News 12/23/14

Top News

CMS announces that 89 new ACOs will join the Shared Savings Program effective January 1, 2015. Aledade founder and former ONC chief Farzad Mostashari, MD wastes no time in celebrating that two will be official Aledade ACOs, with one in Delaware and the other spanning New York, Delaware, and Arkansas.

HIStalk Practice Announcements and Requests

Here’s the video from Ed Marx’s book launch last week for “Extraordinary Tales from a Rather Ordinary Guy.”

Acquisitions, Funding, Business, and Stock

Total Child Health joins the Allscripts Developer Program, integrating its Child Health and Development Interactive screening System (CHADIS) with Allscripts’ TouchWorks EHR.

Announcements and Implementations

MFI Recovery Center, a California-based behavioral health provider, selects Core Solutions Inc.’s Cx360 as its second-generation EHR.  

Orion Health integrates Blue Shield of California historical data into the Cal Index HIE, and is working to do the same with data from Anthem Blue Cross. The data integration is part of a two-year project in which Orion Health will also deliver system analytics, improved care coordination tools, and patient engagement applications. Cal Index made headlines last week when Consumer Watchdog urged Californians to opt out of the payer-backed HIE, saying that it hasn’t explained its privacy policy clearly.

Government and Politics

Rep. Renee Ellmers (R-NC) and 29 of her House colleagues urge HHS Secretary Sylvia Burwell to reduce the 2015 Meaningful Use Stage 2 reporting period from 365 days to 90.

ONC releases the agenda and a handful of confirmed speakers for its annual meeting, scheduled for February 2-3 at the Washington Hilton in D.C. Attendees may want to stick around for the eHealth Initiative Annual Conference, taking place February 3-5 at the Omni Shoreham Hotel. If my MapQuest skills serve me right, attendees should be able to walk easily from one venue to the other.

The Supreme Court will hear King v Burwell on March 4. The case argues that the Obama administration overstepped its authority by providing federal subsidies to Healthcare.gov users when the ACA’s language only authorized subsidy payments for insurance acquired through state-run exchanges.

Research and Innovation

Rock Health initiative XX in Health seeks feedback for its Women in Healthcare, 2015 Industry Survey. Results will inform Rock Health’s annual report on the state of women in the healthcare industry. Last year’s stats definitely showed room for improvement:

• 29 percent of women are not satisfied with their ability to make an impact at work.
• 40 percent who find education important aren’t satisfied with the opportunities available at work.
• 63 percent lack a mentor.
• 73 percent lack a sponsor.

This article highlights the work researchers at Johns Hopkins are doing to mine Twitter for direct tweets related to mental health diagnoses and language cues linked to certain disorders. Researchers hope to share their findings with public health officials to improve on the traditional (i.e. slow and costly) method of collecting data through surveys.

People

NaviNet promotes Paul Johnson to vice president of platform implementation, and appoints Grant Ho (CareCloud) vice president of marketing and Stephen Hess (Ipswitch) vice president of product management.

CompuGroup Medical US promotes Chris Lohl to VP of R&D, ambulatory information systems.

Vermont Information Technology Leaders names Nancy Rowden Brock (World Learning) CFO.

AMC Health appoints Paul Argay (Resolution Health) chief marketing officer.

Other

Has telemedicine jumped the shark? Celebrity investor and entrepreneur Sir Richard Branson joins the hype cycle as part of a media campaign put together by the AMA, ATA, ANA, and Kaiser Permanente, among others. Branson is an investor in telemedicine company Doctor on Demand, which closed a $21 million round of funding in August.

Westby G. Fisher, MD points out the danger of developing “skill-fade” as physicians become increasingly reliant on healthcare technology:

“[W]ho needs doctors at all if care is reduced to point and click?  While our new breed of physicians have never known medicine without a computer, will all of their study and preparation to become clinicians at the bedside be rendered moot as these young doctors find themselves little more than data entry clerks? How will we keep them clinically skilled? Homogenized mannequins programmed to respond to regimented scenarios? Computers and EMRs must inform the physician rather than mandate, instruct rather than impugn, encourage adaptation rather than thwart it, and always facilitate rather than inhibit patient care.”

