files and you can't get to them because they are locked by the database engine and you can't even copy them while they are in use. If your EHR is designed correctly, or at all, you can't expose this to the internet. Epic is one of two huge companies who vend EMR/EHR systems. Clearly they are doing something wrong.
In related news, the other huge EMR/EHR vendor, Cerner, just allowed its CEO, Neal Patterson, to cash in his stock options for a net $26,900,000 ($26.9 million). Patterson has led Cerner since 1995 when they began with 1095 employees. Today they employ more than 22,200 world wide. Patterson still holds options to buy 1,138,000 more Cerner shares at $3.70 apiece. The stock closed Friday at $66.45. If we do the math, that means that this guy stands to make another $71,000,000 in addition to his salary.
Here are a couple of problems: as a software vendor, you don't need people. Sure, you have to have developers, and you have to have a support team to reset passwords, but 22,200 people??? We have one guy that does bug fixes, support, administration and biling. WE call him the "Maytag Repairman" because outside of clicking the "Go" button to send out bills, he literally doesn't do anything. Everything is automated. With 22,200 people I could describe the universe and give three examples and NOT lose anyone's data. Second, I don't care if this guy is the second coming AND the worlds greatest developer, he isn't, he isn't worth $100,000,000 plus his salary.
How are these stories related? If there are two big vendors, we have to conclude that they have similar offerings. If they didn't, one would shrivel up and die and the other would flourish. Since this isn't happening the obvious conclusion is that they are, for all intents and purposes the same. If they are the same and Epic just exposed 655,000 patient records to the internet, then Cerner either has or will expose thier patient records to the internet. Just do a search for "Cerner Data Breach" I suggest Bing. Go ahead, I'll wait.
So Cerner has data breaches too. The top stories I found were about someone hacking into their data center, not just some hospital out in the world with lax or nonexistent security either. Clearly, obviously, demonstrably we can't trust these huge vendors to secure our data. I don't really want anyone to know I'm getting treated for carbuncles on me bum, but even worse, there is enough information on those servers (think date of birth and social security numbers) to open a credit account in my name and start buying things.
At Sentia, we don't have files laying around and honestly can't figure out why anyone would. All our data (images included) reside in our database, as it should, that has a resting encryption so that even if the database itself is stolen, (it can't be) the hackers couldn't get into it. That isn't even the double security layer. First, all data transfer is done over secure sockets. That means the data is encrypted before being transmitted across the internet. That wasn't enough for us. The NSA can break that encryption, in real time and look for my carbuncles. The second layer is an ever changing Globally Unique IDentifier (GUID) that identifies both the user and the session. This GUID is never transmitted across the internet and is required to authenticate both the user and the session for each database call. We literally CAN NOT have an Epic style data breach.
Meanwhile, these numbskulls are charging hundreds of millions of dollars per installation and paying idiot CEOs hundreds of millions of dollars when they clearly, obviously and demonstrably do not know what they are doing. And who do you suppose, dear reader is paying for all of this? You are..
Here is a simple question: would you rather pay hundreds of millions per installation and tens or hundreds of thousands per month for support and infrastructure, plus hundreds of millions to dunderheaded CEOs (I'm aiming squarely at you Neal Patterson and Judy Faulkner), or would you rather have a secure, well written EMR provided for free by your insurance company who also charges 1/3 less than your current health insurance provider?
If I were you, dear reader, I would start calling and writing my senators and representatives and the administrators of my local hospital right now and demanding better. Heck, the VA is looking at Cerner and Epic and that installation will cost billions and both have completely failed installations that had to be rolled back to paper records. Sentia will do it better and faster than they can and do it for 1/100th of whatever price they quote.
99% discount sounds pretty good, doesn't it? We provide:
Real Solutions
Visit https://sentiahealth.com or email us at info@sentiahealth.com
Thursday, August 11, 2016
Apple is Dabbling in Healthcare. Let's All Watch Them Fail Spectacularly
After brushing my teeth this morning, I jumped right in and read all about how the VA wants feedback as it pursues commercial EHR system from my buddy Shahid Shah at Healthcare Guys. You all know that there are two big commercial EMRs they have to choose from, Cerner and Epic and both of them are train wrecks costing hundreds of millions per installation. Guess who pays THAT, dear reader? You do. Both Cerner and Epic have several abject, unacceptable failures causing the hospitals in most cases to go back to paper records as a better alternative. But, I thought to myself, nobody wants to read another rant on how Epic and Cerner are figuratively (literally if you throw in the insurance companies) ruining the world, and we can do (and have done) it better, so I kept reading the news.
