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MedTech and Devices
The Healthcare IT Guy
January 17,2012


Do’s and Dont’s of Telemedicine

This is the next post in my series of Do’s and Don’ts Healthcare IT. As we all know, some of our
most important citizens live in rural settings, small cities, the countryside, or remote areas. These
areas have smaller populations and less direct access to vital healthcare resources. In the past 15
years or so we’ve made some great strides in remotely accessible healthcare; these offerings,
called telemedical tools, provide important clinical care at a distance. Here are some do’s and
don’ts of telemedicine:

      Do use commonly available web meeting and online video tools bring expert caregivers
       anywhere. WebEx, GotoMeeting, Adobe Connect, Skype, and a variety of other “web meeting”
       tools used mostly in professional office settings and remote sales pitches are wonderful tools to
       connect caregivers in populated communities to their rural patients. A simple $30 to $50 per
       month account on the physician side with almost no direct cost for the patient is an excellent
       way to engage with patients. These kinds of web meetings can happen securely either at the
       patient’s home or patients can be brought into satellite offices with high-quality telepresence.
       Then, instead of waiting for days or weeks for a health professional to travel to an area or
       patients having to take off many hours or entire days traveling to experts in big cities, care can
       be given almost immediately with less inconvenience. Don’t assume that kinds of web meeting
       solutions are HIPAA compliant out of the box; however, do realize they can be made HIPAA
       compliant with appropriate protections.
      Do use medical devices for remote monitoring of in-home care improve clinical observations.
       While web meetings are great for basic primary care, it’s not perfect for elder care, long-term
       care, and other types of clinical requirements. There is a new class of devices that can put near-
       hospital-quality patient monitoring devices into patient homes and “beam” that data to
       monitoring centers that can watch for important events across many patients in different
       geographical areas. Toss in a nurse or other caregiver that can visit once a week or once a
       month to calibrate the devices and you can see how much more convenience patients can have
       and have their physicians, wherever they may be, have immediate access to their actual vitals
       and clinical status.
      Don’t assume that medical device connectivity will be fast or easy to do on your own — you’ll
       need something like Qualcomm’s 2net platform. 2net is a trustable, Class I FDA-listed,
       standalone gateway with an embedded cellular component that sends clinical data truly “in the
       cloud” without requiring local internet connectivity. Medical data can be sent from devices in
       the same way that e-books can be read on Kindle devices – using 3G cellular, from mobile
       phones, and software APIs.
      Don’t always send patients to labs; instead, take labs to patients with mobile imaging and lab
       specimen collections that allow remote reading and web-based report distribution. It’s difficult
       for many rural communities to have their own full diagnosticians but mobile imaging centers
       and lab specimen “kiosks” can do the X-rays, take pictures, and perform collections and then
       send the data electronically to large populated centers where they can be “read” and analyzed;
       the reports can be distributed via secure e-mail or other web-based applications to doctors in
       the rural areas or physicians remotely available and connected through web meeting or other
       similar tools.
      Do try and make behavioral health, mental health, and related care made more accessible.
       Veterans of our foreign wars are coming home with many problems that can be easily diagnosed
       with proper access and many of the veterans live in rural communities; while primary care and
       specialty care is difficult to get in smaller population regions, behavioral and mental health is
       even harder to access. Telemedical assistance through online chat, Skype-like video
       conversations, and secure online messaging can provide quick relief.
      Don’t leave patients on their own and encourage them to join online communities. Online
       community building tools allow populated city citizens to meld with their rural counterparts.
       Patients helping other patients is a terrific approach to extending care; sometimes what a
       patient needs is not necessarily a health professional but a curated session with fellow patients
       going through the same problems. Online, electronic, community tools such as can connect geographic communities and bring them closer together
       without increasing costs or requiring anything more than a simple mobile phone or computer.

What do’s and don’ts would you add to a telemedicine strategy? Drop me a comment below.

January 13,2012


Do’s and Don’ts of mobile/mHealth strategy for hospitals and HCPs

I recently wrote, in Do’s and Don’ts of hospital health IT, that you shouldn’t make long-term
decisions on mobile app platforms like iOS and Android because the mobile world is still quite
young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A
couple of readers, in the comments section (thanks Anne and DDS), asked me to elaborate
mobile and mHealth strategy for healthcare professionals (HCPs) and hospitals.

A couple of the key points were:

      (Anne) how can you avoid making long-term mobile decisions at this point? After all, hospitals
       that don’t steer their doctors are going to be managing whatever technology the doctors invest
       in, aren’t they?
       (DDS) the risk is that people will take this to mean that they shouldn’t move at all on mobile app
        platforms, and this would be a mistake. This is the perennial issue with health IT; if it’s not
        perfect, then wait.

The approach I recommend right now for mobile apps, if you’re developing them yourself, is to
stay focused on HTML5 browser-based apps and not native apps. So, to answer Anne’s and
DDS’s question specifically, no you shouldn’t wait to allow usage of mobile apps by anyone;
but, if you’re looking to build your own apps and deploy them widely (not in simple experiments
or pilots) then you shouldn’t write to iOS or Android or WP7 but instead use HTML5
frameworks like AppMobi and PhoneGap that give you almost the same functionality but protect
you from the underlying platform wars. In the end, HTML5 will likely win and it’s cross-
platform and quite functional for most common use cases. If you’re not developing the apps
yourself and using third-party apps, then of course you must support the use of iOS native,
Android native, and soon Windows native apps on your network.

So, from a general perspective you should embrace mHealth but do so in a strategic, not tactical
manner. Here are the most critical questions to answer in a mHealth strategy — it’s not a simple
one size fits all approach:

       How will you allow doctors’ or patients’ own devices within your hospitals / organizations —
        simply by providing connectivity and wireless access on the production network or some other
       How will you allow doctors’ own devices to connect to hospital IT systems?
       How will you extend hospital IT systems via hospital-owned mobile devices?
       How will you allow the hospital or organization to “prescribe” the use of apps to patients and
        track the usage of apps?
       How will you approve or deny the use of certain apps that may not meet FDA regulations if they
        get close to MDDS or Class 1/2/3 devices?

If there is interest in this topic, I will expand on my list of Do’s and Don’ts — mHealth is a very
complex topic and requires a good strategy. Just saying that you allow the use of mobile devices
like smartphones in your hospital is not an mHealth strategy.

January 10,2012


MU attestation vendor data available for analysis

In case you haven’t seen it, MU attestations data is now available on and it includes
analyzable vendor statistics.
The data set merges information about the Centers for Medicare and Medicaid Services,
Medicare and Medicaid EHR Incentive Programs attestations with the Office of the National
Coordinator for Health IT, Certified Health IT Products List. This new dataset enables
systematic analysis of the distribution of certified EHR vendors and products among those
providers that have attested to meaningful use within the CMS EHR Incentive Programs. The
data set can be analyzed by state, provider type, provider specialty, and practice setting.

The data set does not include dollar amounts or the difficulty of attestation (e.g. how many times
it took to pass). I’ll try and find out if that data might be available in the future. It’s also unclear
whether the provider counts were broken up into each line (meaning one provider per row) or if
multiple providers were aggregated into lines (meaning multiple providers were grouped).

The dataset is available now on at and is worth
checking out. Since the file has been downloaded over 75 times, it’s clear some of you already
know about this so if you’ve done some analysis with it; if you’ve done any analysis or posted
results please drop me a note below so that everyone can benefit.