Connecticut Health Policy Project Executive Director Ellen Andrews takes the now defunct HITE-CT HIE to task upon release of a new report by state auditors highlighting deficiencies in financial controls, legal problems, and a “need for improvement in management practices and procedures.” A former HITE-CT board member, Andrews provides fly-on-the-wall insight into the management issues that really caused the state legislature to shut it down after spending over $4 million on its development: “The board fell apart and attendance at the monthly meetings waned as major decisions were made in small committees between meetings, and just submitted to the board as a done deal. Most meetings included long executive sessions, held out of public view, to discuss the continuing legal, personnel, and management problems.” The state is working to stand up another HIE through its Department of Social Services with many of the same players.

Two students in the U.K. take wearables in a more relaxed direction with development of a device that prompts recording of your favorite T.V. program once it detects you’ve dozed off. The KipstR 3-D printed bracelet uses pulse oximeters to detect when dozing occurs, and then acts as the user’s remote to pause and record the show that was playing. Developed with help from Virgin Media, the device could also be used to determine emotional reactions to a show, prompting suggestions of similar programs. I’m willing to bet Netflix will soon appropriate similar technology as it looks to ramp up its original programming based on the viewing habits of its users.

Sponsor Updates

• Greenway Health releases the latest version of its PrimeMOBILE EHR platform.
• E-MDs becomes the first EHR to exchange provider information with the infectious disease registry of the Kansas Health Information Network, helping users comply with Meaningful Use Stage 2 requirements.
• Greenway Health will sponsor pro golfer Blayne Barber, who will wear the company’s logo on his shirts.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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5 Questions with Toby Sadkin, MD Primary Care Health Partners

Toby Sadkin, MD is Executive Committee Chair at Primary Care Health Partners, a group of eight primary care offices located in Vermont and upstate New York. She is also the managing partner of PCHP’s Vermont offices, and the recipient of MGMA’s 2014 Physician Executive of the Year Award. PCHP uses version 11.4.1 of the Allscripts Touchworks EHR, GE Healthcare’s Centricity Group Management (fka Groupcast) PM system, and Microsoft Office. It employs 165 clinical and ancillary staff, which collectively see an average of 470 patients per day.

Given that you have been overseeing EHR implementations since 2007, how have you seen that process change?
Our EHR implementation team has become more experienced and has developed a good, efficient process for training new users and for periodically updating and reviewing with current users. We continue to face challenges of periodic system errors, slowness, too many “clicks,” and the glitches (and expense) that come with upgrades and hot fixes.

Overall, our group embraced the move to the EHR and we try to use the system to its full advantage. However, we continue to struggle with some of the ongoing frustrations mentioned above. In some ways, we have lowered some of our expectations to try to tolerate the things we don’t like, trying to balance them against the many advantages of the EHR. All of our physicians and NPs are participating in Meaningful Use. At this time, some are in Stage 1 and others are in Stage 2.

In terms of workflow, what types of technology do you feel have had the most positive impact with regard to physician satisfaction and patient outcomes?
The EHR has made many significant, positive impacts. To name just a few:

• The ability for multiple clinicians and staff to view and use the same chart at the same time.
• The ability for the physician to access records remotely.
• Electronic prescribing (keeping accurate and up-to-date medication lists with built-in interaction checking).
• The ability to track quality measures for a multitude of chronic diseases and recommended health screenings.
• Quick and easy access to references and patient education material.
• The use of portals as a method to communicate with patients.

How do you feel about the current state of interoperability (or lack thereof)?
PCHP has capability to communicate among our own offices. There is currently not much for functional interoperability among different EHRs. We try to get by with interfaces for labs/results, but these are expensive and have been variable with reliability. We look forward to comprehensive interoperability among different EHRs, which will allow even better care for patients, giving physicians all the available clinical information regardless of where the services were rendered and eliminating unnecessary duplication of diagnostic tests. Very recently, HIE has become available for our region, and so PCHP is in the early stages of working through the logistics and hoping it will prove to be successfully functional.

Has your organization encountered any healthcare IT implementation challenges in the last year? Do you anticipate implementing any new technologies within the next year or two?
PCHP worked hard to be sure to get the necessary EHR update in order to meet the requirements for Meaningful Use, and also to be able to meet all the measures for high-level scores on our NCQA/patient-centered medical home recertifications. This required significant investment into hardware, software, and training. We continue to struggle with the right decision regarding disaster recovery/business continuity, as the best solutions are cost-prohibitive.

At the same time, the physician partners in PCHP have decided to do a full re-assessment of our EHR and want to compare to several other EHRs. To that end, we have a work group that will be doing this evaluation, thoroughly evaluating the advantages and disadvantages , and making a recommendation of whether to stay with our current EHR or to take on the daunting project of going through a conversion to another system.

What implementation best practices can you share with other providers?
It is important to have a dedicated EHR team, with representation that includes a variety of perspectives and expertise (We have administration, implementation staff, physicians, nurse, and IT). Our team started meeting from the time we made the decision to move to an EHR (eight years ago) and has continued this regular meeting schedule. This team guides all the decisions related to the EHR, takes in feedback and suggestions form the users, and keeps all the users informed with regard to any changes, system upgrades, and workflow recommendations. A combination of administration, IT, and implementation staff make up a help desk team that users can reach out to for troubleshooting.

Even as our group begins the process of reassessing our EHR and considering a possible change in systems, we are cautious to remember that in contemplating such a change, the grass may not be greener – just different.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 12/18/14

Top News

Traffic at Healthcare.gov reaches a record high on the final day for sign ups, with over 1 million people logging in on Monday to buy policies that go into effect January 1. CMS reports that 2.5 million visitors had enrolled as of last Friday. Final figures have not yet been released for total sign ups during the enrollment period, though some industry experts are optimistic it will surpass the government’s stated goal of 9.1 million. Marketing agreements with higi healthcare kiosks, Monster.com, Peers.org, LinkedIn, and even 7-Eleven (via PayNearMe) likely helped boost that figure.

HIStalk Practice Announcements and Requests

We’re running an end-of-year special on promoted and produced webinars for those signed by December 31, so it’s a great time to contact Lorre to book a slot before the HIMSS conference.

Webinars

December 18 (Thursday) 1:00 ET. Virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy,” a new book by “CIO Unplugged” contributor Ed Marx. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.

Acquisitions, Funding, Business, and Stock

American Well closes a Series C round of $81 million. The Boston-based company, which announced integration with Apple’s HealthKit several months ago, will use the additional capital to expand its telehealth services.

Predilytics secures $10 million in a Series C round led by Qualcomm Ventures, with participation from existing investors Highland Capital, Foundation Medical, and Flybridge Capital Partners.

Lightbeam Health receives an unspecified capital investment from former Allscripts executives Glen Tullman and Lee Shapiro.

Announcements and Implementations

Fremont Family Care (NB) receives the HIMSS Ambulatory Davies Award of Excellence for its use of EHR technology to improve patient outcomes while achieving ROI. The non-profit subsidiary of Fremont Health is the twelfth eClinicalWorks customer to receive the award in the past seven years.

MTBC launches its iEHR iPad app featuring  schedule access, patient eligibility, chart creation, e-prescribing, and claim creation. The New Jersey-based company went public this summer.

LifeWise Health Plan of Oregon announces it will offer its members virtual visits with Teladoc physicians beginning January 1. It will also offer the service to members in the state of Washington.

Wellcentive joins the CommonWell Health Alliance.

Government and Politics

HHS awards over $665 million to 28 states, three territories, and the District of Columbia in the second round of funding for its State Innovation Models initiative. Individual states will use their allocated funds to create “statewide health transformation to improve health care,” which will likely include expanding the adoption of healthcare IT.

Media outlets report that CMS will hit 257,000 EPs with penalties January 1 for failing to meet Medicare Meaningful Use requirements. Payment adjustments will go into effect January 5. Providers will be able to apply for reconsideration if they feel they’ve been incorrectly penalized.

Research and Innovation

The Healthcare Incentives Improvement Institute gives 40 states and the District of Columbia an “F” on their ability to provide publicly available information on the quality of their physicians. Just six states passed with a “C” or higher, with Minnesota and Washington earning “As” for the second year in a row. HIII applauds their efforts, while taking the other 48 states to task: “What they have shown through their efforts is that the process of measuring physician quality is achievable, and that designing a website to publish that information is perfectly feasible. In other words, by their actions, they accentuate the failures of the other states.”

The Massachusetts General Hospital Center for Global Health hosts a Stop Ebola Hackathon at MIT to come up with new ways to battle the deadly disease. Technology-related concepts included a computerized facial-recognition system that could be used in the field to quickly link patients with their medical records, and a low-cost wristband device that could measure a patient’s temperature and alert a doctor of developing fever.

New research shows that 49 percent of primary care patients prefer to withhold data contained in their medical record from some or all of their health care providers. The first real-world trial of the impact of patient-controlled access to EHRs highlights the “tension between patients who should have control over their health information and doctors who may not serve them well, and may actually harm them, if important information is hidden.”