Ok, you got me, I mentioned it anyway.
Then I ran across this on HIStalk from my favorite anonymous probably Doctor working for a non-profit hospital, about Apple and how they are getting into healthcare. If you didn't know, we feel that Apple hasn't had aproduct worth mentioning since LISA in 1983. Apple is a marketing company and was propped up by Microsoft for decades until the iPod, which was a horrible idea that addressed a problem solved better by EVERYBODY else. There hasn't been a single innovation made by Apple since 1983, which could presage their success. Nope. They dumbed the technology down until it was almost unusable, then touted it as "easy to use" while charging prices that were multiples of what everyone else was and then created the wholly uneccessary Application Market. You don't need apps, you have the internet. So I was amused at best to hear that Apple is getting into healthcare.
So Tim Cook says this:
Really. Let's count a few of the ways Apple hates money.
Even worse, he takes it back by saying (healthcare) "may even make the smartphone industry look small." Talking out both sides of his mouth there. Here is what he sees: the global automobile industry generates about $3.5 trillion worth of business. The global health industry generates about $9 trillion, nearly three times what the automotive industry does. Out of global GDP of $74 trillion, that's a huge chunk.
The end of that story is that Apple has some gifted people in engineering and software who can demonstrably get some stuff done. Apple is also a marketing company led by a bunch of bean counters and MBAs who have zero interest in anything BUT making money, Tim Cook included. I'm going to watch Apple closely as they put their little cutesy spin on healthcare and most likely fail spectacularly.
Watch with me.
We provide:
Visit https://sentiahealth.com or email us at info@sentiahealth.com
Ok, you got me, I mentioned it anyway.
Then I ran across this on HIStalk from my favorite anonymous probably Doctor working for a non-profit hospital, about Apple and how they are getting into healthcare. If you didn't know, we feel that Apple hasn't had aproduct worth mentioning since LISA in 1983. Apple is a marketing company and was propped up by Microsoft for decades until the iPod, which was a horrible idea that addressed a problem solved better by EVERYBODY else. There hasn't been a single innovation made by Apple since 1983, which could presage their success. Nope. They dumbed the technology down until it was almost unusable, then touted it as "easy to use" while charging prices that were multiples of what everyone else was and then created the wholly uneccessary Application Market. You don't need apps, you have the internet. So I was amused at best to hear that Apple is getting into healthcare.
So Tim Cook says this:
| "We've gotten into the health arena and we started looking at wellness, that took us to pulling a string to thinking about research, pulling that string a little further took us to some patient-care stuff, and that pulled a string that's taking us into some other stuff," he says. "When you look at most of the solutions, whether it's [sic] devices, or things coming up out of Big Pharma, first and foremost, they are done to get the reimbursement [from an insurance provider]. Not thinking about what helps the patient. So if you don't care about reimbursement, which we have the privilege of doing, that may even make the smartphone market look small." |
Really. Let's count a few of the ways Apple hates money.
- Most expensive products in its industry
- Creating the 'app' industry (anything done in a mobile app could be done in a free web app)
- Inserting itself into the music industry, soaking up money from musicians.
- Proprietary interfaces (plugs) that only fit Apple products and change with every iteration
Even worse, he takes it back by saying (healthcare) "may even make the smartphone industry look small." Talking out both sides of his mouth there. Here is what he sees: the global automobile industry generates about $3.5 trillion worth of business. The global health industry generates about $9 trillion, nearly three times what the automotive industry does. Out of global GDP of $74 trillion, that's a huge chunk.
The end of that story is that Apple has some gifted people in engineering and software who can demonstrably get some stuff done. Apple is also a marketing company led by a bunch of bean counters and MBAs who have zero interest in anything BUT making money, Tim Cook included. I'm going to watch Apple closely as they put their little cutesy spin on healthcare and most likely fail spectacularly.
Watch with me.
We provide:
Real Solutions
Visit https://sentiahealth.com or email us at info@sentiahealth.com
Tuesday, August 9, 2016
Accessing your Personal Health Information: See Doc’s Notes
So my online buddy Mr. X (actually probably Dr. X) from HIStalk published an article from the Journal of the American Medical Informatics Association about Inviting patients and care partners to read doctors' notes.
