HIMSS 2018

Another HIMSS conference is in the books. Amidst the craziness that HIMSS can be, it is always a pleasure to spend time running into friends, collaborators, and former colleagues.  There have been lots of great pieces written about 2018 HIMSS, including by Chrissy Farr and by Lisa Suennen. Here are some of my thoughts and takeaways:

1 – Where’s the Peds?

HIMSS pretty much has a little something for anybody. However, walking the exhibition hall and seeing vendor booths, attending sessions, and talking with colleagues, there was a noticeable under-representation of anything having to do with pediatric care. I’m guessing this has something to do with $$, but I would love to see more attention paid to the specific needs of children, parent caregivers, pediatric care, and children’s hospitals.

2 – Cash and Flash

HIMSS had its usual plethora of vendor swag giveaways, plush carpeted booths, sponsored parties and happy hours, steak dinners, and other signs of the amount of money flowing through the system. One couldn’t help but wonder, if the biggest challenge facing American healthcare is one of cost and value, how could we be spending this much money on HIMSS while telling each other we were there to save money?

Some great tweets on this subject:

Screenshot 2018-03-12 10.20.56Screenshot 2018-03-12 10.20.33

 

3 – Interoperability’s Day Has Arrived

With many thanks to years and years of tireless work by Ken Mandl, Josh Mandel, Aneesh Chopra, Micky Tripathi, Graham Grieve, and so many others, there was a palpable sense that FHIR APIs are crossing from “early adopter” to “mainstream.” CMS announced “Blue Button 2.0,” an API containing four years of Medicare claims data for 53 million beneficiaries that allows individuals to allow third parties to receive that data via API. The VA announced its Lighthouse platform, which gives external developers access to data and tools from the VA in order to more easily build apps to serve the needs of veterans. This is happening.

4 – 2018 HIMSS Word Cloud

AI. Cloud. Interoperability. Security. Provider Burden. API. Connected. Engaged. Consumer. Coordinated…… and Blockchain

4b – My favorite 2018 HIMSS pitch

Started off with the company saying, “even though all our founders come from an AI-background, and all our competitors use AI, we do not use AI in our product.”

5 – From EHR Implementations to Pilots to Mainstream Digital Health

Lots of thought and effort is going into thinking about how to scale innovation and move digital health into the mainstream. How can we create the infrastructure, processes, and tools to try things out, iterate, and scale innovations to get beyond the pilot trap? You can still feel the tension as people try to move past the era of EHR implementations to actually using their EHRs as an underlying platform to achieve care delivery goals like patient engagement, population health, and precision medicine. How can we best use EHRs as a platform on top of which we can integrate novel apps, analytics, and decision support?  To me, solving this at scale is the key question and challenge of the next several years.

 

 

Advertisements

HealthCare Innovators Podcast: Patient-Generated Health Data

I recently had the opportunity to sit down with Travis Good, MD, MBA, Co-Founder and CEO at Datica to discuss emerging trends in the use of patient-generated health data (PGHD) in healthcare delivery.

Here is a link to the Podcast episode

Thank you to Travis for a fun and engaging conversation and for all of the great work Datica does promoting a vibrant digital health ecosystem!

Doximity Dialer

Sometimes simple is the best. I recently tried a new smartphone app – Doximity Dialer – that is just that. I have been so struck by it that I have started showing it off to people at any opportunity. It is incredibly simple to use (from download to using it in <5 minutes) and solves a straightforward, but common problem. It is 8pm and you’re at home working on messages in your EHR. You need to call your patient back about a lab test result. Enter this conundrum… You can either use *67 to block your caller ID in which case the patient will think it is a telemarketer calling and not answer. Or you can leave your caller ID on, in which case the patient now has your cel phone number. While some physicians have become comfortable with their patients having their cel phone numbers, many still have not.
Doximity Dialer allows you to “trick” Caller ID into showing a phone number of your choice, e.g. your office number, to the call recipient. This means that you can make calls to patients from your cel phone, but the patient sees your office number on Caller ID.  Now, they recognize the number as their doctor and will answer the phone, and doctors do not have to feel squeamish that a patient will have their personal cell phone number.
Win-win. Simple.

Could voice control of the EHR improve physician efficiency and satisfaction?

Farhad Manjoo, the NYTimes tech reviewer, wrote a story this week about the Amazon Echo, a device for the home using the Amazon Alexa voice recognition service to allow natural-feeling interactions with web searches and web-connected home devices. My immediate reaction was that this will be the human-computer interaction with the future EHR.

Where we now use the mouse and keyboard to search endlessly through complicated menus, in 5-10 years, we will instead be able to say aloud, “Order Mrs. Jones a metabolic panel, lipid panel, and A1C to be done today and again in 6 months. Send the order to the Quest lab. She also needs a bone density scan ordered to screen for osteoporosis. Make sure she has this scheduled and completed by the end of the year. Make a referral to Dr. Smithson in Cardiology for management of coronary artery disease. Send in a one-year refill of her metformin. At the end of our visit today, please send a letter with my full note from today’s visit to her primary care physician.”

As a physician speaks these orders, his shopping cart menu will build on-screen, allowing for verification that the system selected the right items. What now takes several minutes and immense cognitive effort could instead be completed with natural speech and minimal effort in far less time.

I hear from colleagues all the time that they are overwhelmed when using EHRs with too many buttons, menus, and too much clicking around. They feel disconnected from the patient sitting in their office, and that the computer screen has intruded in that relationship. Perhaps a natural language voice recognition system like Alexa is one step closer toward a more satisfying and connected experience for everyone.