Other

Harvard Medical School’s Center for Primary Care launches InciteHealth, a year-long fellowship program with an aim to improve healthcare access, affordability, and outcomes. The program will provide “Inciters” with mentorship; education and collaboration; partnerships with the medical community; and access to established leaders in primary care, venture investment, law, and entrepreneurship. Applications for the 2015 program will be accepted through January 9.

Sony announces it’s getting into the smartglasses game with the unveiling of its Single Lens Display Module. Designed for sports and work, the clip-on unit will turn eyewear into a smart device capable of displaying visual information. 

Snapchat also seems to be getting into smartglasses. Reports are circulating that it has acquired Vergence Labs, which makes frames that can shoot and store video. In an ironic twist, the reports have been sourced from hacked Sony emails sent by Sony Entertainment CEO Michael Lynton, who serves on Snapchat’s board.

The American Medical Association lists EHR improvements among its “10 top issues that impacted physicians in 2014.” Ebola and the Open Payments program also made the cut.

Sponsor Updates

Employees of PerfectServe collected donations for the Florence Crittenton Agency in Tennessee, donating clothing and 10 suitcases for the agency’s “Wheels of Hope” campaign that allows children who arrive carrying their belongings in a trash bag to leave with their own suitcase.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 12/16/14

Top News

The American Telemedicine Association launches an accreditation program for online, direct-to-consumer healthcare consultations. According to ATA CEO Jonathan Linkous, the new program will provide benchmarks for organizations building an online practice; provide reassurance to payers that the virtual services they reimburse follow federal and state laws and regulations; assure patient privacy; are transparent in pricing and operations; use qualified, licensed providers; and follow appropriate clinical practices and guidelines. I can only assume the ATA’s program will live longer than the recently shuttered Happtique’s healthcare app certification program, especially given recent findings that “replacing in-person acute care services with telehealth visits reimbursed at the same rate as a doctor’s office visit could save the Medicare program an estimated $45/visit.”

I reached out to Teladoc, which already uses a provider credentialing process certified by the National Committee for Quality Assurance, to gauge its thoughts on the ATA’s news. A company representative shared this with me: “We applaud the ATA’s efforts to improve the quality of care people receive through telemedicine. We will certainly look carefully at the ATA’s announcement to see if there is anything we believe will improve our processes, quality standards, value, and marketability of our services.” Marketability will likely be the key word in the eyes of vendors when it comes to determining the success of the new program.

HIStalk Practice Announcements and Requests

The first book of HIStalk “CIO Unplugged” contributor Ed Marx has been released and we’re holding a virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy” this Thursday, December 18, at 1:00 p.m. ET. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.

I had to chuckle, and ask myself why Mr. H (certifiably pro Oxford comma) hasn’t been asked to respond to @CelebrityOxford’s question above. Handle creator Rick Mueller sums up the movement’s origin and celeb responses here.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

Acquisitions, Funding, Business, and Stock

Google Ventures invests heavily in healthcare and life sciences, with plans to do it again in 2015. More than one-third of the $425 million Google Ventures invested in 2014 went to healthcare and life-sciences companies, up from 9 percent each of the prior two years. Flatiron Health, which Google invested $100 million in earlier this year, is Google’s second-biggest venture investment after Uber. (Read Mr. H’s interview with Flatiron Health CMO Amy Abernethy, MD, PhD here.)

Government and Politics

Vivek Murthy, MD is confirmed as U.S. Surgeon General (the youngest ever and the first of Indian-American heritage). His confirmation comes after his initial nomination earlier this year stalled when the NRA raised objection to Murthy’s characterization of guns as a health issue. A graduate of Harvard and Yale, Murthy is founder of Visions Worldwide, which works on AIDS education in India; advocacy group Doctors for America; technology company TrialNetworks; and was most recently a hospitalist at Brigham and Women’s Hospital (MA).

Announcements and Implementations

Aviation & Occupational Medicine (CO) selects PM software from Benchmark Systems. The new system will better enable the workers compensation clinic to transition to ICD-10, as well as automate front- and back-end billing operations.

The Medical Society of the State of New York selects DrFirst as its recommended provider of e-prescribing software. MSSNY’s endorsement comes just a few months before New York’s I-STOP mandatory e-prescribing legislation takes effect.

Northern Medical Specialists (NY) selects the eClinicalWorks EHR for its 70 physicians at four locations. NMS offers its patients the FollowMyHealth portal from Allscripts.

Compleat Rehab and Sports Therapy Center (NC) and Hot Springs Sports Medicine (AR) – both owned by Kare Partners – select Clinicient’s TotalInsight software and revenue cycle management services for seven clinic locations.

