Data Liberation Is The First Step Towards True Collaboration

I generally agree with this idea. It’s really hard to collaborate with someone if you’re not sharing the data about a patient. So, data liberation can be a true enabler for collaboration.

While I think most hospital CIOs will agree with this, I wonder how many act like data liberation is an important strategy for them. Is data liberation really a core value of their hospital organization? My guess is that for most of them it is not.

One major place they can start to make this part of the culture is in the procurement and contracting process. Software vendors are going to happily keep the data as closed as possible unless you require it of them in the contract stage. Once hospital systems make data liberation part of the IT systems procurement process, then we’ll finally be able to see the benefits of data liberation.

The problem we have today is that data liberation and sharing wasn’t part of the previous procurement and contracting process. My guess is that most assumed that being able to share data would be allowed, but few people looked at the fine print and realized what it would mean to them when it came to data sharing. Thus, we’re in a situation where many organizations have contractual issues which make data sharing expensive.

It will take a cycle of new contracts for this to be fixed, but even then it won’t be fixed if you’re organization doesn’t add this to their agenda. Software vendors happily provide the customer what they demand. We need more hospital organizations demanding data liberation.

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HIPAA Breach at Kaiser

Healthcare IT News reported that Kaiser had it’s Fourth HIPAA breach. Here’s a part of their description of the breach:

Some 5,100 patients treated at Kaiser Permanente were sent HIPAA breach notification letters Friday after a KP research computer was found to have been infected with malicious software. Officials say the computer was infected with the malware for more than two and a half years before being discovered Feb. 12.

We have confirmed that the infection was limited to this one compromised server, and that all other DOR servers were and are appropriately protected with anti-virus security measures,” said Tracy Lieu, MD, director of the division of research at Kaiser Permanente, in an emailed statement to Healthcare IT News. “It is important to note that the compromised server is used specifically for research purposes at the DOR and is not connected to Kaiser Permanente’s electronic health records system.

It’s quite interesting that in one part they say that the computer was infected with malware and that caused the breach. Then, they note that the antivirus software wasn’t being updated properly because of a “human error related to configuration of the software.”

This is a little disturbing to a tech person like me, because the person doesn’t know the difference between anti-virus software which works to stop and prevent viruses from infecting your computer and malware which usually isn’t covered by anti-virus software. They do have malware software to prevent malware, but it’s only so so in my opinion. It’s fighting a losing battle, but an important battle nonetheless.

I bet if we went into any hospital today, we’d find dozens of their computers infected with malware. Would be an interesting study for someone to do. I know many hospitals lock their computers down and block them from surfing many internet sites to try and deal with this problem. That can be pretty effective, but you do make many of your users angry in the process. The IT security people don’t mind that at all. Luckily, with phones people can still get their Facebook IV drip without having to infect the hospital computer. That is until the personal mobile phone gets compromised and infects the hospital network. That’s coming down the road as well.

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Dialysis Clinic, Inc., Selects Sandlot Solutions to Support Comprehensive End-Stage Renal Disease Care Initiative

New technology platform will aid a company-wide initiative to improve quality and care coordination across all facilities.

DALLAS and NASHVILLE, Tenn., April 14, 2014 - Sandlot Solutions, a leading community health interoperability and analytics provider, today announced the beginning of a five-year contract with Dialysis Clinic, Inc. (DCI), a nonprofit corporation providing comprehensive care for patients with kidney disease.  Sandlot’s health information technology solutions will help DCI achieve effective clinical interoperability. The ability to exchange clinical data and share information across health systems will enable DCI to deliver exceptional care management and improved patient outcomes.  A certified Medicare dialysis provider operating in 28 states, DCI will implement two Sandlot modules, Sandlot Connect, for comprehensive data gathering and exchange, and Sandlot Dimensions, which combines a data warehouse with business intelligence tools.

“We are honored to partner with Sandlot Solutions to improve the coordination of care for our patients.  Currently many providers often operate in separate silos and are unable to see the care given by other providers to patients with kidney disease.  With our new partnership with Sandlot, different providers in each community will be able to obtain a better view of the overall care of patients with kidney disease and will be able to communicate in a secure manner as they partner to improve care for patients with kidney disease.  In addition, we will have the capacity to evaluate the cost of care and determine which of our new interventions are most effective at providing better care, at a lower cost to patients with kidney disease,” said Doug Johnson, MD, Vice Chairman of the DCI Board of Directors.