The Case for a Patient-Centered EHR: My Dad (full post at Medscape.com)

In the 10 years since my father was diagnosed with multiple myeloma, he has accumulated thousands of lab results, hundreds of physician progress notes, and dozens of imaging studies. Because his myeloma has been hard to treat, and perhaps because he is a well-regarded physician in his field, he has accessed the best care available, including fantastic doctors and new therapies available at distant research centers.

Despite the fact that all of his physicians use electronic health records (EHRs), nobody actually has his medical record. It does not exist. Rather, his thousands upon thousands of data points are scattered across the country, with no one health system or physician having unified access to all of it, including my dad.

As a clinical informaticist, I spend a lot of time thinking about interoperability—the extent to which systems are able to exchange data and subsequently present those data such that they can be understood by a user—but nothing prepared me for seeing my dad play the role of his own health data aggregator.

Tracking data over time is a key component of multiple myeloma care. Imaging scans looking for bone lesions and the “light chain” blood tests that measure the myeloma cancer protein are done periodically to assess response to treatments. Each result, depending on its direction, either brings a sigh of relief or a rise in stress and fear along with a shift in treatment regimen. To optimize my dad’s care, his doctors would need to see the full picture: the imaging, labs, and each historical chemotherapy treatment over time.

You can imagine how this ideal interface would look, with a nice, clean graph showing his light chain results, imaging, medications tried (and failed), and the location of his treatment. But no such graph exists. Worse, it cannot exist in our current system because each health system where my father is treated is only responsible for their portion of his overall medical record.

Keep reading full post at Medscape.com (warning: requires Medscape account)

What’s the Health IT Buzzword of 2015? (Full post at Medscape.com)

Note: This is an excerpt from my first column at Medscape.com.

While walking my dog one recent evening, I listened to a podcast in which two Internet pioneers suggested that there are only two ways to make money: via “bundling” or “unbundling.”[1] They described everyday examples, such as the music industry, which started out by bundling individual songs into record albums. The music industry then turned to unbundling, when iTunes® sold individual songs for 99 cents, then bounced back to a bundling phase with such services as Spotify® or Rhapsody® that bundle entire music libraries to sell for a monthly fee.

A similar ebb and flow occurred with television. Cable TV channels have long bundled individual channels to be sold as a package. However, we are now seeing unbundling, with such services as HBO GO® selling individual channels to consumers.

Remember browsing the never-ending connections of the Internet on the World Wide Web using your desktop browser? The Web has also been unbundled. We all now have dozens of smartphone apps that offer unique, distinct, and generally siloed functionalities.

Bundling and Unbundling Digital Healthcare

Healthcare has experienced similar trends. Before the era of electronic health records (EHRs), the typical physician’s office had its own paper chart for each patient. Every chart was its own silo, unseen and inaccessible to other physicians’ offices. I can still remember working in my primary care clinic and having to ask my patients what their specialist had said in consultation, because I had no access to their consult note. Lab information systems, pathology systems, radiology systems, and billing systems were all separate.

Today, at medium-sized to large healthcare organizations, the enterprise EHR has facilitated the integration of these systems. Hundreds or thousands of physicians across an organization share a single chart for a patient, which includes the patient’s lab results, radiology results, pathology results, and billing functionality, providing a unified and accessible medical record for each patient at each healthcare institution.

At the same time, these institution-wide EHRs include potentially unwanted or unneeded functionalities, much like that bloated cable TV bundle at home. In some cases, EHRs contain some inferior modules that must be used simply because they came with the package, and they lack other capabilities that the organization really needs.

Entrepreneurs have seized this opportunity, filling these functionality gaps and creating thousands of digital health apps. Each app attempts to offer a slice of functionality to consumers or to the healthcare system that is either unique or of higher quality.

We are not yet able to allow healthcare organizations to create mix CDs

The trouble is that most apps create siloed data and siloed functionalities. Although the EHR is the centerpiece of clinical workflows, most apps do not easily interact with the EHR. Most apps do not exchange data with the EHR. Nor do most apps even interact with each other, allowing free flow of data between them.

This is “unbundled” digital health. It is the iTunes era. We are not yet able to allow healthcare organizations to create mix CDs, where there is an intentional order and flow from track to track. Instead, we remain in the era of “come and buy your favorite songs à la carte for 99 cents, stick them all on your iPod Shuffle, and hit ‘play.'”

Click here for the rest of the blog post.

Can 3D Sculpture Help Patients ‘Grasp’ Diabetes Data? (Full post at Medscape.com)

Note: This is an excerpt from my most recent column at Medscape.com (full post at Medscape).

Recently, I was given a first look at a fresh take on BG monitoring, created by artist and technologist Justus Harris. Justus is an artist and technologist based in Oakland, California, and Chicago who was diagnosed with type 1 diabetes at age 14 years. He is blazing a new trail by bringing together personalized health data and the tactile world, creating 3-dimensional (3D) data visualization sculptures.

Often the most exciting innovations happen at the intersection of disciplines, such as the intersection of art, technology, and medicine. Sitting at this crossroads, Justus created an object that can be viewed through many different lenses. As an art gallery piece, it is a form of self-expression for someone struggling with a chronic disease, using art to humanize the BG numbers that he lives with on a daily basis. As a medical education tool, it is a very creative method that connects a patient with his BG data in a 3D, tactile, and visual fashion. This approach could even become a way for someone with low health literacy to rapidly understand whether his diabetes is in good or poor control, beyond what glycated hemoglobin conveys.

To read the full post, please go to the article at Medscape.com (note: you will need to sign in to Medscape to access it)

%d bloggers like this: