Andy Oram

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Precision Medicine Can Save More Lives and Waste Less Money

Andy Oram | EMR & HIPPA | August 10, 2016

Andy OramThe previous section of this article looked at how little help we getfrom genetic testing. Admittedly, when treatments have been associated with genetic factors, testing has often been the difference between life and death. Sometimes doctors can hone in with laser accuracy on a treatment that works for someone because a genetic test shows that he or she will respond to that treatment. Hopefully, the number of treatments that we can associate with tests will grow over time. So genetics holds promise, but behavioral and environmental data are what we can use right now...

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Problems with Health Information Exchange Resist Cures (Part 1)

Andy Oram | EMR & EHR | March 22, 2016

Given that Office of the National Coordinator for Health Information Technology (ONC) received 564 million dollars in the 2009 HITECH act to promote health information exchange, one has to give them credit for carrying out a thorough evaluation of progress in that area. The results? You don’t want to know. There are certainly glass-full as well as glass-empty indications in the 98-page report that the ONC just released. But I feel that failure dominated. Basically, there has been a lot of relative growth in the use of HIE, but the starting point was so low that huge swaths of the industry remain untouched by HIE...

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Pursuing Adoption of Free and Open Source Software in Governments

Free and open source software creates a natural — and even necessary — fit with government. I joined a panel this past weekend at the Free Software Foundation conference LibrePlanet on this topic and have covered it previously in a journal article and talk. Our panel focused on barriers to its adoption and steps that free software advocates could take to reach out to government agencies. Read More »

Q&A with Andy Oram: How Can We Tell Whether Predictive Analytics Are Biased?

Andy Oram | Zoom Data | May 24, 2017

The fear of reproducing society's prejudices through computer algorithms is being hotly discussed in both academic publications and the popular press. Just a few of the publications warning about bias in predictive analytics include the New York Times, the Guardian, the Harvard Business Review, and particularly a famous and hotly contested article by Propublica on predictions of recidivism among criminal defendants...

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Radiology Initiatives Illustrate Uses for Open Data and Open AI research

Fans of data in health care often speculate about what clinicians and researchers could achieve by reducing friction in data sharing. What if we had easy access to group repositories, expert annotations and labels, robust and consistent metadata, and standards without inconsistencies? Since 2017, the Radiological Society of North America (RSNA) has been displaying a model for such data sharing. That year marked RSNA's first AI challenge. RSNA has worked since then to make the AI challenge an increasingly international collaboration. Organizers of each challenge curate and annotate medical imaging studies and ask the research community to come up with models to answer important questions.

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Regarding Open Source, Security, and Cloud Migration, Old Prejudices Die Hard in Health Care

Although the health care industry has made great strides in health IT, large numbers of providers remain slow to reap the benefits of a “digital transformation”. Health care organizations focus on what they get paid for and neglect other practices that would improve care and security. At conferences and meetings year and after year, I have to listen to health care leaders tediously explode the same myths and explain the same principles over and over. In this article I'll concentrate on the recent EXPO.health conference, put on in Boston by John Lynn's Healthcare Scene, where the topics of free and open source EHRs, security, and cloud migration got mired down in rather elementary discussions.

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Sansoro Health Record API Will Unite Them All

Andy Oram | EMR & HIPPA | June 20, 2016

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

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Scenarios for Health Care Reform (Part 1 of 2)

Andy Oram | EMR and HIPAA | May 16, 2017

All reformers in health care know what the field needs to do; I laid out four years ago the consensus about patient-supplied data, widespread analytics, mHealth, and transparency. Our frustration comes in when trying to crack the current hide-bound system open and create change. Recent interventions by US Republicans to repeal the Affordable Care Act, whatever their effects on costs and insurance coverage, offer no promise to affect workflows or treatment. So this article suggests three potential scenarios where reform could succeed, along with a vision of what will happen if none of them take hold...