Here is the abstract of the paper:
We give this a hearty DUH. I guess next they will be telling us the sky is blue and water is wet. Well, water is wet, by definition, but the sky is really black. Anyway, People are going to be curious about what someone, anyone, particularly a doctor says about them. So they are going to go snoop if they can. Once they snoop, they get informed, and informed people make better decisions.
I don't know who or what OpenNotes is, they have no explanation on their site, but I can surmise that they are some kind of clunky third party application that scrapes the practitioner's patient encounter documentation from the EMR database, or even worse, the practitioner is required to copy and paste the notes into the worse-than-clunky system. So yeah, it's a great idea, but I'm less than impressed by this installation of this particular bell on this particular cat.
So of course, Sentia Health does it better. We KNOW you get tired of hearing that so go sign up! We've allowed patients to read all the practitioner's notes since 2009. If your doc uses our EMR, you get a log in and password to view all of your encounter information. This includes notes, x-rays, images, diagnoses, tests, treatments and everything else your practitioner puts in for you. there is no copying and pasting or having a kludgy third party 'system' come and read your doctor's database. What is this OpenNotes security model, anyway? you don't want someone in Kazakhstan reading about your carbuncles, or worse. Nope, you need an EMR with a BUILT IN patient portal. Yup. there is only one.
So tell me again why you aren't telling your doctor about us. If you are a doctor, why aren't you using us? We have technology that is getting close to a decade old that is still making news in the medical industry.
Maybe I should hire a marketing firm.
We provide:
Visit https://sentiahealth.com or email us at info@sentiahealth.com
Here is the abstract of the paper:
I don't know who or what OpenNotes is, they have no explanation on their site, but I can surmise that they are some kind of clunky third party application that scrapes the practitioner's patient encounter documentation from the EMR database, or even worse, the practitioner is required to copy and paste the notes into the worse-than-clunky system. So yeah, it's a great idea, but I'm less than impressed by this installation of this particular bell on this particular cat.
So of course, Sentia Health does it better. We KNOW you get tired of hearing that so go sign up! We've allowed patients to read all the practitioner's notes since 2009. If your doc uses our EMR, you get a log in and password to view all of your encounter information. This includes notes, x-rays, images, diagnoses, tests, treatments and everything else your practitioner puts in for you. there is no copying and pasting or having a kludgy third party 'system' come and read your doctor's database. What is this OpenNotes security model, anyway? you don't want someone in Kazakhstan reading about your carbuncles, or worse. Nope, you need an EMR with a BUILT IN patient portal. Yup. there is only one.
So tell me again why you aren't telling your doctor about us. If you are a doctor, why aren't you using us? We have technology that is getting close to a decade old that is still making news in the medical industry.
Maybe I should hire a marketing firm.
We provide:
Real Solutions
Visit https://sentiahealth.com or email us at info@sentiahealth.com
Friday, August 5, 2016
Big Corporate "Innovation" Is Usually Smoke and Mirrors
I am perusing the usual morning email and run across "The value of Machine Learning in Value-Based Care" by Mary Hardy, Vice President of Healthcare for Ayasdi. Just like in every other case, the 'Machine Learning' they are shouting about is all corporate smoke and mirrors. I actually read the article (and did some research honestly) hoping to find a new and better way to accomplish things that need to be done. Maybe there was a big breakthrough in neural pathways or Inductive Logic Programming.
As it turns out, what the big corporate idiots are really talking about is a query on a database using aggregates. Any first year database developer could have taken the data given and answered the question asked. In fact, we at Sentia have the tools in place to ask that question without even the programmer, but I digress. The question was "What do patients who have had a total knee replacement who have the shortest length of stay have in common?" We could write that query in about 35 seconds, but that doesn't mean that anyone has ever written it before. Basically what they want is good outcomes, in this case short length of stay, correlated with non-obvious controllable factors. What they found is that patients who were given pregabalin, a drug used to mitigate the effects of shingles, obtained this better outcome.
While this has nothing to do with 'Machine Learning' it does sound like a bona fide, dyed in the wool medical breakthrough predicted by "Machine Learning." …until you hear that there were four physicians who actually read the documentation that comes with pregabalin and believed that administering the drug prior to surgery would inhibit postoperative pain. It did. The point is that Mary's analytics (let's call a spade a spade and admit that there is no breakthrough here (unless it is by those four doctors who actually read the documentation (and probably love nested parentheticals)), much less Isaac Asimov turning at 6000 rpm in his casket) predicted nothing and actually had no value, in this case. If she had predicted the outcome before the pregabalin was administered and the surgery done, she might have had something. As it is, that is kind of like me reading tea leaves and poking around in chicken innards in June of 1969 and then 'predicting' man would walk on the moon in our lifetimes. The smart kids were already doing the work necessary to get the outcomes they want. What Mary did was read some tea leaves and shuffle some tarot cards and have a junior developer tell her something the smart kids already knew.