January 8,2012


Do’s and Don’ts of hospital health IT

Last year I started a series of “Do’s and Dont’s” in hospital tech by focusing on wireless
technologies. Folks asked a lot of questions about do’s and dont’s in other tech areas so here’s a
list of more tips and tricks:

       Do start implementing cloud-based services. Don’t think, though, that just because you are
        implementing cloud services that you will have less infrastructure or related work to do. Cloud
        services, especially in the SaaS realm, are “application-centric” solutions and as such the
        infrastructure requirements remain pretty substantial – especially the sophistication of the
        network infrastructure.
       Do consider programmable and app-driven content management and document management
        systems as a core for their electronic health records instead of special-purpose EHR systems
        written decades ago. Don’t install new EHRs that don’t have robust document management
        capabilities. Do consider EHRs that can be easily integrated with document and content
        management systems like SharePoint or Alfresco.
       Do go after virtualization for almost all apps – as soon as possible, make it so that no
        applications are sitting in physical servers. Don’t invest more in any apps that cannot easily be
       Do start looking at location-based asset tracking and app functionality; your equipment should
        be aware of where it’s physically sitting and be able to “find itself” and “track itself” using
        location-based awareness. Don’t invest heavily in systems that can not support location-based
        awareness (like potentially allow or disallow logins based on where someone is logging in from
        as well as enable / disable certain features in applications on where logins are occurring).
       Do start implementing single sign on and common identity management with CCOW integration.
        Don’t invest in any systems that cannot meet common identity or SSO requirements.
       Don’t make long-term decisions on mobile app platforms like iOS and Android because the
        mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere
        near being resolved. A platform that looks strong today may be weak tomorrow and become
        legacy quickly; however, HTML5 is not going anywhere and will be ultimate winner of the next
        15 years just like HTML4 is the winner from 1995 to now. Do start investing in HTML 5 and CSS3
        and away from HTML4. Don’t install any more apps that require IE6/7 or older browsers and
        don’t invest in systems that don’t have HTML5 in their roadmaps.
       Don’t write applications on top of legacy EHR platforms; write applications with proper HL7
        connectivity and platform independence. Most EHR platforms are using technologies that are
        either ancient or need to be replaced; by integrating deeply but remaining independent of their
        technologies you’ll get the best of both worlds.
       Don’t buy any medical devices from vendors that don’t have a deep and thorough medical
        device to healthcare IT enterprise connectivity strategy. If a device doesn’t have wired or
        wireless TCP/IP access, doesn’t have data export or HL7 connectivity is not worth purchasing.
       Don’t buy any thick-client applications that do not have thin-client “remote viewers” available.

January 2,2012


Preparing for EHR implementation with the AHRQ Health IT Toolkit for Workflow Assessment

One of the most important activities you can undertake before you begin your EHR
implementation journey is to standardize and simplify your processes to help prepare for
automation. Unlike humans, which can handle diversity, computers hate variations. Before you
begin your software selection process, get help from a practice consultant to reduce the number
of appointment types you manage, reduce the number of different forms you use, ensure that
your charting categories (“Labs”, “Notes”, etc.) don’t look different per patient type or
physician, determine how you will manage medication lists and problem lists across the patient
population, and deal with how you’ll manage paper in your digital world.

If you spend even just a few hours a week doing the prep-work before you buy any software, you
will be better prepared in your selection process. Without some level of standardization your
EHR implementation will either fail, be delayed, or have many unhappy users; the more you can
standardize and simplify, the more likely you will have a successful outcome. A strong project
manager with authority to make decisions will be the difference maker in the simplification
To help you with your workflow assessment and standardization efforts, check out the The
Agency for Healthcare Research and Quality ( Workflow Assessment for Health IT
Toolkit. Even if you’ve done workflow assessments before, the toolkit is worth checking out.

December 24,2011


Healthcare Cloud definitions should be based on NIST’s definitions

As most of my regular readers know, I work as a technology strategy advisor for several
different government agencies; in that role I get to spend quality time with folks from NIST (the
National Institute of Standards and Technology), what I consider one of the government’s most
prominent think tanks. They’re doing yeoman’s work trying to get the massive federal
government’s different agencies working in common directions and the technology folks I’ve
met seem cognizant of the influence (good and bad) they have; they seem to try to wield that
power as carefully as they know how. Since most of you are in the technology industry, albeit
specific to healthcare, I recommend that you learn more about NIST and the role it plays – they
can make your life easier because of the coordination and consensus building work they do for us
all. I, for one, was thrilled when NIST was picked as the governing body for the MU certification
criteria. These guys know what they’re doing and I wish they got more involved in driving
healthcare standards.

A few years ago NIST came up with the first drafts of the seminal definitions of Cloud
Computing; they ended up setting the stage for communicating complex technical concepts and
helping making “Cloud” a household name. After 15 drafts, the 16th and final definition was
published as The NIST Definition of Cloud Computing (NIST Special Publication 800-145) in
September. It’s worth reading because it’s only a few pages and is understandable by the
layperson. No computer science degree is required.

Yesterday I was speaking to a senior executive in the EHR space and we had a great discussion
on what healthcare providers are doing in terms of cloud computing and how to communicate
these ideas to small practices as well as hospitals. It reminded me of the numerous similar
conversations I’ve had with other senior executives we serve in the medical devices and other
regulated IT sectors. In almost every conversation I can remember about this topic over the past
couple of years, I had to remind people that NIST has already done the hard work and that we
can, indeed, rely on them. Most of the time the senior executive was unaware of where the
definitions came from so I figured I’d put together this quick advisory.

My strong recommendation to all senior healthcare executives is that we not come up with our
own definitions for cloud components – instead, when communicating anything about the cloud
we should instruct our customers about NIST’s definition and then tie our product offerings to
those definitions. The essential characteristics, deployment models, and service models have
already been established and we should use them. When we do that, customers know that we’re
not trying to confuse them and that they have an independent way of verifying our cloud
offerings as real or vapor.

Below I have copied/pasted from NIST 800-145 their key definitions. Imagine how many
debates you would avert with technicians at clients when, during conversations with a client, you
communicated some of the following information first, showed them how it was a “standard
definition” and handed them a copy of the publication, and then mapped your offerings and
discussions to the different areas. Your sales teams and the marketing teams would appreciate
the clarity, too.

Note that you do not need to map every offering you have to every definition – just start mapping
the obvious ones and then figure out how you can communicate the “gaps” as being not
applicable to your products / services or if those gaps will be filled in the future as part of your
roadmap. Treat these definitions as canonical but not inclusive – meaning that just because your
SaaS offering doesn’t fit every essential characteristic doesn’t mean that you’re not “cloud” – it
just means partially cloud.

If you’ve got questions about how to map your product offerings, drop me some comments and
I’ll assist as best as I can.

Here are the key definitions from NIST 800-145, copied directly from the original source:

Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a
shared pool of configurable computing resources (e.g., networks, servers, storage, applications,
and services) that can be rapidly provisioned and released with minimal management effort or
service provider interaction. This cloud model is composed of five essential characteristics, three
service models, and four deployment models.

Essential Characteristics:

On-demand self-service. A consumer can unilaterally provision computing capabilities, such as
server time and network storage, as needed automatically without requiring human interaction
with each service provider.

Broad network access. Capabilities are available over the network and accessed through standard
mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile
phones, tablets, laptops, and workstations).

Resource pooling. The provider’s computing resources are pooled to serve multiple consumers
using a multi-tenant model, with different physical and virtual resources dynamically assigned
and reassigned according to consumer demand. There is a sense of location independence in that
the customer generally has no control or knowledge over the exact location of the provided
resources but may be able to specify location at a higher level of abstraction (e.g., country, state,
or datacenter). Examples of resources include storage, processing, memory, and network
Rapid elasticity. Capabilities can be elastically provisioned and released, in some cases
automatically, to scale rapidly outward and inward commensurate with demand. To the
consumer, the capabilities available for provisioning often appear to be unlimited and can be
appropriated in any quantity at any time.

Measured service. Cloud systems automatically control and optimize resource use by leveraging
a metering capability1 at some level of abstraction appropriate to the type of service (e.g.,
storage, processing, bandwidth, and active user accounts). Resource usage can be monitored,
controlled, and reported, providing transparency for both the provider and consumer of the
utilized service.

Service Models:

Software as a Service (SaaS). The capability provided to the consumer is to use the provider’s
applications running on a cloud infrastructure2. The applications are accessible from various
client devices through either a thin client interface, such as a web browser (e.g., web-based
email), or a program interface. The consumer does not manage or control the underlying cloud
infrastructure including network, servers, operating systems, storage, or even individual
application capabilities, with the possible exception of limited user-specific application
configuration settings.

Platform as a Service (PaaS). The capability provided to the consumer is to deploy onto the
cloud infrastructure consumer-created or acquired applications created using programming
languages, libraries, services, and tools supported by the provider.3 The consumer does not
manage or control the underlying cloud infrastructure including network, servers, operating
systems, or storage, but has control over the deployed applications and possibly configuration
settings for the application-hosting environment.

Infrastructure as a Service (IaaS). The capability provided to the consumer is to provision
processing, storage, networks, and other fundamental computing resources where the consumer
is able to deploy and run arbitrary software, which can include operating systems and
applications. The consumer does not manage or control the underlying cloud infrastructure but
has control over operating systems, storage, and deployed applications; and possibly limited
control of select networking components (e.g., host firewalls).

Deployment Models:

Private cloud. The cloud infrastructure is provisioned for exclusive use by a single organization
comprising multiple consumers (e.g., business units). It may be owned, managed, and operated
by the organization, a third party, or some combination of them, and it may exist on or off

Community cloud. The cloud infrastructure is provisioned for exclusive use by a specific
community of consumers from organizations that have shared concerns (e.g., mission, security
requirements, policy, and compliance considerations). It may be owned, managed, and operated
by one or more of the organizations in the community, a third party, or some combination of
them, and it may exist on or off premises.

Public cloud. The cloud infrastructure is provisioned for open use by the general public. It may
be owned, managed, and operated by a business, academic, or government organization, or some
combination of them. It exists on the premises of the cloud provider.

Hybrid cloud. The cloud infrastructure is a composition of two or more distinct cloud
infrastructures (private, community, or public) that remain unique entities, but are bound
together by standardized or proprietary technology that enables data and application portability
(e.g., cloud bursting for load balancing between clouds).

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News and Views

Entegration Blog
Managing the health of your network
September 28,2011


Entegration, Inc. announces new client – RMA of New York

Entegration, Inc. announces new client Reproductive Medicine Associates of New York Morristown, NJ –
Sep 29, 2011 – Entegration, Inc. (Entegration) is pleased to announce that Reproductive Medicine
Associates of New York (RMA of New York) has signed on as a new client. RMA of New York is a full-
service fertility center specializing in in [...] Related posts:

    1. Every Medical Practice Needs a CIO
    2. Network Costs of an EMR Implementation
    3. The dangers of cloud computing

September 10,2011


7.9 million records breached and counting

According to a report to Congress from The Department of Health and Human Services (HHS), there
have been almost 8 million records breached since 2009. That is a staggering number. What is worse it
that the number of data breaches continues to increase. Another way of looking at it is that we are only
in [...] Related posts:

    1. Every Medical Practice Needs a CIO
    2. HIPAA Security Rule Implementation
    3. HIPAA Security Rule Risk Analysis and Management

August 28,2011


Disaster Recovery planning can be high tech and low tech

 It has been a turbulent week on the East Coast. We have had a rare 5.9 earthquake and have been hit
by a Category 1 hurricane that have left millions without power and has caused major flooding. So
naturally I have been thinking about Disaster Recovery. It really takes extreme cases like the past [...]
Related posts:

    1. Every Medical Practice Needs a CIO
    2. HIPAA Security Rule Implementation
    3. Disaster Recovery for everyone

August 12,2011


Anyone can fall victim of a phishing attack

I woke up this morning to see that while I was sleeping I somehow managed to send out about 100
Twitter direct messages with a message saying: “You look different in this photo.″
Needless to say, I didn’t actually send the direct messages and was a victim of a phishing scam. I
received the [...] Related posts:

    1. OCR gears up for HIPAA / HITECH Audits
    2. Privacy breaches affect 3.4 million individuals and counting…
    3. 2010 Data Breach Investigations Report

August 4,2011


Details of the HIPAA audits

Health Info Security has published the transcript from an interview with Susan McAndrew of the
Department of Health and Human Services’ Office for Civil Rights. The article is very good and should be
read in its entirety. Below are some of the key points. When asked if business associates as well as
covered entities will [...] Related posts:

    1. HIPAA Security Rule Implementation
    2. EMRs are like guns in the wrong hands
    3. The perfect storm for data breaches
July 27,2011


Phishing should be one of your security concerns

I write a lot about network security, HIPAA and protecting patient data. I truly believe that these
concerns should be on the top of every healthcare organization’s security list. But recently something
has hit my radar that concerns me even more. Phishing has always been a problem but now it seems like
an epidemic. Let’s [...] Related posts:

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MedTech and Devices

Heart Staple
April 1,2011


How To Read an EKG?

                                               The P Wave P waves are caused by atrial
depolarization. In normal sinus rhythm, the SA node acts as the pacemaker. The electrical
impulse from the SA node spreads over the right and left atria to cause atrial depolarization. The
P wave contour is usually smooth, entirely positive and of uniform size. The P wave duration is
normally less than 0.12 sec and the amplitude is normally less than 0.25 mV. A negative P-wave
can indicate depolarization arising from the AV node.

Note that the P wave corresponds to electrical impulses not mechanical atria contraction. Atrial
contraction begins at about the middle of the P wave and continues during the PR segment. The
PR Segment PR segment is the portion on the ECG wave from the end of the P wave to the
beginning of the QRS complex, lasting about 0.1 seconds. The PR segment corresponds to the
time between the end of atrial depolarization to the onset of ventricular depolarization. The PR
segment is an isoelectric segment, that is, no wave or deflection is recorded. During the PR
segment, the impulse travels from the AV node through the conducting tissue (bundle branches,
and Purkinje fibers) towards the ventricles. Most of the delay in the PR segment occurs in the
AV node. Although the PR segment is isoelectric, the atrial are actually contracting, filling the
ventricles before ventricular systole.

The QRS Complex In normal sinus rhythm, each P wave is followed by a QRS complex. The
QRS complex represents the time it takes for depolarization of the ventricles. The Q wave is not
always present. The R wave is the point when half of the ventricular myocardium has been
depolarized. The normal QRS duration range is from 0.04 sec to 0.12 sec measured from the
initial deflection of the QRS from the isoelectric line to the end of the QRS complex.
Normal ventricular depolarization requires normal function of the right and left bundle branches.
A block in either the right or left bundle branch delays depolarization of the ventricles, resulting
in a prolonged QRS duration.

The ST Segment The ST segment represents the period from the end of ventricular
depolarization to the beginning of ventricular repolarization. The ST segment lies between the
end of the QRS complex and the initial deflection of the T-wave and is normally isoelectric.
Although the ST segment is isoelectric, the ventricules are actually contracting.

The T Wave The T wave corresponds to the rapid ventricular repolarization. The wave is
normally rounded and positive.

May 1,2010



April 27,2010


Recipes for Heart Attack!!
April 22,2010


Happy Earth Day Today with Top Ten Actions!

Top 10 actions
                                                                              Earth Day
Canada president Jed Goldberg has identified his top 10 actions to make every day Earth Day.

1. Think before you act. Shopping has become a form of entertainment. While it can be difficult
to avoid the seduction of advertising, Goldberg advises to think about what you need, not what
you want, before you buy.

2. It’s all about conservation. Goldberg says we need to make the shift from being “consumers”
to “prosumers” – producing consumers – to conserve energy and resources. Planting a garden is
a great way to start.

3. Go vegetarian one day a week. Meat production has a huge environmental impact. Eating
lower on the food chain just one day a week helps to conserve water, reduce greenhouse gas
emissions and preserve valuable farmland.

4. Rethink convenience. Goldberg says people do things because they perceive that it’s easier,
but easy isn’t always what’s best. Doing things in an environmentally responsible way can
ultimately end up being more convenient and much cheaper, too! One example, stop buying
bottled water and use tap water instead.

5. Eat and shop locally. Most of our food travels thousands of kilometres to get to our dinner
plates. Ditto for our clothing and other consumers goods. Supporting local businesses also helps
to build strong local communities.

6. Vote with your dollar. Advertisers and producers are conscious of what consumers want says
Goldberg. Take the time to express your opinion to store owners with your wallet and your

7. Use active transportation. Whether it’s walking, cycling or rollerblading, when you use your
body to get from A to B instead of a motorized vehicle, you not only get the benefit of improved
fitness while reducing your environmental impact, but you get to experience your community.

8. Borrow, don’t buy. Consider renting, borrowing or sharing what you need.

9. Refashion your yard. Instead of trying to achieve the perfect, lawn, why not get rid of the lawn
altogether. Plant native shrubs, wildflowers or a vegetable garden. You’ll use fewer resources
and free yourself from the lawnmower, too!
10. Use your sphere of influence. Collectively we have a great influence over our politicians,
says Goldberg. Engage your family, friends, coworkers and community.

More info at

April 18,2010


Little Known Ways to Control Glucose Level to Prevent Diabetes

Our pancreas is affected by diabetes – specifically, Type 2.Our body contains glucose found in
the blood stream, which it gets from the sugar in food. Our body uses the glucose, but only when
it goes into our blood cells and the insulin released by our pancreas converts it. Insulin
production and utilization is difficult for someone who lives with Type 2 diabetes .There is a lot
of glucose in the body, but your cells cannot locate them.

The American Diabetes Association has the duty of looking for information regarding this
important medical condition. 23.6 million individuals living in America currently have diabetes,
and because of this the country is seen as very unhealthy. Ninety percent of this figure has been
diagnosed with Type 2 diabetes. Diabetes and the tendency to be overweight usually run in the
family. If there is too much glucose in your body, it could result in serious internal organ damage
and affect one’s nervous system.

Living with Diabetes

A life with Type 2 diabetes is best lived in a healthy way. Diabetics will find that healthy
practices will have a huge effect on them. Simple actions like eating healthy food and exercising
are considered as healthy practices. Keeping the levels of your glucose within the appropriate
range ensures you stay away from health complications.

To check the levels of blood glucose in your body, you can do the common finger prick test.
Physicians say that such a test is comparable to the HbA1c test when tracking the glucose
fluctuations in your body. This HbA1c test works by determining how high your glucose levels
are and by identifying the blood’s exact glycated hemoglobin percentage. According to results of
the A1c tests, people who have diabetes maintain their levels at seven percent. A seven percent
maintaining level of a1c, according to the CDC, can dramatically reduce the risks of this disease
by around forty percent.

Too-Tight Controls

Many studies in the medical field show that if your a1c levels are below seven percent it could
mean a bad thing. People who use insulin and people who have median a1c levels have a higher
death risk, according to the Seattle Lancet and Swedish Medical Center’s studies. Other tests
maintain that keeping your a1c level at seven percent is still on the healthy side. Accredited
endocrinologist Matt Davies shares that seven percent is healthy but it is still important for
physicians to consider a patient’s medical history before implementing treatment.

About the Author – Kristina Ridley writes for the bloodless glucose meter blog , her personal
hobby blog focused on healthy eating and tips to measure blood glucose levels at home to help
people understand early diabetes symptoms.

April 6,2010



SmartOne ECG is a self-service consumer portable heart monitor for checking abnormal heart
The device can safely measure electrical activities of the heart using one’s finger tips without the
need for any trained technician.Upon placing thumbs on the sensor panel of the portable ecg
machine,a digital output of the heart rhythm is displayed.If the reading displays any abnormal
heart rhythm,it indicates the user the type of abnormal heart rhythm.Atrial fibrillation is an
important risk factor for stroke.

According to the WHO,15 million people worldwide suffer a stroke. Of these, 5 million die and
another 5 million are left permanently disabled, placing a burden on family and community.

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A recent survey findings of Californians shows that patients and physicians not discussing end-of-life care
Key findings include About of Californians said they would want to discuss end-of-life care with their
physician if they had a serious illness Only

January 18,2012


Engaging Staff with Social Media

The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying
Your Customers column, titled Engaging Staff with Social Media. In the article I describe how
successful leaders will prepare for the shifts occurring in the healthcare workplace; including the
push for efficiency and new generations. I also include a few examples of where social media is
contributing to a more effective workplace in hospitals.

Social media technologies are tools that can help increase customer, physician and employee
satisfaction. I hope you will take the time to read the article and share your thoughts.

Another blog post that includes a few great workplace examples is list of 20 hospitals with
inspiring social media strategies.

January 17,2012


Is Age Just a Number, or a Challenge to Widespread HIT Adoption?

I was interviewed for a recent article in Becker's Hospital Review that explores the common
belief that older adults have more difficulty accepting and using technology. It includes some
great comments about "digital natives" and "digital immigrants" by the other interviewees.

Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has
embraced technologies as I have found value to my work and life. And, I believe that this
applies to older adults in general. There are differences in the generations and the oldest may
need the most convincing and support, but it isn't that they can't incorporate technology into their
daily life.

I remember older adults thinking it was a bit silly for people to carry around a cell phone. But,
once they began to realize value - they feel safer because they can call for help -- then older
adults start using the technology just as anyone else. If I'm correct, I also I believe this is how
telephone adoption went. It took a long time for it to catch on and for people to find value in the
Health IT is just one more advancement that needs to progress through the adoption cycle.

January 15,2012


Candy Stripers and Junior Volunteers

I've posted on the subject of volunteers, young people working in hospitals and those considering
a career in healthcare administration, previously. However, this last week, I've been specifically
researching Candy Stripers, who are sometimes referred to as Junior Volunteers.

                                                                 Candy Stripers at Doctors Memorial Hospital, FL

I'd love to here your thoughts or stories about the youngest of our hospital workforce! If you
prefer something more personal, send me an email: Christina {at} cthielst {dot} com

I'm thinking I should also start researching the Pink Ladies, too!

January 12,2012


ACP Ethics Manual on Social Media, Catastrophes, and More

The American College of Physicians has released an update to its Ethics Manual and new or
expanded sections include, among others, confidentiality and electronic health records, health
system catastrophes, boundaries and privacy, social media and online professionalism. I really
appreciate the manual and have pulled out a few key points based upon the topics I cover often
on this blog.

      Communication through email or other electronic means can supplement face-to-face
       encounters; however, it must be done under appropriate guidelines. Issuance of a prescription
       or other forms of treatment, based only on an online questionnaire or phone-based
       consultation, does not constitute an acceptable standard of care. (Exception: on-call situations)
       (pg 75)

      Shifting principles guide the patient-physician relationship during catastrophes and physicians
       need to be prepared for decision making and the just delivery of healthcare. (pg 80)

      Physicians who use online media, such as social networks, blogs, and video sites, should be
       aware of the potential to blur social and professional boundaries. They therefore must be
       careful to extend standards for maintaining professional relationships and confidentiality from
       the the clinic to the online setting. Physicians must remain cognizant of the privacy settings for
       secure messaging and recording of patient-physician interactions, as well as, online networks
       and media and should maintain a professional demeanor in accounts that could be viewed by
       patients or the public. (pg 81)

All Changes to the Manual since the 2005 (fifth) edition
January 11,2012


Report on Hospital Acquired Infection in CA Released

Healthcare-associated infection data on all hospitals in Califorinia has been released by the
California Department of Public Health (CDPH). This means anyone can see the nosocomial
infection rates of their local hospital by unit. But, I urge some caution among consumers with
comparing rates of different hospitals and units. Instead, this data should be used to prepare
questions and for a discussion with your physician or the hospital. Hospitals may be interested
in using this data to benchmark themselves against other hospitals.

Healthcare-associated infections (HAIs) are infections that patients develop during the course of
receiving healthcare treatment for other conditions. They can happen following treatment in
healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers,
long-term care facilities such as nursing homes, rehabilitation centers, and community clinics.
They can also occur during the course of treatment at home. They can be caused by a wide
variety of common and unusual bacteria, fungi, and viruses.
HAIs are the most common complication of hospital care, occurring in approximately one in
every 20 patients. The following HAIs occurring in hospitalized patients are required to be
reported to the CDPH by all California general acute care hospitals:

        Central-line associated bloodstream infections;
        Clostridium difficile infections;
        Methicillin-resistant Staphylococcus aureus (bloodstream)
        vancomycin-resistant Enterococcus (bloodstream)
        Surgical site infections

Data is also available on a couple of hospital practices that that contribute to a reduction in HAI
rates and length-of-stay.

        Central-line insertion practices
        Staff influenza vaccination rate

January 10,2012


Gartner Worldwide IT Spending Forecast

I participated in this morning's Gartner Worldwide IT Spending Forecast. Gartner, the technology research giant,
brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially
at this moment in time. The issues will have major revenue implications for vendors (perhaps leading to service
changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.

The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of
hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to
meeting demand. There is some uncertainty about this timeline.

This means:

        There will be storage and server component shortages. Storage will not be cheap and providers will need
         to be efficient.
        Virtualization (the cloud) may be a more affordable option.
        We can expect longer lead times for delivery, backlogs and double ordering of products.
        We can expect an increase in costs over the short term (re-assess those budget projections you made last

One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of
components to help prevent business disasters like this one. In this case all of our (the world's) eggs (hard drives)
are manufactured in one basket (Thailand).
PC and software spending is down due to the downturn in the economy. But, there was one bit of good news that I
pulled from the discussion on software. Spending on software (tools) for collaboration is increasing. Companies are
investing in technologies that will help them stay competitive and this means tools that will help their employees
collaborate will reduce the need to bring on additional people.

Now, I've been seeing this in other industries and have started to see it trickle into healthcare. With health reform
upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage
collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.

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April 21,2011

Emerging from the Radio Silence

Peeps – sorry for the radio silence. Will make it up to you with this:

January 4,2011


Hewing Away: Its all in the eye of the sculptor

                                             Hew (hyū) v.

    1. To make or shape with or as if with an ax
    2. To cut down with an ax

“In every block of marble I see a statue as plain as though it stood before me, shaped
and perfect in attitude and action. I have only to hew away the rough walls that
imprison the lovely apparition to reveal it to the other eyes as mine see it.” –
                        An unfinished Michealangelo sculpture.

I just re-read this quote – I think it is a powerful metaphor for any innovator that is out
there trying to change the world.They are the ones that can see the fully defined, fully
articulated, and fully functional end product within the building blocks that others
pass off as mere landscape material. I think this gift of vision – this ability to “see”
what others cannot – and the doggedness to stick to the mindless chipping away until
others can see it enough to give you the tools you need to finish it off.

