Santa's Gone Green - Happy Holidays from the Health IT Junkie and SecureGirl

 ‘Twas the night before our 13^th Christmas and I could barely hold open my eyes

Wondering if a sweater would be required for tomorrow’s pre-dawn ride,

My neoprene stockings hung drying by the chimney above the fire

But all I could wonder was whether I’d packed a spare tube and tire,

Major, our boxer of eleven years, looked up at me like any other dog

His only concern that I not step on him in my early morning fog,

K slumbered peacefully surrounded by stuffed animals and dolls

While T snoozed, protected by the superheroes adorning his walls,

When from outside I heard something land softly upon the frozen sod

It sounded like a low-pitched hum and was really quite odd,

I slipped out of bed, leaned in and pressed the window to my cheek

When all of a sudden I swore I heard the thud of a boot and a loud kick,

“Hybrid my ass” he yelled tersely and in anger tossed his sack down

It was at this very moment I knew Santa was indeed back in town,

“If I’m to deliver toys in this Go Kart I’d love to know how

This hybrid sleigh ain’t gettin’ it done; I’ll never make my deadline now!”

I couldn’t help but chuckle at the elf as he cursed his difficult situation

I soon realized what St. Nick needed was some stiff holiday libation,

“Pssst, Santa,” I whispered, hoping the neighbors wouldn’t awake

“Come inside, let’s talk it over, you clearly need a break,”

“Yes, I suppose I should stop, take inventory and talk beneath your tree

No use driving a sleigh led by Rudolph and his low voltage LED,”

Having downed his first pint of stout and now safely inside

I couldn’t resist asking him why he’d ditched his sweet ride,

“I have to limit my carbon footprint, at least that’s what I’m told

Now naughty kids get recycled plastic rocks instead of a lump of coal,”

“But enough global warming talk,” he said with newfound cheer

“What have the Umbachs been up to during this past year?”

T still goes to Montessori having this spring turned four

He loves tumbling, being read to, and anything Star Wars,

K is now seven and thinks 2^nd grade is quite fantastic

She still plays soccer, rides her bike a ton and really loves gymnastics,

Deb’s still jogging & practicing yoga for exercise, but this year she’s found a new joy

Tweeting and blogging as SecureGirl (so different from all the boys)

I still ride regularly with a group of guys when it’s very early

At that hour and that pace, our mood is sometimes a little surly,

This spring we managed to fit in a last-minute trip to Disneyland,

And in the summer, we made our annual trips to Cape Cod and Storyland

Between us we attended 3 reunions spending time with old friends and having great fun

With a 10th b-school and two 20th high school reunions, we certainly weren’t feeling very young,

We continue to enjoy our work, often by night and by day

I’m now a director at PolyRemedy, while Deb is still managing at RSA,

With Deb now in her kerchief and me at the bottom of my mug

I looked at Santa, we bumped fists, and exchanged a big ‘olman hug,

Though his sleigh was fully charged and his belly full of beer

His fondness for more horsepower was still quite clear,

Then he shouted down from his hybrid as he reached for the starter switch

“Recycle and turn off unused lights, this global warming is a bitch!”

2010 was a record-breaking year for the Pan-Mass Challenge.  The PMC Kids rides (of which K is a 2-time rider) raised over $810,000!  The “adult” PMC raised $33M, and thanks to many of you, I was able to contribute$5,475 to that total (my largest amount to date)!  I sincerely thank you for your continued support.

@healthITjunkie

@SecureGirl

On Being Thankful

This year's ride is in the books and all donations are in - this post-ride recap, however, is woefully late, and for that I apologize (Debbie reminded me that the Christmas poem was just around the corner!).

Logan, Taylor and me at the finish in Provincetown, MA

PMC 2010 was as eventful and full of memorable moments as always - I even made the front page of the Boston Globe on day 1 (that's me in the very bottom left, seriously).  This year, I was able to ride, dine, and speak with senators Scott Brown (R) and John Kerry (D) as both rode form Sturbridge to Bourne on day one.  Senator Kerry was coming off hip replacement surgery (#2 I think!) and Senator Brown was headed out to the Middle East, after riding 110 miles, the very next morning.  Kudos to the senators for continuing to show their support by riding under those circumstances, although I'm quite certain both are well aware of the sacrifices that the patients for whom we ride are making, rendering the sentators' medical and travel "challenges" routine by comparison.