What is the lesson here? Once again, big corporate entities are really good at telling you things you already know and making you think they have reinvented the wheel. As we've said before real innovation comes from small teams of dedicated people who work hard and achieve great things. Mary's thinking is certainly in the right place, but without the technical background to actually do the work, she is hopelessly outclassed and doesn't even know that Miss Cleo (RIP) is lighting candles and shuffling cards and generally putting on a show (well, not anymore) to make people believe that they've accomplished 'Machine Learning.' Yes, we know this is a tough, touchy subject. You, dear reader, should take away the fact that most of what you read on this subject is complete crap and you should do the deep dive and trust people who don't misuse technical terms and try to sell you on their "innovation" like Mary Hardy just did.
We provide
As it turns out, what the big corporate idiots are really talking about is a query on a database using aggregates. Any first year database developer could have taken the data given and answered the question asked. In fact, we at Sentia have the tools in place to ask that question without even the programmer, but I digress. The question was "What do patients who have had a total knee replacement who have the shortest length of stay have in common?" We could write that query in about 35 seconds, but that doesn't mean that anyone has ever written it before. Basically what they want is good outcomes, in this case short length of stay, correlated with non-obvious controllable factors. What they found is that patients who were given pregabalin, a drug used to mitigate the effects of shingles, obtained this better outcome.
While this has nothing to do with 'Machine Learning' it does sound like a bona fide, dyed in the wool medical breakthrough predicted by "Machine Learning." …until you hear that there were four physicians who actually read the documentation that comes with pregabalin and believed that administering the drug prior to surgery would inhibit postoperative pain. It did. The point is that Mary's analytics (let's call a spade a spade and admit that there is no breakthrough here (unless it is by those four doctors who actually read the documentation (and probably love nested parentheticals)), much less Isaac Asimov turning at 6000 rpm in his casket) predicted nothing and actually had no value, in this case. If she had predicted the outcome before the pregabalin was administered and the surgery done, she might have had something. As it is, that is kind of like me reading tea leaves and poking around in chicken innards in June of 1969 and then 'predicting' man would walk on the moon in our lifetimes. The smart kids were already doing the work necessary to get the outcomes they want. What Mary did was read some tea leaves and shuffle some tarot cards and have a junior developer tell her something the smart kids already knew.
What is the lesson here? Once again, big corporate entities are really good at telling you things you already know and making you think they have reinvented the wheel. As we've said before real innovation comes from small teams of dedicated people who work hard and achieve great things. Mary's thinking is certainly in the right place, but without the technical background to actually do the work, she is hopelessly outclassed and doesn't even know that Miss Cleo (RIP) is lighting candles and shuffling cards and generally putting on a show (well, not anymore) to make people believe that they've accomplished 'Machine Learning.' Yes, we know this is a tough, touchy subject. You, dear reader, should take away the fact that most of what you read on this subject is complete crap and you should do the deep dive and trust people who don't misuse technical terms and try to sell you on their "innovation" like Mary Hardy just did.
We provide
Real Solutions
Thursday, August 4, 2016
Why Does the Doctor Always Hand You a Ream of Forms To Fill Out, and How Do You Make Them Stop?
So I get my usual email this morning from my buddy John Lynn over at EMR and HIPAA and one of his acolytes, Anne Zieger, is recounting a recent experience where she went to her primary care physician and was handed a sheaf of paperwork to fill out. Anne has Parkinson’s Disease and it is difficult and painful for her to hand write on forms. Even worse, when the practitioner finally saw her, she had to answer all the same questions a second time. Even worse, I’m absolutely positive (I’ve seen it happen and heard more about it) the same practitioner has to type the hand written responses into their EMR, wasting time, effort and money.
We here at Sentia can’t help with being asked the same questions verbally a second time. What we have done is given your practitioner the ability to come up with their own questionnaires so that first, you don’t have to write your name address and phone number a thousand times (hyperbole, the sign of good literature, or at least of reading Bloom County in the 80s) and second that your responses don’t take up a valuable practitioner’s time to re-type into his or her EMR
Here is how it works: You come in, see the receptionist and he or she assigns whatever prebuilt questionnaire is appropriate and hands you a tablet or directs you to a kiosk to fill it out. Alternatively, since you already have access to Sentia Health’s EMR, you as a patient can go in and fill it out ahead of time, from home. Not to mention that you can see all of your medical records right there in the system, including notes, x-rays and whatever else the practitioner wants to put in there.
