Feature Articles

Lost in the Signal...Is Most Healthcare Spending Being Wasted?

I finally got around to reading Bryan Caplan's The Case Against Education: Why the Education System Is a Waste of Time and Money. In it, Dr. Caplan, an economics professor at George Mason University and self-avowed libertarian, argues that, aside from basic literacy and numeracy, our educational system serves less to educate and more as a way to signal to employers who might make good employees. Oh, boy did this book make me think about our healthcare system.Dr. Caplan's views on economic signaling are by no means out of the mainstream, although his application of it to education may be. Think of it this way:

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Health Organizations Implore Congress to Fund Public Health Surveillance Systems

HLN Consulting joined more than eighty organizations, institutions, and companies in imploring Congress to fund public health surveillance systems. The appropriations request letters – one to the House and one to the Senate – seek one billion in funding over ten years (and $100 million in FY 2020) for the Centers for Disease Control and Prevention (CDC). This funding would allow CDC, state, local, tribal, and territorial health departments to move from sluggish, manual, paper-based data collection to seamless, automated, interoperable IT systems and to recruit and retain skilled data scientists to use them.

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Is WeWork's Ecosystems Approach a Model for Healthcare Platforms?

Maybe you don't work in a WeWork office setting. Maybe you haven't ever visited one. Maybe you haven't even heard of WeWork. In that case, then you'll probably be surprised that this audacious real estate start-up now has a valuation close to $50b, with over 400,000 "members" in 100 cities across 27 countries (and they claim to "touch" 5 million people worldwide). Or that their plans go well beyond their unique twist towards office sharing. Who in healthcare is thinking about them, and who should be worried...or intrigued?...WeWork was never just about finding people and companies office space: it wanted to "help people work to make a life, not just a living." It focused on building a culture in its spaces, complete with amenities and events to help build a community among its members.

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GAO Report on Patient Matching: Nothing New Under the Sun

On January 15, 2019 the US Government Accountability Office (GAO) released a new report to Congress, Health Information Technology: Approaches and Challenges to Electronically Matching Patients' Records across Providers. This report is in response to the mandate in the 21st Century Cures Act for the GAO to study patient matching. To develop this report, GAO reviewed available literature and interviewed more than thirty-five stakeholders (who are not identified) over the course of a year. I have written several blogs and a feature article on patient matching developments in the US. Similarly, this new GAO report is an excellent retrospective on industry efforts over the past several years.

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ONC Releases New NPRM on Interoperability: How Might it Affect Public Health?

On February 11, 2019, the Office of the National Coordinator for Health Information Technology (ONC) released its latest Notice of Proposed Rulemaking (NPRM) to Improve the Interoperability of Health Information. Referred to by some people as the "Information Blocking NPRM," since this was the primary topic anticipated, the document actually covers a host of other topics related to interoperability driven primarily by requirements of the 21st Century Cures Act. Besides the initial text of the NPRM, ONC also released a set of summary slides and fact sheets to help explain the document.

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How Open Data and Tools Can Save Lives During a Disaster

If you've lived through a major, natural disaster, you know that during the first few days you'll probably have to rely on a mental map, instead of using a smartphone as an extension of your brain. Where's the closest hospital with disaster care? What about shelters? Gas stations? And how many soft story buildings-with their propensity to collapse-will you have to zig-zag around to get there? Trying to answer these questions after moving back to earthquake-prone San Francisco is why I started the Resiliency Maps project. The idea is to store information about assets, resources, and hazards in a given geographical area in a map that you can download and print out.

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So I Survived HIMSS19…

This was perhaps more of a fete than it initially seems. The conference was massive, with over 40,000 attendees. It centered around a trade show exhibit hall that spanned multiple football fields in length. In some ways, it was so big that I felt somewhat discouraged from attending some educational sessions because they were located so far from where I was hanging out that I could get back and forth in time. So I spent most of my time at the Interoperability Showcase since HLN was participating in two of the use cases: Immunization Integration & CDS, featuring our ICE open source immunization evaluation and forecasting system...

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Closing the Referral Problem in Distributed Care Networks

There have been any number of people and companies working tirelessly to solve healthcare's interoperability challenges. Hospitals, EHR software companies, Health Information Exchanges (HIEs), Federal and State governments, payers, and others have developed, tested, and implemented many in-house or vendor-built solutions to try to clear this hurdle. Recently, consumer technology vendors and patient-centered innovation programs have begun to make significant strides on directly expanding patients access to their own records. This is great news for patients, but when I am a patient, I also want my doctors and other caregivers to be able to communicate about me when needed. So, making me responsible for stewarding pieces of my record between them doesn't solve the challenge. Especially if I have received care in three or four different places or worse yet, become incapacitated.