Together we raised $5,475 - eclipsing the $5k mark for the first time!  I am truly thankful for your support and humbled by your generosity.  As I often like to do, and with the benefit of more participation history under my saddle, I've taken a look at the fund raising numbers over the years, and here is what I've found.

With the exception of 2008, the total amount raised and the average donation has risen steadily.

The total number of donors has remained remarkably steady, and the number of repeat donors continues to increase.

I'm looking forward to the challenge of raising the fundraising bar in the coming years, in particular by leveraging social media.  I have a modest network of friends on Facebook and a slightly more modest list of followers (hopefully growing) on Twitter, but with each friend and follow my reach and opportunity to influence donations grows.  Social media is increasingly becoming a part of my job (anyone's in marketing for that matter), and it seems to have worked well for Doug Haslam, who has a nice summary of the impact of Social Media on his fundraising efforts.  I have some time to think it through, but it'll be here before I know it - registration comes in January!

As for the winner of this year's $200 donation challenge drawing - according to the accounting firm of Taylor and Logan, LLC - that bounty goes to Greg Greely!  Greg, the check is "in the mail."

The PMC is about many things to each of the 5,000+ riders who train and raise money year after year - I think this video captures it nicely.  For many it's the triumph over a dreadful disease - for others it's remembering those who weren't as fortunate.  Before sunup on day two of this year's ride, someone from the "Auburn Family" passed away after nearly 10 years of battling cancer.  We are constantly reminded of our daily grace and reasons to give thanks.

Thank you for your continued generosity, and see you on the road!

Why Doctors Need Marketing Now More Than Ever

I just returned from the Diabetic Limb Salvage conference in Washington, DC. I could end this post on that note. If there ever was an example that screamed for marketing help, it's a conference (or anything for that matter) that goes by the name of "Diabetic Limb Salvage." But that's actually not the entire point.

Physicians get a bad rap for a number of reasons often characterized generally as being more Dr. Evil than Patch Adams. A common explanation (not excuse) cited is that doctors walk out of med school with triple-digit debt - and that's only from four years of study - forget that most go on to additional years of training at salaries not in-line with their level of expertise or responsibility. That would certainly challenge my disposition.

But it goes beyond simple salary implications. For the first time in history doctors are being forced to purchase and use electronic medical records (EMRs). You might think this is a good thing given the rest of the world stands in line for hours to buy the next "iThing" that Steve Jobs dreams up. But EMR technologies have not been designed the way Apple designs their products - that is to say, they have not been designed to serve the end user above all else. In addition, all specialties are at financial risk going forward, and the delta between them is shrinking. Finally, healthcare reform aims to provide benefits to nearly everyone, thereby guaranteeing an oversupply of patients for a chronically under-supplied pool of physicians. We need doctors, now more than ever.

Two things stood out to me at the DLS conference this week. First, doctors are "wicked smaht." Yes, I always knew this having spent my career working with and/or designing products for their use. But if everyone could sit in a packed conference room watching a surgeon operate on a patient while simultaneously discussing (and debating) the merits of his approach before a panel of world-renown experts, you would get a new appreciation for just how much they really know. Secondly, doctors care very deeply about their profession and their patients. The winner of this year's Georgetown Distinguished Achievement Award in Diabetic Limb Salvage went to Dr. Gary W. Gibbons. Dr. Gibbons was one of the more, shall we say, challenging physicians on the expert panel. Yet not five minutes later, while accepting the award, he gave an impassioned, emotional speech not about his career achievements (which are quite lengthy and impressive) but about their collective calling. He challenged everyone in the room to work together like never before on behalf of their profession, but more importantly on behalf of their patients. His conviction was as clear as the crystal award he held at the podium.

The themes of Dr. Gibbons' speech and the dedication of those in attendance at the DLS conference should be part of the broader healthcare debate. See you at next year's "Diabetic Limb Preservation" conference!

When Will mHealth Become Standard Practice in Medicine?

How about when an iPhone replaces a stethoscope?

Long the symbol of the medical professional, this is exactly what's starting to happen with an iPhone app designed by a researcher at University College in London.  More than 3 million users have downloaded this app that turns an iPhone into a stethoscope.  Need more evidence?  Google "mHealth conferences" and see how many results are returned.  Search "#mHealth" on Twitter and admire the minefield of tweets.  Even consider the fact that physicians have adopted smartphones at a greater rate than consumers.

Now that device quality (e.g., form factor) and connectivity have essentially been removed as barriers, what are some of the key factors that will continue to accelerate or potentially slow this fast-paced train? I'll throw out a few of them.

Accelerating Factors:

• Physicians.  As mentioned previously and in many articles of late, physicians love mobile health.  This should not be surprising if only because medical professionals are inherently mobile. Whether rounding in the hospital or shuttling between offices or simply taking a call from a colleague, physicians are always on the go.  If they can access important clinical information upon which to base their decisions all the better.  Despite popular (though fading) opinion, physicians are also technology enthusiasts.
• Consumers.  For better or worse, the largest portion of apps in the "Medical" category on iTunes are really more health and wellness the medical apps.  To the extent these and other apps begin to connect with or take on some of the functionality of a mobile Personal Health Record (mPHR), consumers will be a major driver in the mHealth movement.  Hospitals, practices and vendors will ignore connectivity with consumers apps at their peril (not to mention this kind of functionality will increasingly become required as part of the Meaningful Use requirements).
• Vendors and App Developers.  To date, the most popular apps used by physicians have been drug reference and medical calculators/resources like Epocrates and Medscape.  These will no doubt continue to be popular, but for deep and sustained penetration, physicians will (and have already begun to) demand access to clinical information on their patients - direct access to EHRs and any other system that contains information on their patients.  EHR and mobile devices vendors have been more than happy to oblige and will likely continue to dip their entire leg into the mHealth pool.

Potential Retarding Factors:

• FDA.  The FDA has already begun to drop not so subtle hints that they are at the very least exploring what their role could and should be with respect to regulating mobile health devices.  The degree to which this crosses over into smartphones running "medical" apps or stays primarily focused on devices used to remotely monitor patients remains unclear and developing. Suffice it to say, this bears watching and could help continue the growth of mHealth to the extent it gives hospitals, providers and patients comfort that someone is looking out for their interests. There will of course need to be a balance struck between regulation and innovation.
• Privacy and Security.  Are mobility, privacy, and security mutually exclusive?  They shouldn't be, yet there are still many people who feel they are.  Still others remind us that our mobile devices may already be transmitting information about us that is equal to or perhaps beyond the scope of some PHI.

What factors do you think will influence mHealth positively or negatively?

Fines Do Not Matter, Transparency Does

I don't normally write about patient safety or risk management issues directly, but the news in today's Boston Globe about a potential whistle-blower lawsuit by a fired Jordan Hospital nurse grabbed my attention. I actually think this story is as much or more about transparency than anything else. Fortunately, in this instance, it appears both mother and newborn twins (born premature) are doing well. I choose to believe this is due to a combination of factors including the talent and care provided by the receiving hospital staff (South Shore Hospital), the mother and her infants, and perhaps even grace.


The Infractions in question relate to a federal law that prohibits hospitals from transferring patients without first making sure they are stable and have been examined by a physician. The plaintiff has been a nurse at Jordan for 38 years, most recently as director of occupational health and risk management - so she is presumably intimately aware of federal and state laws attendant to transfers as well as reporting violations to proper authorities when they occur. Nurse O'Connor accuses Jordan Hospital of terminating her employment because she reported a violation of the aforementioned federal law.


What is most concerning about this alleged incident (now that mother and children have recovered) is the focus on fines (of the hospital) and punishment (of the hospital and the nurse, assuming it contributed to her termination) rather than on transparency. The protections afforded to whistle-blowers stand as an important example of the great strides the healthcare industry has made over the last decade toward the issue of transparency. Public reporting of healthcare costs, outcomes and quality improvement by providers (including hospital leadership, example Paul Levy's popular blog), payers (including CMS) and vendors (including WebMD) alike will continue contributing to this movement. An environment that celebrates and encourages transparency will ultimately have a far greater impact on quality and safety than fines and punishment.

How Do You Get 5,100 Cyclists to Ride 190 Miles & Raise $31M?

Give them free food and drink, of course! There are few topics as serious or important as cancer research and treatment - except maybe research and treatment of pediatric cancer. But the Pan-Mass Challenge is much more than just a hugely important fundraiser. For many, it's a vehicle to sacrifice in a comparatively small way and take part in something bigger than the individual. For these people, the ride is a way to jump in with both feet (or wheels) and try to make a difference for friends, family members or even themselves if they too are battling the disease.

Whatever your reasons for raising funds and putting in the miles, every rider will take away at least two things from this year's edition of the Pan-Mass Challenge:

1. unbelievable memories from the stories, signs and shared spirit among fellow cyclists, volunteers, and survivors, and
2. fee food and beer

Yes, due to the annual and very generous donations of sponsors like Cape Cod Potato Chips, Harpoon Brewery, Stop & Shop, Whole Foods, and many others, riders will enjoy some of the following goods over the 3-days of PMC:

• 19,000 bananas
• 14,000 bags of trail mix
• 9,800 hamburgers
• 7,000 Cliff bars
• 6,800 slices of pizza
• 5,500 hotdogs
• 3,000 bagels
• 3,000 lbs of chicken
• 1,600 loaves of bread
• 1,400 lbs. of pasta
• 1,300 lbs. of peanut butter
• 500 lbs. of sliced turkey
• 500 lbs. of sliced ham
• 275 watermelons
• 160 kegs of beer

Thanks and cheers to ALL the sponsors and volunteers, all 3,000+ of you!

The HEALTH in Health IT Junkie

While this blog is ostensibly about all things healthcare IT, I do have other interests in my life. One of those is cycling and another The Jimmy Fund. As it turns out, those two interests converge each year on the first weekend in August when I ride in the Pan-Mass Challenge. In its 30-year history, the PMC has raised over $270 million dollars for cancer research and treatment through The Jimmy Fund.

By this time each year I will have ridden my bike over 2,000 miles and raised over $4,500 in preparation for this annual ride. I will have sent out 400 emails, 40 letters and still more hand-delivered in neighborhood mailboxes (old school SPAM) requesting donations. Now all I have to do is ride my bike with over 5,000 of my closest friends across the state of Massachusetts in two days. In other words, now the fun (and rewarding) part begins.

You can donate to the cause by visiting the PMC website.

I Will Gladly Pay You Tuesday For A Hamburger Today

It will be three weeks ago tomorrow since CMS and ONC unveiled the Holy Grail of HCIT - the Meaningful Use Final Rule. Why have I waited so long to write about it? Hey, one must savor 864 pages of government-speak every now and again (not counting the comparatively wimpish 228 pages of Standards and Certification Final Rule). True it takes time to go through these with a fine-tooth comb, but one can fairly readily identify the most talked-about pieces of the Final Rule - namely those that tell hospitals and eligible providers what they must do to earn the money. But there have been countless blogs and articles describing the Final Rule - they've largely done a fine job with that, and you don't need yet another one here. I'd rather write about what I think the Final Rule means for HCIT adoption. At least two things stand out to me:

First, there STILL remains a fair amount of important detail left to the imagination, particularly about CPOE, that makes it difficult to predict exactly what it means for HCIT adoption. The Fed clearly lowered the bar across the board by including the Emergency Department and decreasing thresholds for many objectives. But for some objectives (again, CPOE) it's not exactly clear what the impact will be. CPOE has been made easier (for hospitals AND vendors IMO) by limiting it to medication orders, including the ED and decreasing the threshold to 30% of patients with a medication order. But ONC has created confusion over the issue of who must enter these orders (I mean really enter them). Ironically (perhaps only to me), the Proposed Rule listed RNs by name as being able to potentially enter orders, yet it's the "by any licensed healthcare professional" in the Final Rule that has everyone scrambling to define whether and which non-physicians must enter orders. Furthermore, by only requiring that ONE medication be entered electronically, has ONC potentially introduced more workflows for providers to navigate - a "compliant workflow" for electronic meds and a "non-compliant" one for paper med orders? That's not an improvement for efficiency and will only stall physician adoption of CPOE.

Secondly, by introducing the concept of Core and Menu Set Objectives (expected) AND changing so many of the thresholds (expected for some) AND limiting CPOE to medication orders (curve ball) AND bringing the Emergency Department into play (never doubt the power of a good lobby), it's hard to get a read on what all this really means. And that brings me to this blog post's mascot - Wimpy. No, I'm not calling the Fed a bunch of wimps - or providers or hospitals for that matter. I will not discount the fact that they still face a daunting challenge to implement, integrate and most importantly use technology that has largely done a poor job at all three.

No, I chose Wimpy because of his famous saying "I will gladly pay you Tuesday for a hamburger today". Am I saying that the government has created requirements for hospitals and providers for which they will not pay incentives in the future? Some fear just that, but it's not my point in citing the wise Wimpy. In fact, I'm kind of saying the opposite - we'll have to wait and see if by giving hospitals and providers a hamburger today whether they will pay us all back (it is the taxpayer's money after all) with use of systems that will achieve the 5 broad Health Outcome Policy Priorities (remember those?) defined by the Fed way back in February of 2009 when the HITECH Act was created.

So what do I really think? I think the government has provided short-term relief for a long-term challenge. If the lowering of the bar in Stage 1 causes hospitals and providers to just go after Stage 1 incentives and then stop then HITECH will have been a failure. If lowering the bar causes hospitals and providers to lose focus on the longer-term challenge of Stage 2 and beyond, then HITECH will have been a failure. Will it have created jobs in the vendor market? Will it have created a lot of investment and interest in HCIT? Yes to both. But neither of these will satisfy the Health Outcome Policy Priorities of:

1. Improve quality, safety, efficiency, and reduce health disparities
2. Engage patients and families
3. Improve care coordination
4. Improve population and public health
5. Ensure adequate privacy and security protections for personal health information

Wimpy, pay up!

Native or Mobile Web - What's Your APPetite?

I'm often asked which is the better approach to mobile applications (apps) - a native app or a mobile web app - for accessing information via smartphones. This question has become increasingly relevant given the tremendous potential impact of mHealth on physician adoption of IT. In fact, physicians continue to adopt smartphones at a greater rate than the consumer market, therefore, this question will become increasingly relevant for organizations and vendors to consider as part of their mobile strategy.

If I had been asked this question only a few years ago, I would've undoubtedly said native apps are preferable if only because cellular networks and Wi-Fi connectivity were not nearly as widespread as they are today. Similarly, device browsers and form factors have greatly improved, making browsing and navigating the mobile web much more useful. Owing to at least these two important factors, the decision to go native or mobile web is not nearly as cut and dry as it has been historically.

Essentially, a native app refers to an application that is installed on a mobile device (usually a smartphone). Although apps developed for and distributed through Apple's iTunes App/Store predominate, other mobile platforms, namely Android and to a lesser extent BlackBerry, are beginning to make headway in the native app space. Still, people tend to think of Apple devices when discussing apps, if only because more data exists on their distribution and use, due in part to the closed ecosystem that Apple has created via the App Store model. 

In simplest terms, a mobile web app is an icon on a device's home screen that links to a website that is optimized for a smartphone's mobile browser. Currently, most web apps require connectivity (either Wi-Fi or cellular) for use, although this could change to the extent that web apps begin to use HTML5, Google Gears, or Widgets to deliver content.