We are privileged to be working on a HUGE project right now with a highly
innovative company that sees the value of what we are doing and wants to be a part of
changing health care. It has been fun to work with them to begin the process of
“hewing” away and to literally see the game changing product we have always seen
begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding
fingers. The process of discovery and refinement is almost as fun as seeing how the
end product will move people.
December 21,2010


NJ ACO: A Sheep in PHYCORE Clothing

I am on an email list of Bill DeMarco’s, a reputable industry insider who has written and
consulted extensively in the physician group and medical management space. He recently sent
me a note about several physician aggregation events in New Jersey.

For some reason it struck a nerve with me . . . which led me to fire off the response below:


I thought we already saw this movie?

My question for you . . . besides banding together in some megagroup – what are these
physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword
excuse to aggregate physicians under a new moniker and a supposed new model.

I am highly suspect that these physicians are doing anything to change the relationship with their
patients, to use enabling technology to create team based care, or actually be accountable for the
outcomes they produce. What systems are they using to tie themselves together? What financial
alignment do they have? What measures are they using to demonstrate superior outcomes? What
about the patient experience – 7 minute visits that push pills as the “treatment” won’t get it done
in the future.

I think your closing statement, “Representatives from Summit and Optimus were unavailable for
comment” says it all.

Am I seeing this the wrong way? Is there anything new about this model this time around? Am I
getting old enough to see these things cycle through?

PS – and no, I don’t mean a wolf. The sheep get nervous and band together waiting to get
pounced on by wolves.

December 15,2010

Unsustainable: Worth a Thousand Words

I don’t even think there is anything to say about this picture:

This is why our health care system as current constructed is a massive #FAIL. Obamacare does
NOTHING to change this.

November 25,2010


Getting Real: Can Health 2.0 Stay Relevant?

                                      Relevant (rĕl’ə-vənt)

1. Having to do with the matter at hand; to the point

I read with amusement Susanna Fox’s redux review about the relevance of Health 2.0 in general
and in changing patient’s behavior specifically. Here questions reveals her bias in a very limited
definition of Health 2.0 that I attempted to abolish originally in some of my bantering with
Matthew Holt. I always saw Health 2.0 as a “movement” that would not be defined so much by
its technology but rather enabled by it. As an “enabler”, the technology can help people do new
things in new ways but I never believed technology in and of itself had the power to truly
change health, health behaviors, or health care delivery in and of itself.

That is why my definition of health 2.0 was always more expansive and contemplated an entire
“movement” to the next generation health care “system”. This new system must include new
delivery models, new financing mechanism, and the new tools and technology that bring all of
this together in a simple, efficient, and affordable way. Clearly this next generation of care
would include technology, the new tools, but until we had a new delivery system that is financed
in a new way we are going to continue to have the same behaviors across the patient, physician,
provider, and payor continuum.

So Susanna, I don’t think your version of Health 2.0 (Tools and Technology) do much to get us
to the behavior change you seek. In fact, getting to the root of behavior change requires almost a
religious experience. Interestingly enough, the health care industry provides plenty of “religious”
experiences including passing close to death, unbelievably poor customer experiences that
invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we
currently enjoy. So while the tools and technology show us what is possible, health care delivery
and health finance are the catechismal doctrines we must reform first that actually incent the
behavioral change we all seek.

So is Health 2.0 Relevant? I think it depends on your definition!

November 4,2010


Extirpating the “Health Insurance” myth

                                 Extirpating (ĕk’stər-pāt’) v.

   1. To pull up by the roots.
   2. To destroy totally; exterminate.
   3. To remove by surgery.

I recently took a great road trip with my two boys. We rented one of the new Kia Soul’s which
my boys recognized from a very funny commercial developed to highlight its hipster (hamster?)
vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from
Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy
between two distinct choices.
This modern reinvention of that age old contrast struck me because it is something that I deal
with everyday in explaining Crossover Health to people. It all stems from a pervasive
misconception about the term “Health Insurance”

Understanding the components parts of our modern conception of "Health Insurance" is the our
first step toward meaningful reform.

The challenge is that “Health Insurance” is a confused term which most people equate with both
Health Care (care delivery) and Health Finance (how you pay for it). Our current employer
based system (wherein your employer provides and in most cases pays for your insurance) as
well as a third party insurance payment system (we have the insurance pay for us) creates all
kinds of weird incentives but also results in no accountability in terms of cost, quality, or
outcome. It is currently imploding before our eyes.

Our reaction, both opportunistic as well as obligatory, is to do something totally different by
blowing up the current Health Insurance model and separating out Health Care from how you
pay for it (Health Financing). We say that there is a better way to do BOTH – pay your
physician directly for the care you need and then get smart about how you pay for it with the
right insurance product. In fact, you should “self insure” with the highest deductible plan you can
find and then take responsibility for your health for all the small stuff or hire someone to do that
for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate
with a parasitic organizations that are taking your premium dollars and wasting it on overhead,
fancy offices, mindless phone trees, and my all time favorite “this is not a bill” disinformation
As people begin to take this in (they always get how the practice model is a radically
improvement), they immediately revert back to the combined “Health Insurance” concept. Does
Crossover Health want to replace my current “Health Insurance”? The answer is slightly
nuanced, but a resounding YES! I want to replace what you call “Health Insurance” with a
direct “Health Care” product (Crossover Health) and a smarter Health Finance product
(highest deductible you can get).

We believe there are large and significant opportunities to roll this into a single product that can
be purchased by employers, families, and other organizations seeking fresh alternatives that can
demonstrate not only trend bending improvements but trend busting outcomes.

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January 16,2012


Electronic Health Records and the challenge of Unstructured Data
By Sheldon Needle

The real problem of an established medical practice moving into the realm of EHR is not the cost
of the medical software package; it is not the training necessary for staff; and it is not security
and backups.

The real problem of moving into EMR/EHR is the problem of unstructured medical data.

If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious
search to compare medical software vendors who are available to answer your questions
honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s
blood pressure or lab test values. You can get used to that.

Neither is it difficult to take notes on a notebook that upload to the EHR system.

The real problem is taking your notes and dictation on a patient that go back 15 years and finding
a way to get his possible symptoms, his worry about IBS, his headache history, and his worries
over his children into a metrically available rendition that that does not take you or a member of
your practices days to decipher. These notes are usually on dictation, hand written notes, and
referral letters.

The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear
symptoms may not translate easily into metrics but may be critically important in future

There are two critical questions here:

   1. 1) Is it worth it? and
      2) If it is worth it, what to do to make this work efficiently?

In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest
of our cultural world, is becoming electronically-based whether we like it or not. But in the long
run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself,
and having all his data available to the admitting doctor in an instant: blood type, history, etc.

Think of a patient being referred to you, the specialist, and having all his patient history available
in less than a minute. What a time saver! What insight!

Medical informatics has a number of methodologies it is using to translate unstructured data into
useful and structured data.

Three basic methodologies exist to accomplish this:

      String matching
      Natural language processing for Medicine (NLP), which uses syntactic rules in extracting data
       from text documents
       Concept-based indexing which uses data base codes to group and relate medical concepts

These methods will be refined, utilized, and integrated in some way into most decent medical
vendor software packages over the next few years. For you the physician or practice manager,
this may start to pay off in a while, but you still have to get from hand written records into the

The obvious way to proceed makes use of our culture idea of, “going forward”:

   1. Start with today’s records being input into the database electronically – this is the easy part.
   2. Then get help in moving 1 year of back data scanned and automated. Get someone technically
      savvy and talk to the support people whose EHR software you are considering about OCR
      (optical character recognition) software that may be available from vendors.
   3. Most vendors of decent repute will have voice recognition software incorporated into their total
      EHR solutions. Have them demonstrate how well it works in moving data into their files.

The real message to practitioners moving to electronic health records is, don’t look at the top of
the mountain when you start climbing, just put one foot in front of the other. Delaying the climb
will not get you anywhere, but starting the march will move faster than you think!


January 10,2012


Don’t let Poor Planning Make the Migration to EMR/EHR More Difficult

Having recently spent time as an observer in a hospital setting, I was struck by the lack of
intelligent planning and forethought made for doctors trying to move into an EMR / EHR

Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR
being used to record certain patient data, doctors were taking their notes in long-hand. Later on
the same day I saw the same doctors transcribing their notes onto their computers. The doctors,
doing double duty on note taking were not available to their patients because they were acting as

When a large clinical environment is incorporating an EHR it has to be done in a modular way
that does not impact productivity any more than it has to. The task is hard enough. If you are
using an EHR to record point of care patient information, give your doctors a Notebook so they
can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change
with some forethought to peoples’ time and effort.