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Fax Technology is the Cornerstone of Interoperability. Here's Why.

Fax is the dominant information exchange technology in U.S. healthcare, outpacing secure direct messaging 25-to-1. Most of that is exchanged using inefficient and unsecure machines. With the emergence of cloud-based fax technology to facilitate secure system-to-system document transfer, the use of cloud fax needs to be part of every CTO's/CIO's digital strategy...The evolution of fax from paper-based to cloud transmission and storage - Cloud Fax Technology (CFT) - is a key step that enables providers to comply with HIPAA and other regulations. Further strengthening CFT as a key component in Healthcare Information Systems (HIS) is its evolution into Direct Messaging platforms, enabling the seamless exchange of Patient Health Information (PHI) between the diverse data and document management systems used by labs, pharmacies, doctor's offices, hospitals, and billing providers. CFT supports and contributes to the goal of interoperability...

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We Don't Need No Stinking Batteries

The problem with many IoT devices, though, is similar to with our other devices: what happens when the battery runs low? It's not easy to get a charger into our gut to repower smart pills, and for anyone worried about the ecological risks posed by computer or smartphone batteries, well, imagine tiny versions of those toxic batteries floating around in your body. We'll need sensors to track the damage done by our other sensors' dead batteries. Not with rectennas. Rectennas are powered by Wi-Fi signals, like the kind you use in your house or at Starbucks to get internet access. This is not a new concept, but what is new is that MIT researchers have been able to harvest enough power to make them useful, in a device only a few atoms thick.

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AHRQ Releases Draft Guide for Registry Interoperability: Does Public Health Have a Role?

On January 11, 2019, the Agency for Healthcare Research and Quality (AHRQ) released a draft Addendum to the Third Edition of Registries for Evaluating Patient Outcomes: A User's Guide called Tool and Technologies for Registry Interoperability. AHRQ has long written about registries - largely from a research standpoint - and I have been following this from afar for some time. This new guide is focused on helping those who both create and use registries understand the issue surrounding leveraging external data to improve registry completeness, accuracy, and usefulness. This report covers lots of ground and does a good job of summarizing important subtopics. Each chapter is overflowing with footnotes and sources.

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Do Unto Robots As You...

We're going to have robots in our healthcare system (Global Market Insights forecasts assistive healthcare robots could be a $1.2b market by 2024), in our workplaces, and in our homes. Some of them will be unobtrusive, some we'll interact with frequently, and some we'll become close to. How to treat them is something we're going to have to figure out. Written by Alex Williams, Do You Take This Robot...focuses on people actually falling in love with (or at least preferring to be involved with) robots. Sex toys, even sex robots, have been around, but this takes it to a new level. The term for it is "digisexual." As Professor Neil McArthur, who studies such things, explained to Discover last year...

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The Shutdown Will Harm the Health and Safety of Americans, even After it's Long Over

With the U.S. federal government shutdown now the longest in history, it's important to understand what a shutdown means for the health and safety of Americans. The good news is that in the short run, the consequences are relatively few. But, as a researcher who studies natural disaster planning, I believe that Americans should be worried about the federal government's long-term ability to ensure good public health and protect the public from disasters. As the shutdown drags on, it increasingly weakens the government's ability to protect Americans down the road, long after federal workers are allowed to go back to work. Many of these effects are largely invisible and may feel intangible because they don't currently affect specific individuals...

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It's 2019. Smartphones are Out...On to the Next Big Thing...

It's amusing to watch old movies where plot points often involved someone's inability to talk to the person they needed, in the pre-mobile phone era. We take our smartphone's omnipresence and virtual omnipotence as a given in our daily lives and treat even its temporary loss as a major inconvenience. So why are people already wondering if the smartphone era is almost over? Speculation on this is not new (voice has been touted as the next big platform for years), but intensified after Apple announced reduced revenue expectations earlier this year -- the first time in 16 years. It specifically cited slower iPhone sales in China and, even more jarring, said it would no longer break out unit sales of iPhones...

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ONC Releases 2018 HITECH Report

In early January the Office of the National Coordinator for Health Information Technology (ONC) issued its annual report to Congress for 2018 on the adoption of electronic health records (EHR) and interoperability. This report is required under the HITECH Act and is further informed by requirements of the later 21st Century Cures Act...One thing that I think is notable was a short discussion about barriers to interoperability that we have heard before. The report identifies three types: technical barriers, financial barriers, and trust barriers. Within trust barriers the report mentions legal incentives to keep data from moving (I guess that would have better been phrased as legal disincentives to sharing), but this misses the point: It is the patchwork of inconsistent and incompatible State and local laws and regulations - not intentional information blocking - that presents a bigger challenge and barrier.

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