So which is the better app approach? Sorry to disappoint, but the answer is, it depends. There are advantages and disadvantages to both shown in the following table:

Whether a native or web app strategy is pursued can depend upon many factors including some of the following:

• Support environment - Does the organization have the IT support infrastructure to support devices installed on mobile (remote) devices that may not be easily retrievable (e.g., physicians who practice one day/week at the hospital)?
• Device ownership and management - Are devices provided to end users by the organization or do users provide their own devices? Is there a narrow and tightly managed list of supported devices or is it a take all comers approach?
• Version control - Does the organization require lengthy internal certification before accepting newer versions of apps?
• The number of users - Does the need organization need to support the deployment and administration for a select number of users or many hundreds of users (e.g., an entire staff of physicians)?
• Connectivity - How widely available and stable is Wi-Fi and/or cellular connectivity (e.g., hospitals are historically inconsistent with respect to Wi-Fi and cellular access)?

Ultimately, the ideal position for both a vendor and a customer/end user is to be able to offer and use either or both application options.

You Say Physicians Don't Like Technology?

Many in the healthcare IT industry generally believe that physicians don't like technology. They cite years of research that shows physicians do not adopt the technology that is ostensibly purchased for them. The research, it turns out, is true - fewer than 10% of hospitals have achieved significant physician adoption of Computerized Physician Order Entry (CPOE), and fewer than 5% have achieved adoption of electronic documentation. Most of the"successful" adoption comes from Academic Medical Centers who employ physicians and residents, and therefore, can control system use to a greater extent. But 90% of US hospitals are community hospitals with largely voluntary staff comprised of independent practitioners - physicians who can and do practice elsewhere including multiple offices and even other hospitals. I would argue these community hospitals are the true test bed for physician adoption of IT.

The notion that physicians don't use technology simply because they don't like it is incorrect. Healthcare is replete with examples of physicians incorporating ground-breaking technologies of all kinds into their practice of medicine. From medical devices like implantable defibrillators to the most sophisticated imaging technology, physicians have shown a willingness, indeed a penchant toward adopting technology. These examples are not limited to technologies that involve direct patient care - witness their adoption of smartphones. The number of physicians using smartphones surged to 64% in 2009, and this number is projected to grow to 81% by the year 2012. This adoption rate out-paces that of consumers, among whom 65% are expected to own a smartphone by 2012.

"Usability" is often cited as the main culprit behind meager physician technology adoption statistics. Calls for improved user interfaces and screen layouts often lead to attempts at trying to weave these constructs into EHR certification criteria, for example. Indeed, the talk in the industry of late is around trying to impart usability as a requirement of Meaningful Use certification. As with prior attempts to legislate usability, however, these efforts are largely doomed to fail as the color, size and location of a button or a screen is not the primary culprit behind historically poor physician adoption.

The primary reasons for poor adoption have more to do with utility than usability. Simply put, if the technology is of no real benefit (or worse a detriment) to the physician and their practice of medicine, they will not use it. CPOE is the poster child for this challenge. Since before the Institute of Medicine's landmark 1999 study "To Err is Human," the industry has tapped technology, namely CPOE, as the keystone for reducing medical errors. Despite broad agreement on this as a chief benefit of CPOE, physicians have shown no real inclination to use these systems. Do physicians not believe in reducing or avoiding medical errors? Of course not. Instead, physicians struggle with systems that do not support their logical workflow and require them to provide information and respond to alerts that are better suited to other clinicians such as nurses, pharmacologists, radiologists, etc. These systems consume additional time on their busy schedules - time they cannot spare (a 10% reduction in physician productivity results in a 20% reduction in revenue).

Ask yourself, would you use something that provided no direct benefit to your daily work, or worse, provided no benefit AND took more of your time? What if that "something" wasn't even designed for your use, would you use it then? That's essentially what we are asking physicians to do - use technology that wasn't designed for their benefit, but we feel is worthwhile nonetheless.

You say physicians don't like technology? I say they don't like technology that does not benefit their practice of medicine.