The technology solutions provided by Sandlot will also support DCI’s long-term goal of becoming a CMS ESRD Seamless Care Organization (ESCO).  ESRD patients make up 1.3% of all Medicare beneficiaries and nearly 7.5% of U.S. Medicare spending. This CMS initiative is designed to test new payment and service delivery models in order to achieve higher quality and more patient-centered care for the ESRD population.

Sandlot Solutions trustee, Fred L. Brown, 2014 inductee into Modern Healthcare’s Health Care Hall of Fame and Past Chairman of the National Kidney Foundation remarked: “I am delighted that Sandlot is working with Dialysis Clinic, Inc. to address the complex clinical challenges of patients who require essential dialysis treatment. Sandlot’s ability to create a comprehensive and longitudinal clinical view of a patient with kidney disease will undoubtedly lead to better care and quality of life.”

“Since its inception, DCI has been an innovator in the delivery of care to dialysis patients. DCI’s goal to become a CMS ESCO builds on this strong tradition and culture of quality improvement. At Sandlot, we are proud to partner with companies like DCI and see firsthand our technology’s role in changing healthcare. We look forward to working together to achieve DCI’s goals of better patient care and outcomes,” said Joseph Casper, CEO, Sandlot Solutions.

Sandlot Solutions and DCI began working together in March 2014. Today’s announcement marks the most recent collaboration between Sandlot Solutions and progressive healthcare providers, payers and accountable care organizations (ACOs) to improve the health of patients and communities while also bending the healthcare delivery cost curve.

About Sandlot Solutions

Sandlot Solutions, founded in 2006, is a leading provider of clinical interoperability and community health management solutions focused on: the exchange of clinical and claims data across the care community, population data analytics and enhanced care coordination. Sandlot provides the tools and technology that enable healthcare organizations to improve the quality of care, understand and manage risk, reduce costs, and transition to new business models. The configurable technology streamlines data-sharing and provides physicians with actionable patient information and analytics, within their existing workflow through a proprietary digital envelope, including prompts to proactively address gaps in care at the point of care.

Based in Dallas, Texas, Sandlot Solutions is jointly owned by Santa Rosa Holdings Inc. and North Texas Specialty Physicians (NTSP). For more information, visit

About Dialysis Clinic, Inc.

Started in 1971, DCI is a nonprofit provider, caring for patients with kidney disease.  We currently care for 14,000 patients on dialysis in more than 215 clinics in 28 states.  DCI is the only leading dialysis provider to have remained under its own control since its founding. DCI has been recognized 11 years in a row by an independent government survey, the United States Renal Data System (USRDS), for having the lowest mortality and hospitalization ratios among national dialysis providers.  In addition, since inception DCI has allocated over $200 million to support research, education and other activities that benefit patients. Visit for more information.

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HHS Secretary Sebelius Resigns

The big news coming out of Washington yesterday was that Kathleen Sebelius is resigning as secretary of HHS. This is the end of a stormy 5 year tenure filled with Obamacare and the famed roll out of I can’t imagine the temporary SGR fix and the ICD-10 delay didn’t help keep her around longer either. For those of us who live and breathe the HITECH Act and EHR incentive money, my guess is that the $36 billion is barely a blip on Sebelius’ radar.

Word is that she chose to leave and wasn’t forced out by the administration. To be honest, would any of you have wanted to be in her position? What a tough job she’s had. Many called for her resignation after the botched roll out, but she stayed. At least she stayed long enough for that to mostly roll through.

In fact, I find the headlines of her departure pretty interesting. For example, the New York Times says, “Sebelius Resigns After Troubles Over Health Site.” Farzad pointed to an article by Vox that says, “Kathleen Sebelius is resigning because Obamacare has won.” Seems like the headline people choose/tweet is in line with their politics.

Word is that Sylvia Matthews Burwell will be nominated as Sebelius’ replacement. You can read more about Burwell here. I saw a doctor tweet the question of whether this is the best we can do, someone with work history at foundations. I imagine many doctors feel the same way. Although, we all understand that the HHS secretary is very much part of the political discussion.