This real-life observation just underscores the need to plan for transition to an EMR rather than
throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful
Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper
Paratus! Always be ready and prepared.

Most good EMR / EHR systems can offer medical clients some guidance as to best practices in
incorporating EMR / EHR systems within their practices.

December 29,2011


EHR for Doctors in 2012: What to Expect, What to Avoid

By Sheldon Needle

The prospects for EHR in the coming year are exciting but more than a little daunting. The issue
is really how to find an EMR/EHR system that will organize and centralize the functions of your
practice, without bankrupting you and throwing your staff and yourself into turmoil.

If you look at the websites for EMR vendors today, you can see that the functions they describe
within their system –the integration of clinical records with practice management data, e-
prescription, patient portals — could conceptually do wonderful things for you and for your
patients in the way you handle their individual cases, but many of the details are still not working

Here are some of the things to be aware of:

   1. If you are getting a client/server system, make sure your internet connection has the bandwidth
      to support the sheer number crunching your system will need. Otherwise your system may well
      freeze up on you or move at the speed of molasses.
   2. If you are a small practice and getting SAAS software, hurray for you! This could be just the right
      way to move towards EMR. But beware of sticker shock. The prices quoted to you on-line for
      monthly subscriptions to SAAS may well not mention additional fees you need to pay for
      licensing, installation, initial training. Make sure everything is clearly stated in your contract.
   3. Think hard about how you are going to transition your current paper based system to digital
      records. Who will do the scanning? What will you do with your dictation? The whole issue of
      free form data (things like scanned documents that need to be OCR’ed in order to get into the
      database, your dictated notes, etc.). It is not enough to just get everything on paper scanned.If
      you can afford to get a service that does transitions like this for a reasonable fee, consider this
      as a viable strategy. It may save you lots of headaches.
   4. Not everyone can necessarily get the benefit of “Meaningful Use” incentive payments right
      away. It will depend on the nature of your practice, your specialty, your patient base, as well as
      how many Medicare or Medicaid patients you service, just to name a few variables. Do not let
      “Meaningful Use” be the only criterion you use in evaluating EMR software.
   5. Find a company that will do serious training for you and your staff, and will not nickel and dime
      you for every question you have for them as you move into the implementation and use phase.

Remember, always read the fine print and ask every question you need to. Know that EMR
software decisions is a very competitive business. The vendors need you just as much as you
need them!

December 23,2011


What is the 5010 Standard and What Does it Have to Do with the Electronic Health Record?

By Sheldon Needle

5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA
transaction standards regulating electronic transmission of medical and healthcare transactions.
The existing standard is called 4010, and 4010 does not support ICD-10 coding.

The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived
its possibilities –it limits the number of new procedure and diagnostic codes that can be created.

This is how the (center for Medicare and Medicaid services, at:
defines the ICD-10:

About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical
Modification/Procedure Coding System) consists of two parts:

   1. ICD-10-CM for diagnosis coding
   2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3
to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric
digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under
ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure

The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic
transmissions including claims, eligibility inquiries and remittance advices must be made in a
5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions
are all expected to upgrade their transmissions. Non-compliance may result in claims denied or
slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are
contemplating buying a system that is so certified, you do not have to worry about the software
compliance, but you do need to educate your staff, including yourself, if you are the physician or
the P.A., on what the differences between 4010 and 5010 mean to their everyday work.

If you are using old medical software that has not been updated, or are contemplating installing
software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer
version, or face delays and uncertainties in your billing and claims submission. In other words,
do some serious upgrading, or else!

December 4,2011


White House Pushing Hard to get Doctors to embrace EHR

By Sheldon Needle

November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the
adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices
and hospitals nationwide, which will improve health care and create jobs nationwide.

The new administrative actions announced today, which will be made possible by provisions of
the HITECH Act, will loosen requirements for doctors and other health care professionals to
receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said
Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many
doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today,
we are making it easier for health care providers to use new technology to improve the health
care system for all of us and create more jobs.”

The press release continues to state: “HHS also announced its intent to make it easier to adopt
health IT. Under the current requirements, eligible doctors and hospitals that begin participating
in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet
new standards for the program in 2013. If they did not participate in the program until 2012,
they could wait to meet these new standards until 2014 and still be eligible for the same incentive
payment. To encourage faster adoption, the Secretary announced that HHS intends to allow
doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014.
Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The
italics are ours.)

We need to understand what acting quickly means: buying in 2011? Incorporating EHR within
the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of
incentive payments to doctors and hospitals and vendors about stepping up the pace of
transitioning practices and HER software to meet standards of Meaningful Use. What
Meaningful use means to the individual practice depends on size, degree of implementation of
the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for
instance, figures into the formula of Meaningful Use.

The Obama Administration is working to create a nationwide network of 62 Regional Extension
Centers, comprised of local nonprofits, to help eligible health care providers learn how to
participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health

See the HHS press release, at: to
learn more.

Keep your eyes on the newspapers, government announcements and on this blog to learn about
EMR and EHR news and updates.

November 21,2011


What is Preventing your Medical Practice from Moving to EMR /EHR?

By Sheldon Needle

You know that your medical practice will have to bite the EMR bullet sooner or later (actually,
sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving
ahead at a planned pace rather than being forced into converting your medical practice to an
EMR at the 11th hour?

Here are some of the most common obstacles people face in converting their practices to the use
of electronic medical record software, and here are some strategies to deal with them or get the
process going:

1. How will we migrate from paper to digital images? Conversion of paper medical records to
digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does
it accept PDF files? JPG format? Ascii text files? Extracts from excel files?

Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of
paper files to convert, decide how many years back you need to go in getting your EMR up and
running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much
further back?

Look into the possibility of having a consultant specializing in data conversion take charge of
your files. There are companies that specialize in just such medical data conversions. If you are
really desperate, hire your responsible college students, make the specs clear, and pay her

2. How will we train everyone in such a new system? Training your self and your staff: Once
you have chosen your EMR system, engage the company’s own training staff; that way, you are
sure you are being oriented in the current system, using the right documentation. Before you
chose your EMR, see what kind of training options the company offers. You might go for a short
orientation up front, with a good help desk that is available 24/7. Check reliable Electronic
medical records ratings to see which companies provide good in person and on the phone / online

3. Do we have to set up all the hardware and maintain the software? I don’t think we can
manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and
commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which
you log onto an EMR that worries about security, and updates to hardware and software.

4. How can I compare products so that my practice knows what it is getting into? How
much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one
basket: While personal referral are extremely helpful and reassuring, not all are meaningful for
your unique EMR practice situation. There are many good EMR products to choose from, and
each has its strengths, and its weaknesses.

The right choice will depend as much on the nature of your medical practice and the answers to
many questions: What is your medical specialty? How many employees do you have? How
expensive is the EMR, per year? How much money can you dedicate to investing in your EMR
annually? Can you integrate your medical billing software with your proposed new EMR? Can
you afford to hire a dedicated IT employee? How comfortable you and the others in your practice
are with using an electronic device as the main source of medical input to your system. These are
just a few of the many questions you need to ask yourself.

Talk to people in other practices, yes; but learn to ask the right questions and compare apples to
apples and oranges to oranges. Great EMR comparison tools are available to you at no charge,
and they can educate you to ask the right questions and maintain a solid baseline for comparison
when choosing an EMR.

Blog url:

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Internet Journal of Emerging Medical Technologies

January 19,2012


New Device Uses Computer Game to Test Vision in Children

Researchers from the University of Tennessee Space Institute are developing a device which
should make eye exams in children a whole lot simpler. The device is called the Dynamic Ocular
Evaluation System (DOES) and it can screen the eyes for abnormalities, while the children watch
a cartoon or play a computer game. Here’s how it works:

        “DOES is low-cost, high-quality, and operator- and child-friendly. It takes about a
        minute to train someone to use it. The test is done as the child watches a three-
        minute cartoon or plays a computer game. Infrared light is used to analyze the
        binocular condition and the assessment is reported on-site within a minute.
        Neither eye dilation nor verbal response is required.

        Read More

January 19,2012


Hidalgo Unveils Equivital EQ02 LifeMonitor

Hidalgo out of Cambridge, England has released its new wireless Equivital EQ02 LifeMonitor
that can continuously record ECG, respiratory rate, skin temperature, and activity levels in
patients. Data is analyzed using special software for PCs, web and mobile devices and can
provide real-time results that can be immediately acted upon by clinicians.