From the practitioner's point of view, he or she doesn't have to keep up with paper, make copies that get skewed and blotchy over time, and only has to build them once with our questionnaire building tool. He or she doesn't have to provide pens, paper, copies and can tell you to access your records and take the questionnaire from home so you aren't sitting there for half an hour sucking up air conditioning and making everyone else sick/getting sick from everyone else in the waiting room.
We have solved problems you didn’t even know you had. Contact us at info@sentiahealth.com or visit us on the web at http://sentiahealth.com. We provide
We here at Sentia can’t help with being asked the same questions verbally a second time. What we have done is given your practitioner the ability to come up with their own questionnaires so that first, you don’t have to write your name address and phone number a thousand times (hyperbole, the sign of good literature, or at least of reading Bloom County in the 80s) and second that your responses don’t take up a valuable practitioner’s time to re-type into his or her EMR
Here is how it works: You come in, see the receptionist and he or she assigns whatever prebuilt questionnaire is appropriate and hands you a tablet or directs you to a kiosk to fill it out. Alternatively, since you already have access to Sentia Health’s EMR, you as a patient can go in and fill it out ahead of time, from home. Not to mention that you can see all of your medical records right there in the system, including notes, x-rays and whatever else the practitioner wants to put in there.
From the practitioner's point of view, he or she doesn't have to keep up with paper, make copies that get skewed and blotchy over time, and only has to build them once with our questionnaire building tool. He or she doesn't have to provide pens, paper, copies and can tell you to access your records and take the questionnaire from home so you aren't sitting there for half an hour sucking up air conditioning and making everyone else sick/getting sick from everyone else in the waiting room.
We have solved problems you didn’t even know you had. Contact us at info@sentiahealth.com or visit us on the web at http://sentiahealth.com. We provide
Real Solutions
Wednesday, August 3, 2016
Doctors:Eliminate the Billing Department
Unless a doctor does not accept insurance, his or her practice needs a billing department. In the small practice, usually the doctor(s) hire(s) a service to handle the messy billing details like 'who is paying' and 'how much.' In the big corporate offices There could be a cast of thousands of clerks shuffling papers back and forth, sending emails and taking calls, drinking coffee and telling stories at the water cooler or whatever else it is that happens in a big, corporate office setting.
I wonder how much a practice pays for such a service. I imagine that if it takes an average cast of seven or eight to have a successful patient encounter, that one or more of those is going to be in the billing office. Think about reception, the nurse who takes your temperature and weight, all the lab people, the medical coder (on both ends) and of course the doctor him or herself. Let's say that on average the practice is conservatively spending 10% on running the billing department. So that's either money out of the care giver/practice's pocket, or money out of the consumer's pocket to run this Dunder Mifflin looking billing outfit.
So what if there was an insurance company that showed the practice what was covered, what isn't and how much it would pay, right up front? We can. What if, in addition to the automation and the free EMR that is detailed on this site's front page, we could also eliminate the need for a billing department? If the practitioner knows what is covered and how much is paid, they can discuss any additional payments with the patient at the time of service delivery and either collect then, or pick a procedure that is covered. Either way, the all the money portion of the transaction is handled before the patient leaves the premises.
What that means is that Sentia's Insurance Company will not only cut 1/3 from the cost of healthcare, but allow the practitioner/practice to keep an additional 10% that currently goes to funding the leech, the vampire, that is the billing department and is sucking dry the practice's profit. There is a better way. We have the better way. Whether this industry goes with us or with another true innovator, this is coming.
Profits go up, costs go down. That is how we do things at Sentia. We deliver:
I wonder how much a practice pays for such a service. I imagine that if it takes an average cast of seven or eight to have a successful patient encounter, that one or more of those is going to be in the billing office. Think about reception, the nurse who takes your temperature and weight, all the lab people, the medical coder (on both ends) and of course the doctor him or herself. Let's say that on average the practice is conservatively spending 10% on running the billing department. So that's either money out of the care giver/practice's pocket, or money out of the consumer's pocket to run this Dunder Mifflin looking billing outfit.