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Scenarios for Health Care Reform (Part 2 of 2)

Andy Oram | EMR and HIPAA | May 18, 2017

Some health care providers balk at the requirement to share data, but their legal and marketing teams explain that they have been doing it for years already with companies whose motives are less commendable. Increasingly, the providers are won over. The analytics service appeals particularly to small, rural, and safety-net providers. Hammered by payment cuts and growing needs among their populations, they are on the edge of going out of business and grasp the service as their last chance to stay in the black...

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Standards and Open Source Make Advances in Apps and Data Exchange for Health

I try to be optimistic about health care, and I managed to move my mood meter in that direction last month after talking about advances in data sharing, standards, and interoperability with a few people involved in the open FHIR standard: Grahame Grieve from the Core FHIR Development Team, David Hay from the FHIR Management Group, and Josh Mandel, a research scientist working on the open-source SMART Platform. Read More »

Three Words That Health Care Should Stop Using: Insurance, Market, and Quality (Part 2 of 2)

Andy Oram | EMH & HIPAA | August 23, 2016

Andy Oram

Endless organizations such as the National Association for Healthcare Quality (NAHQ) and the Agency for Healthcare Research and Quality (AHRQ) collect quality measures, and CMS has tried strenuously to include quality measures in Meaningful Use and the new MACRA program. We actually have not a dearth of quality measures, but a surfeit. Doctors feel overwhelmed with these measures. They are difficult to collect, and we don’t know how to combine them to create easy reports that patients can act on. There is a difference between completing a successful surgery, caring for things such as pain and infection prevention after surgery, and creating a follow-up plan that minimizes the chance of readmission. All those things (and many more) are elements of quality.

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Twine Health Found a Niche for a Software in Health Care

Andy Oram | EMR & EHR | April 1, 2016

Apps and software services for health care are proliferating–challenges and hackathons come up with great ideas week after week, and the app store contains hundreds of thousands of apps. The hard thing is creating a business model that sustains a good idea. To this end, health care incubators bring in clinicians to advise software developers. Numerous schemes of questionable ethics abound among apps (such as collecting data on users and their contacts). In this article, I’ll track how Twine Health tried different business models and settled on the one that is producing impressive growth for them today.

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Uncontrolled Health Care Costs Traced to Data and Communication Failures

Andy Oram | EMR & EHR | April 13, 2016

The previous section of this article provided whatever detail I could find on the costs of poor communications and data exchange among health care providers. But in truth, it’s hard to imagine the toll taken by communications failures beyond certain obvious consequences, such as repeated tests and avoidable medical errors. One has to think about how the field operates and what we would be capable of with proper use of data. As patients move from PCP to specialist, from hospital to rehab facility, and from district to district, their providers need not only discharge summaries but intensive coordination to prevent relapses. Our doctors are great at fixing a diabetic episode or heart-related event...

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VistA is Going Places, and Also Staying Put

The Veterans Health Administration's hospital software, VistA, is a computing legend. Few pieces of software have become the subject of a popular book (Best Care Anywhere), won repeated awards for their usability, or been credited with a 180-degree turn-around in an organization's quality. But VistA is getting long in the tooth, and many--including now the VA itself--are questioning whether it's time for something new.The speculations aren't just about VistA. They extend to all health care software of that generation, including the industry's leading electroinc health record (EHR) system--Epic--and the venerable Intermountain Healthcare.

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Vocera Aims For More Intelligent Hospital Interventions

Andy Oram | EMR & HIPPA | October 14, 2016

Vocera Communications’ and Extension Healthcare’s solutions blend to take pressures off clinicians in hospitals and improve their responses to patient needs. According to Brent Lang, President and CEO of Vocera Communications, the two companies partnered together on 40 customers before the acquisition. They take data from multiple sources–such as patient monitors and electronic health records–to make intelligent decisions about “when to send alarms, whom to send them to, and what information to include” so the responding nurse or doctor has the information needed to make a quick and effective intervention.

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