Hidalgo’s technology has already been in use by UK’s Cambridgeshire Fire and Rescue,
Addenbrooke’s hospital, and the US Marine Corps in Iraq where wireless, mobile, and easy to
use devices save the day.
Read More

January 19,2012


Agfa DX-M Digitizer Supporting Phosphor Plates and Needle-based Detectors Coming to U.S.

Agfa received FDA clearance for its DX-M digitizer with needle-based detectors for use in
mammography and general radiography. It features the firm’s MUSICA2 advanced image
processing software, three image resolution modes (50 μm pixel pitch (20 pixels/mm), 100 μm
pixel pitch (10 pixels/mm) and 150 μm pixel pitch (6.7 pixels/mm)), a “drop-and-go buffer” for
cassettes so you don’t have to wait for the digitization, and a number of other features that
improve workflow.

The system can support both needle-based detector cassettes and standard phosphor plate
cassettes, and the two types are colored differently to eliminate confusion.

Read More
January 19,2012


Savile Row Unicondylar Knee Implant for a Personalized Fit

While joint arthroplasty has become impressively advanced over the past few decades, the
essence of the procedure still ultimately boils down to trial and error. Using pre-operative X-rays
and intra-operative sizing guides, joint surgeons pick from a pre-set list of joint replacement
“sizes.” Then, once the bone cuts have been made, temporary implants called “trials” are used to
see how the fit is, and the best fit is selected. Rarely are these pre-determined sizes a perfect fit,
but they are usually more than sufficient and function quite well.

However, in the quest for perfection, patient-matched custom implants are beginning to increase
in popularity. Stanmore Implants just announced the launch of their custom matched
unicondylar knee replacement system dubbed “Savile Row,” after the famous Tailoring
destination. Unicondylar knee replacements are used in patients with isolated arthritis in one part
of their knee and only replace the damaged portion.

Read More
January 19,2012


Contact Lenses for Extended Release of Anesthetics following Eye Procedures

Laser eye surgeries like LASIK and especially photorefractive keratectomy (PRK) can be painful
on the eyes for a few days following the procedure. To alleviate the pain anesthetic eye drops
are used, which have to be regularly administered by the patient. Not only is that inconvenient,
but one can actually overdose a bit on them drops.

Now researchers at University of Florida are reporting that they developed a way to load topical
anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion.
And since many of the patients that undergo eye procedures have been wearing contacts prior,
they’re already used to putting them on.

Read More

January 19,2012


Medtronic’s Endurant II AAA Stent Gets EU CE Marking
Medtronic announced receiving European approval for its Endurant II AAA Stent Graft System
and will be making it available globally.

The device provides a minimally invasive (endovascular) option for addressing abdominal aortic
aneurysms and includes a few improvements on the previous model:

Read More

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News and Views

MedTech and Devices

A Forum for discussion of EHR EMR implementation selection Meaningful Use and Certified EMR

January 19,2012


Preparing for HIMSS 2012 – #HIMSS12

It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12
preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a
newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real
planning. I just went and enjoyed myself.

As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people
that the core of my business is great content and advertisers. Turns out that every booth and
every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many
exciting things to try (and you might even say you get sick after “eating” too many as the flavors
all run together). To be quite honest, I love the entire experience. I was meant for the system
overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess
that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).

HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year
there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the
neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS,
I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t
find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies
exhibiting at HIMSS this year.
What does all this mean? Well, as my mother always told me: You can’t do everything. I’d
always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think
this describes my approach to HIMSS as well. Although, each year I am getting more selective
on what I spend my time doing.

Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the
Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I
have filed away already, I’m going to have to apply a pretty strict filter.

What then are my filters?

First, if you’re an EHR company, then I’m probably interested in connecting with you in some
form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then
I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just
EHR companies considering how many EHR companies there are out there. Plus, I think I’m
going to bring around my flip video and do an EHR series called “5 Questions with EHR
Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.

However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I
should look at things outside of EHR and they all said I should. I’m a man for the people, so I
must listen. How then could another healthcare IT company get me interested in meeting with
them at HIMSS?

The best way to get me interested in talking with your company is to provide something that will
be interesting, unique and insightful to my readers. Remember that my main goals are great
content and advertising. If you provide me with great content that my readers will love, then I’ll
love you and likely write about that content.

I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any
conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for
example. Instead, every person that I talk to I’m trying to discover what stories are being told at
HIMSS that are worth telling. I’m always happy when people help me find interesting stories.

Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect
with people is through social media and in particular Twitter (see this post I did on EMR and
HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the
charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of
the HIMSS Social Media Center summarizing the most important tweets during HIMSS.
Granted, that’s an almost impossible task to ask anyone to do.

Of course, the HIMSS related hashtags will be another great way to filter through the various
HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:

HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media
Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to
participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with:
Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer
Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/, Neil
Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community
and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I
always like to mix it up a bit.

New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm
to get Biz Stone to come to the HIMSS meetup.
Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s
been in the past. I personally like these dates better than the other ones.

There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d
love to hear if you’re going to HIMSS. If you know of any events, sessions, parties,
announcements, technologies etc. that I should know about at HIMSS, let me know.

And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.

No related posts.

January 18,2012


Collaboration is Key When it Comes to HIT Workforce Development

One thing that I love about this industry is its willingness to collaborate, and I’m not just talking
about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as
the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20
minutes later you’re going to have a new idea related to care delivery, product development or
possible partnership on your hands. It gets even more prolific when editorially minded marketing
folks like me are added to the mix.

I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month
in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore
Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT
certification programs with training and jobs. Some of you may have noticed several comments
left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at
Cincinnati State – a community college in the HITECH College Consortia; project manager at
the Kentucky Regional Extension Center; and creator of the, a free
resource to help students enter the HIT work environment.

In his comments, he advocates for a mentor-protégé program: “Students still need some more
help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing
students with industry professionals who can mentor them into the industry. I’ve passively done
that…to success. I think that will work.” He later followed up with the news that he hopes to
work with HIMSS, which is developing a similar program, to get this model off the ground.
I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to
find out just how he plans to jumpstart it:

It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think
there needs to be a more structured process so that students coming out of these [HITECH
College Consortia] programs who want to be mentored have a place to go, they know how to get
and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really
been tightly coupled with the workforce development program.

When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really
excited to talk with me, and pointed me to HIMSS’ career development page to look around and
see what they have out there. I’m thinking of how we can connect [what they’re already doing]
into the workforce development program within the overall HITECH project structure, so that we
can connect students who come out of these programs with their local HIMSS chapter, which
could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s
what’s really necessary to get people plugged into this profession – especially if they’re coming
from outside of this profession.

HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so
they’ve been developing their career development program. They’re near completion of a new,
entry-level certification called the CSHIMS certification. That is something where you don’t
need to have a whole lot of experience in health information technology, but you need to
demonstrate some degree of knowledge in subject matter to obtain that certification. That might
be a good way to help these students take the next step into the profession, when they’re looking
to get a job. That could be part of the whole mentorship program concept.

Isn’t there a double-edged sword to it financially? Wouldn’t students have to become
paying members of HIMSS, and then would they have to pay for certification? If they’re
looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and
becoming a member. There is a student membership discount. There’s a cost to certification,
obviously, so these are things that are to be considered. That has not escaped me, so that’s going
to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out

One of the things I want to be able to do is make this attractive for people, particularly students,
and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially
strapped, it becomes not just a double-edged sword, it becomes a disincentive.

I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS
chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for
students. So this might be something that the boards or the individual chapters could subsidize.
If you’re in the HITECH workforce development program, maybe HIMSS would be willing to
waive membership for one year. That might be something they may be interested in doing.

This is part of the whole brainstorming session that I’m going to try to have over the next month
or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up
with a good strategy by the end of February. And then we’ll start piloting it in the March

I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development
folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog
comments, might actually create job opportunity in the industry.

Related posts:

   1. Finding an EMR Job Champion
   2. Emdeon Gets in the Holiday Spirit with Donation of EHR Technology
   3. EMR Job Seekers Get Their Big Break

January 17,2012


Sad Illustration of Government’s Understanding of EHR

I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12
Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be
dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets
have been cut so much in past years that lawmakers won’t have to focus all of their initial energy
on budget shortfalls.

Most of the list is not surprising with managing the state budget and jobs are at the top of the list.
However, there are a couple healthcare and health IT related sections in their list of top
government issues as well.

One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is
making the Medicaid budgets in states a real challenge and many are looking for cost containing
actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical
homes and streamlining services. The ACO part was quite interesting to me. I wonder how much
of an effect lack of Medicaid budget will push forward a new model of healthcare.
The disturbing part of the report comes in the “Health: Reform in the states, health care
exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money
and HIEs.