ChartSpan, a health record organization tool, becomes the most downloaded iPhone and iPad medical app in the U.S. The company hasn’t released exact figures, but has noted it beats industry conversion averages for downloads-to-active-users by nearly 500 percent. An Android version is expected early next year.

Comet-IS adopts HL7’s Fast Healthcare Interoperability Resources (FHIR) into its Carefluence application development platform.

IPatientCare launches the miWatch patient and physician engagement app for Android-based smartwatches. The app serves up appointment reminders, refill requests, and portal notifications, among other features.

Physician management services vendor Women’s Health USA chooses athenahealth’s EHR, revenue cycle, and patient engagement services for its 250 providers. The companies will also jointly offer their bundled services to other physicians.

Allscripts certifies the Healthwise Patient Engagement Solution for integration with its TouchWorks EHR. The solution includes patient care instructions, videos, and interactive tools developed by the Boise, Idaho-based non-profit.

Research and Innovation

Smart thermometer developer Kinsa conducts a pilot project with schools in Texas to aggregate de-identified temperature data to create a “map of human health,” which it hopes to sell to weather forecasters and pharmaceutical companies. The company closed a $9.6 million Series A financing round last week from Kleiner Perkins Caufield & Byers and FirstMark Capital, among others.

A study (and I use that term loosely) in New Zealand finds that more popular magazine titles are more likely to be stolen from patient waiting rooms. “Gossipy” and “most gossipy” titles (those with five or more celebrities on the cover) were pinched most frequently. National Geographic, BBC History, and the Australian Women’s Weekly also garnered a trip out of the office. Issues of Time and the Economist were not touched.

People

Jamie Coffin, PhD (Clarify Healthcare) is named CEO of ambulatory surgery software vendor SourceMedical.

Other

The local paper spotlights the roll out of MediSecure’s Dr Shop prescription abuse prevention software in Australia. The tool enables physicians to determine if a patient has been prescribed 138 dangerous drugs by other doctors on the same day or in the last 90 days. Dr Shop only works with MediSecure’s e-prescribing software, which is used by around half the nation’s medical practices.

CMS consultants travel to Micronesia to spend two days training Medicaid and public health personnel on the upcoming conversion to ICD-10. Similar training will take place on Guam, Puerto Rico, the U.S. Virgin Islands, and American Samoa.

The non-profit Physicians Foundation points out five critical areas that will greatly impact physicians over the next year in its Watch List for 2015 .

Sony Pictures Entertainment emails its employees confirming that HIPAA data might have been compromised during the breach that took place just before Thanksgiving. Stolen data may have included Social Security Numbers, claims, appeals information (including diagnosis and disability codes), dates of birth, home addresses, health plan member ID numbers, and medical information provided to Sony outside of SPE health plans.

This article highlights the unsuccessful efforts of the Health Data Exchange Group in Oregon to develop an interoperable, record-sharing system for local healthcare providers, largely due to financial concerns. Exchanging information with hospitals, most of of which are on Epic, remains “like exploring a house with hundreds of rooms,” according to Regina Dehen, ND CMO, National College of Natural Medicine. “We’re at that point with electronic medical records where I can get the information, but I may not be able to read it or parts of it may be uninterpretable by my system. Sometimes it works flawlessly, and it’s amazing, Unfortunately, right now, you go, ‘Whew, it works,’ as opposed to just taking it for granted.”

Sponsor Updates

• Medicomp is integrating Quippe and the MEDCIN Engine with the Soteria clinical management system of Infocare in South Africa. Above are Medicomp team members Jay Anders, MD (chief medical officer), Dan Gainer (CTO), Jason Valore (senior manager of solutions), and Dave Lareau (CEO) at the Cape of Good Hope.
• SyTrue and nVoq will jointly market their respective smart data platform and speech recognition systems.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

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DOCtalk with Dr. Gregg 12/15/14

Pain, EMRs, and Appreciation

Did it ever occur to you how rarely you notice the absence of pain? I mean, it’s easy to notice pain. Pain sends a “HEY!” message that interrupts your stream of consciousness to make sure you pay attention. But the lack of pain often goes unnoticed, and often much underappreciated.

Pain is always “appreciated” by your brain for its reminder that something isn’t right. Pain can be both … well … a pain, but also a friend; it lets you know when something needs attention. (But it’s also something that can be managed with more than an “ouch” or a whine.) And just as importantly, the lack of pain should be something that is more often acknowledged and valued.

Near the beginning of the classic and epic movie Lawrence of Arabia, a young T.E. Lawrence shows some of his mapmaking military buddies how he can a hold a lit match, unflinchingly, until it burns down to his fingers and goes out. When a cohort, William Potter, tries the same and recoils in burning pain, he asks, “What’s the trick, then?” Lawrence’s response? “The trick, William Potter, is not minding that it hurts.”

That scene and those lines have held a special meaning for me. Years ago, I began having daily “chronic cluster headaches,” a major pain to say the least. They have been dubbed “the worst head pain known to man” and are nicknamed “the Suicide Headaches.” (People have been known to commit suicide not only during one of the excruciating pain episodes, but also in between, in dreaded anticipation of the next.) Women who have them say they’d rather go through childbearing than another cluster headache.

Not surprisingly, having one to eight of these nasty, far-worse-than-a-migraine episodes every day of your life for years can be life-stealing. In fact, they very nearly did take over my whole life. But, when pain is that all enveloping, you sort of have two choices: Succumb to it, or figure out a way to turn it into a background noise – a part of your life, but not the central part of it. That decision was enabled by the remembrance of a movie line – a great movie line to be sure, but still a movie line – where young Lawrence of Arabia first shows his unique life views.

That line has continued to inspire me as I so often have been forced to reflect upon pain, its value, and its point.

Yes, you can learn to “manage” pain, but one of the key things I’ve also noted in dealing with a plethora of pain is that its absence is so poorly appreciated. Honestly, when was the last time you noted – and appreciated – the fact that you didn’t have a headache, or a sore throat, or a stomachache. When you have a pain, it’s so easy to focus upon it and wish for its disappearance. But when it’s gone – like when you wake up in the morning and that dull, achy headache you had the night before isn’t there – how easy is it to get up and go on about your day before you even remember that you had a headache the day before (if you ever do)?

But, let me tell you, because of the unique nature of cluster headaches, I’ve become a true connoisseur of the absence of pain. By that I mean, clusters hit fast, all of a sudden, and amazingly they also tend to go away almost as quickly. One moment you’re in pure and total agony; the next moment you have this overwhelming sense of joy that the anguish is over. When you’re faced with such pure pain, repetitively, day after day, and then when you also repeatedly experience the utter relief that comes at a moment’s notice when the pain subsides, you become exquisitely sensitive to the value of the absence of pain.

How does this relate to healthcare IT? Here’s an example. Today, my EMR vendor (Elation) added a few really cool, though small, updates that made several areas of my workflow even better. (Their workflow is already the best I’ve ever seen.) The updates eliminated a few “pain” points that we had dealt with using minor workarounds. Nothing major, but little “flinches” of workflow pain that occurred every time they disrupted the daily routine. So, today, when I didn’t have to deal with those little moments of aggravation – those little moments of pain – it occurred to me that the feeling was similar to the relief of pain I have so learned to value with clusters: Every day when I don’t feel pain, or when pain subsides, I’m exquisitely aware of the blessing.

Projecting this appreciation of the lack of pain onto my EMR may seem a bit of a reach, but it really isn’t. Appreciating good things and maintaining an awareness of them is a challenge because it’s the pain points that so typically draw our attention. When so many providers are now dealing daily with the frustrations of new digital workflows and all the changes those alteration have wrought, it’s the pain points we all tend to focus upon. “Why doesn’t my system do this thing that the system at the hospital does?” “Why can’t my vendor make this little change I want when it seems so simple?” “Why can’t this be as easy as writing with pen and paper used to be?”

It’s so easy to be lasered in on the problems and aggravations while forgetting the advantages. How easy is it to schedule on your EMR or EHR compared to paper schedules? (Remember those nightmares?) How wonderfully painless is e-prescribing? How much better are your notes, and how much more legible to others? How much more engaged are you with your patients when they start understanding and utilizing your patient portal? How about those clinical decision support reminders – the ones everybody struggles to balance? Have they ever helped you avoid missing an important care point or prevent a missed test or vaccine? How much – how very much – easier is it to find things in your patient charts? How much more insight can you have now into the intimate parameters of you practice, both clinical and managerial?

The trick, William Potter, is not minding that the pain points hurt, at least until they might one day be resolved … and to remember to count your blessings, your lack of pains.

From the trenches (with happy holiday wishes to all) …

"I can’t make out whether you’re bloody bad-mannered or just half-witted.” – Gen. Sir Archibald Murray (to Lawrence)

“I have the same problem, sir.” – Lawrence of Arabia

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

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