So what if there was an insurance company that showed the practice what was covered, what isn't and how much it would pay, right up front? We can. What if, in addition to the automation and the free EMR that is detailed on this site's front page, we could also eliminate the need for a billing department? If the practitioner knows what is covered and how much is paid, they can discuss any additional payments with the patient at the time of service delivery and either collect then, or pick a procedure that is covered. Either way, the all the money portion of the transaction is handled before the patient leaves the premises.
What that means is that Sentia's Insurance Company will not only cut 1/3 from the cost of healthcare, but allow the practitioner/practice to keep an additional 10% that currently goes to funding the leech, the vampire, that is the billing department and is sucking dry the practice's profit. There is a better way. We have the better way. Whether this industry goes with us or with another true innovator, this is coming.
Profits go up, costs go down. That is how we do things at Sentia. We deliver:
Real Solutions
Monday, August 1, 2016
Risk Stratification: Identifying High/Many Risk Patients and How to Help Them
A couple of days ago I ran across this from ChilMark Research, titled "Evolution To Total Active Risk Report Hits the Streets." It's a treatise on the move toward Risk Stratification or predicting which patients will be at high risk for expensive utilization patterns. That means "getting sick."
At Sentia, we created our first Risk Stratification report over a decade ago, and made it run without any other user input than clicking a button. In fact, the model we use now is intended to make the patient think about his or her behavior and make better choices. That means we do more than just draw and analyze blood. There are a couple of dozen lifestyle questions with the usual "how much do you exercise?" and the like, but there is also "How many friends can you share problems with?" and "How many fillings do you have/do your gums bleed when you brush your teeth?" These questions are designed to make the patient think about life choices that you wouldn't normally associate with a Health Risk Assessment. We go even further by using the Uth, Sørensen, Overgaard, Pedersen Equation to estimate maximum volumetric oxygen uptake (VO2Max) and therefore Body Age. We then modify this answer with the answers to his or her lifestyle questions to come up with a Body Age that shows how well they are doing overall. A lower Body Age indicates better health, and a higher one, specifically higher than his or her chronological age indicates less than healthy lifestyle choices and means the patient should seriously consider changing those choices.
We even go a couple of steps further and produce a Population Health Report that details all of the metrics we collect (there are dozens) and aggregates them to show the performance in each category and an overall Body Age of the population. Comparing these year to year gives us a good idea of how we are doing as a group. We also produce a Self-Comparison report that details how the population is doing when compared to itself during the patient's own last visit. That means that a year ago. We had, say, 15 individuals with 3 or more risk factors and this year, we have only 5. That is real, measurable progress. Even better, with the Patient List Generator talked about here we can single out those patients with either high risk factors or many risk factors and individually counsel them on reading and following the patient education that we generated for them. Or they are going to die.
So yes, once again, ChilMark, the industry has come up with a great idea that we have already implemented, and done so years and years ago.
At Sentia, we created our first Risk Stratification report over a decade ago, and made it run without any other user input than clicking a button. In fact, the model we use now is intended to make the patient think about his or her behavior and make better choices. That means we do more than just draw and analyze blood. There are a couple of dozen lifestyle questions with the usual "how much do you exercise?" and the like, but there is also "How many friends can you share problems with?" and "How many fillings do you have/do your gums bleed when you brush your teeth?" These questions are designed to make the patient think about life choices that you wouldn't normally associate with a Health Risk Assessment. We go even further by using the Uth, Sørensen, Overgaard, Pedersen Equation to estimate maximum volumetric oxygen uptake (VO2Max) and therefore Body Age. We then modify this answer with the answers to his or her lifestyle questions to come up with a Body Age that shows how well they are doing overall. A lower Body Age indicates better health, and a higher one, specifically higher than his or her chronological age indicates less than healthy lifestyle choices and means the patient should seriously consider changing those choices.
We even go a couple of steps further and produce a Population Health Report that details all of the metrics we collect (there are dozens) and aggregates them to show the performance in each category and an overall Body Age of the population. Comparing these year to year gives us a good idea of how we are doing as a group. We also produce a Self-Comparison report that details how the population is doing when compared to itself during the patient's own last visit. That means that a year ago. We had, say, 15 individuals with 3 or more risk factors and this year, we have only 5. That is real, measurable progress. Even better, with the Patient List Generator talked about here we can single out those patients with either high risk factors or many risk factors and individually counsel them on reading and following the patient education that we generated for them. Or they are going to die.
So yes, once again, ChilMark, the industry has come up with a great idea that we have already implemented, and done so years and years ago.
Real Solutions
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