All in all, I don’t think Sebelius being gone will mean much change for those of us in the trenches.

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Eating is So Personal

The always insightful Dr. Kvedar has a great post up on the cHealth blog. The full post is worth a read, but I was struck by his analysis and experience tracking the food he ate. I’ve seen so many apps that are working on ways for you to track your eating habits. It’s amazing how sophisticated many of them have become at trying to simplify the entry of the food you eat.

However, Dr. Kvedar points out a major problem with tracking the food you eat. We all have a very personal and emotional connection to food. Food is so much apart of every culture and much of our lives revolves around food. It stirs up so many emotions. The idea of tracking the food we eat can really impact us in a way that’s not so good. It’s like we’re being judged on what we eat every time we enter the info into the app. Who wants to be judged all the time? Especially when it comes to something as personal as food?

My wife used one of these apps for a little while and then just stopped using it. This is a problem for those app makers. My wife described how the app was good, because it helped her know what she was eating and the impact it would have on her weight loss efforts. However, once she’d learned those things, she wasn’t getting the same value out of the app.

Personally, I just don’t see myself ever using one. I’d hate to be judged every time I was eating. Plus, I try to make up for bad eating with extra exercise. We’ll see when that finally catches up to me. Either way, I’ll be surprised if I ever start tracking my eating habits. Maybe once the tracking just happens automatically.

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Outsourcing Your Disaster Recovery Team

I imagine most hospital CIOs are overwhelmed by the total number of systems and applications that they have to support. Hospital systems can have hundreds of applications that they’re required to support. Along with having to support the day to day operations of these systems, you also have to plan for business continuity and disaster recovery as well.

Every 6 months to a year, it seems we get a stark reminder of the need for good disaster recovery thanks to some devastating hurricane, earthquake, or other natural disaster. Plus, the stories of Hurricane Katrina and Super Storm Sandy and their impact at hospitals still ring in my ears and likely many other hospital CIOs.

Considering this background, I was intrigued by this Florida Hospital Case Study on Disaster Recovery. Obviously, Florida sits out there in a position that’s just waiting to be hit by a hurricane. So, good disaster recovery is a necessity for them.

What was most intriguing to me was that this hospital chose to use a managed recovery program from SunGard to make this a reality. While I don’t suggest outsourcing all of your disaster recovery (you need in house expertise deeply involved), I think it’s a great idea to work with a third party provider for your disaster recovery.

First, there are so many systems that it’s great to have a third party hold you accountable for all of your systems. Second, a third party can ensure that you do proper and regular disaster recovery testing of your systems. Third, they can provide an outside perspective that can improve your internal approach to disaster recovery.

Many of the above items can be done in house as well, but we all know that there’s a certain level of accountability that comes from having paid someone to hold you accountable. Otherwise, it’s really easy for one of your staff who’s being pulled in a hundred different directions to let your disaster recovery program slip through the cracks.

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Podcast: Owen Tripp, CEO of Grand Rounds

Yesterday, Grand Rounds, a San Francisco-based startup that makes an “outcomes management platform” for large employer groups, introduced Office Visits, an online service that helps consumers find “quality” physicians close to home. I’ve long been skeptical of any claims of healthcare quality or any listing of “best” physicians or hospitals, so I invited Grand Rounds co-founder and CEO Owen Tripp on for a podcast to explain what his company is doing.

He told me that a proprietary algorithm helps Grand Rounds “recommend with confidence” the top physicians among the 520,000 medical specialists the company graded nationwide, based on numerous publicly available data sources and some self-reporting. Of those more than half a million specialists, only about 30,000 meet the company’s criteria for recommendation, which shows, at the very least, that Grand Rounds is highly selective.

Based on this interview, I think the product has a lot of potential. It’s nice to see ratings based on outcomes data and not squishy criteria like “he is a great doctor,” as parodied in The Onion this week (“Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating”).

At about 18:30, the conversation reminds me of another recent podcast, with University of Rochester neurologist Dr. Ray Dorsey. It turns out that Dorsey is among the 1,000 or so medical advisors to Grand Rounds.

Podcast details: Interview with Owen Tripp, co-founder and CEO of Grand Rounds. MP3, stereo, 128 kbps, 23.8 MB, running time 26:04.

1:00 “Safety” vs. good outcomes
2:20 “Downright terrifying” facts about choosing doctors
4:15 Story behind Grand Rounds
5:30 Algorithm for measuring physician quality that he says has shown about a 40 percent lower rate of mortality on common cardiac procedures
7:10 Data sources, including some self-reporting
8:35 Care coordination services Grand Rounds provides for patients
9:50 Why the direct-to-consumer market is so difficult in healthcare
12:00 Care teams
14:00 Availability and scope of service
16:15 When patients should travel for care and when they should not
18:15 Elements of telemedicine
19:35 Importance of asynchronous communication
21:45 Target market and why he sees the $200 fee as a bargain for patients
23:35 Managing patient records and other data
24:35 Company goals

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Tablets going away in the future?

Recently, I was contacted by a reader who attended the recent Startup Weekend in Madison.  He asked me about my thoughts on using tablet computers to work with an EMR system.

I told him that, although it is possible to work with our EMR via tablet, I usually use a PC desktop machine, which I find much more versatile.  I like the concept of a tablet, but it really is more of a visual statement/wow factor (think Star Trek) for patients to see a doctor using rather than necessary.  I think it might be more important if I were walking around a hospital from room to room, or moving from room to room to see patients.  However, my workflow model includes a brief exam with each patient at the beginning of our encounter and then moving quickly from the exam room to my office for across-the-desk counseling and discussion.  It works well this way and appears more professional in my opinion (rather than doing everything in the exam room and then ending the encounter.)

My further thoughts on tablets are that they may be a passing fad, especially now that Apple has introduced lightweight “Air” laptops.  In reality, I have both an iPad-2 and an iPad-Mini that, for the most part, sit in a drawer unused.  I do almost everything in my life on an iPhone, my Macbook Air, my office PC, and my home PC.  Tablets do not play a major role.  I think the necessity of a good physically distinct keyboard is so natural and intuitive that this essentially makes tablets less attractive.  The only thing that makes a tablet more attractive, which I predict will be included in laptops in the future, is standalone cellular service that obviates the need for wi-fi or hardwire connectivity.

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Parody of Katy Perry’s Waking up in Vegas for #HITMC

Check out this funny parody of Katy Perry’s Waking Up In Vegas for the Health IT Marketing and PR Conference.

Hopefully attendees will remember more than just what John told them since the conference has about 30 amazing speakers over two days. If you’re interested in this topic, you can join the live video stream of the event for free.

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What About Data Beyond the EMR?

I saw this tweet from the famous @HealthcareWen which asks a really good question:

While I enjoy the humor of the tweet as much as the next person (everyone who knows me knows I’m all about the humor), this conversation reminds me a lot of what was done with ICD-10. The “funny ICD-10 codes” got all the attention and made ICD-10 a joke in the minds of so many people. This was highlighted by this guest post on EMR and HIPAA called “Why Do People Find ICD-10 So Amusing?” Those who support the shift to ICD-10 did a poor job explaining why ICD-10 was valuable to the quality of care a patient gets. Talking about all the funny ICD-10 codes (and they are funny) goes against the goals of those who see value in the move to ICD-10.

I bring this up because the same thing could easily happen with big data in healthcare. While it’s funny to think about how a doctor might treat us if they know we had a donut for breakfast, there are really meaningful data sources beyond the EMR. If we focus too much on the periphery of the data, then we’re going to miss out on a lot of the value that comes from the not so funny parts of big data.

Right now our EMR systems can’t support most of the data that could come from outside the EMR. However, that shift is going to happen and it’s going to happen quickly. My gut tells me that it will start with the wave of consumer centric medical sensors. Then, I see genomic and social data getting integrated next (both really large projects). These three areas will set the baseline for how outside data is integrated with the EMR data.

Let me offer the key points to consider in these data integrations:
-Automated: The data must pass seamlessly without the need for user interaction
-Smart Data: The user of the system needs the system to be smart. The user should only be notified with what’s actionable, but with the ability to drill into the data as needed.
-Bi Directional: The data needs to be seen and updated by both provider and patient. The system will need to have a great way to track who updated which data. However, we need both the patient and providers eyes on the data with the ability to update incorrect data.

These points should illustrate why integrating outside data is going to be such a challenge. However, it’s also why it holds such promise.

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