       HEALTH INFORMATION EXCHANGE: One focus for state legislatures in
       2012 will be how to move health care providers, especially those participating in
       the Medicaid program, toward the adoption of certified electronic health records
       (EHRs). Essentially, instead of having a different health record at each doctor or
       provider you visit, an EHR will serve as one file that all of your doctors can see.
       EHRs, once fully implemented, are expected to provide doctors and health
       professionals with easier access to patient histories and data, resulting in cost-
       savings and better health outcomes by removing costly errors and duplications in

I love how this basically assumes that by having widespread adoption of EHR software, that
we’ll then have one patient record that each doctor you visit can see instead of having a different
health record at every doctor. Of course, those of us in the EHR world know that this is a far cry
from the reality of EHR software today. In most cases you can’t even share a patient record with
someone using the same EHR software as you let alone sharing a patient record with a doctor
who is using a different EHR.

The sad part is that whoever wrote these legislative issues must have realized that there was
some issue with EHR software exchanging information, because then they wrote the following
about the state HIE initiatives.

       In addition, states are responsible for building and implementing health
       information exchanges (HIEs) where those EHRs can be accessed by health care
       providers. HIEs function like an online file cabinet where your medical record is
       securely stored, and can be accessed by any doctor or health care professional you
       visit. By mid-year 2012, every state should have Medicaid EHR Incentive
       programs in place and will be working toward building an HIE by late 2014 or
       early 2015 as required by deadlines attached to federal cooperative agreements.

So, wait. If EHR software has created one file where any doctor can access our patient record,
then why do we need “an online file cabinet” for our medical records? We know the answer is
that we need the online filing cabinet because EHR software isn’t connected and there isn’t one
patient record. Each doctor maintains their own patient record and that’s not going to change any
time soon.

The above quote also implies that every state is working towards an HIE program per the federal
program. I must admit that I haven’t gone through every state, but is every state working on an
HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t
think that every state had funding for HIE. I guess maybe the question is whether there is any
state that doesn’t have some sort of HIE program in the works.
Reading issues described like this, you can understand how government passes legislation with
limited understanding. Based on this resource, EHR software creates one patient record.
Wouldn’t that be nice if it were the case?

Related posts:

   1. How do ACOs Deal with Non-compliant Patient?
   2. Watching the Leaves Fall and EMRs Install in North Carolina
   3. What’s Next in Health Information Exchange (HIE)?

January 16,2012


ONCHIT’s Healthy New Year Challenge

EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know
I have. My New Year resolution was a very unambitious I will exercise at least every other day,
and I couldn’t hold on to that for a week. However, all is not lost. Even if you’re falling short on
fulfilling your resolutions, you can still make a compelling video on some kinds of health IT
related resolutions and maybe walk away with a decent cash prize. Don’t know what I’m talking

The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants
need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.

Here are some examples listed on the ONCHIT website:

        I will set up an online personal health record for myself (or another family
        member) so I can have all of my health information conveniently stored in one

        I will ask my doctor for a copy of my own health records — electronically if
        available — and help him or her to identify any important information that may
        be missing or need to be corrected.

        I will find an online community that helps me figure out the best ways to manage
        my health condition (depression, cancer, diabetes, etc.)
        I will use an electronic pedometer to help me track my physical activity and will
        try to take 10,000 steps per day.

        I will find an app on my smartphone to help me track my food intake so I can lose
        10 pounds by my high school reunion.

        I will sign up for a text reminder program on my cell phone to help me stop
        smoking or remind me to take my medications on time.

Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to
get creative and create your own HIT resolutions.

Of course, being as it is 2012, and well into Web 2.0fication of our lives, it’s not enough to make
resolutions about improving our health. If you want to participate in the ONCHIT challenege,
you’ll have to find ways to incorporate health IT into your resolution. I’ve worked pretty much
my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT
can only solve some classes of problems, so I’m a bit wary when developers and programmers
bring their hey-I-can-create-an-app-for-that attitudes whenever they’re confronted with any
problems. That said, I do think some aspects of health IT can be useful. And I’m excited to see
what creative things people will come up with.

No related posts.

January 13,2012


101 Tips to Make Your EMR and EHR More Useful – EHR Tips 6-10

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR
More Useful. I met someone at a conference who commented that they liked this series of posts.
I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR

10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start
measuring something and displaying the results of that measurement, then the measurement
improves. Study after study has shown this.

9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff
to support every platform, every version, and every type of device out there. Tech innovation is
moving way too fast and an attempt to go this route will lead to failure. Create some standards so
you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.

8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get
as much data as possible and focusing on the time it takes to do things is one of the best places to
get data since this is incredibly important for users. Second, don’t shy away from the truth. If
your EHR software has doubled the time it takes to do something, don’t be afraid to find that out.
It’s better to know that there’s a problem and try to fix it than to let the problem fester because
you didn’t want to know the truth.

7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you
might want to find other IT. There’s no way that IT can help to design the proper system for the
clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need
to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true
when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing

6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you
Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real
forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able
to prepare for trends due to environment or time, make sure to have PA built into your EMR and
easily available for all providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page
with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Related posts:

   1. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85
   2. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 61-65
   3. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 41-45

January 12,2012

Digital Health Summit at CES and Stop SOPA

As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at
most conferences, it’s hard to blog about the happenings at the conference while attending the
conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES
Press Room. Although, I must admit that I haven’t found too many things all that impressive.
More on that later.

For today, I thought I’d give you a little picture view of what I call the Garden of Eden booth
that United Health Group has at CES (click twice to see full size image):

They seriously have grass on the ground and a wood path through their booth. Plus, they have
some of the only benches at CES (many really enjoyed those including myself). They’re also
doing the pedometer promotion they did last year at CES and that they did at mHealth Summit,
but this time you record your findings through the OptumizeMe app. I better win the iPad for all
the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in
the booth across from United Health Group. That was totally unfair (No, I’m not bitter).

Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get
the word out to more people. SOPA is an abomination that they’re trying to push through
Congress. Here’s the tweet I sent out recently about it:

       Join me & change your profile picture to protest SOPA:
       #BlackoutSOPA #vegastech #HITsm

       — John Lynn (@techguy) January 12, 2012

As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some
other places, likely including the blog logo above. I’m good with legislation that actually works
to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw
up the internet as we know it today. I hope others will join me in helping to stop SOPA. This
weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.

No related posts.
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MedTech and Devices

Health IT Corner
April 26,2010


Common Themes of Successful EMR Implementations

Over the last couple of weeks I have been running across various success and failure stories of EMR
implementation in various settings, ranging from small practices to large hospital wide
The number one factor in a successful EMR implementation from all the read reports have been due to
physician/surgeon buy in. Makes sense, after all these are end users of the applications and if you don't
have anyone on the provider side vying for a successful workflow adaptation, there is no reason to
implement an EMR. Also, if you have an M.D. as your champion, won't the rest of the staff have to buy
in for fear of replacement of someone who will? I know in other occupations, what the boss says, goes.
The true is same in healthcare, no?

The next seemingly most important factor is the ability to customize the application in a way that will
best benefit the providers. This is absolutely a main component in the success factor of an EMR in my
opinion. Vendors have to do what they can to include everything in their system that a practice, clinic or
hospital may use.

In a hospital system, this problem is very clear. A hospital system has to be a nightmare to the
specialists who use it. Why would a provider want to sift through literally thousands of medications
when they typically only prescribe certain ones for their patients. This is where careful planning and
delegating comes in. The customer needs to understand that the hospital system is meant to meet the
needs of all providers in the entire system. It is recommended that each specialty department within
the community appoint select staff to create a list of "Favorites" within the medications, procedures,
diagnosis, orders etc. tabs. This way, time will be saved when completing a patient visit.

In a smaller setting, I have to recommend going with a specialty specific vendor. In doing this, the
provider will have a more robust system specifically catered to their needs and will not include any
additional data fields that they will never have a need for. The specialty specific vendors are also more
likely to already have certain reporting tools already preloaded in the system to generate specialty
specific and relative reports, such as those required for Centers of Excellence. Exemplo Medical
( is one such company that develops specialty specific software. For
example, Exemplo's application for Breast Cancer, eMD for Breast Centers, is an application designed in
conjunction with Breast Surgeons and staff that only shows pertinent workflows that a typical Breast
Center or Practice may use. The workflow includes specific data fields for patient visits, orders,
medications, procedures and so on. They even have a specific report that automatically generates a
NQMBC report that is easily submitted to the National Consortium of Breast Centers for their COE

Of all the success stories these two themes: provider buy in and customization seem to be at the top of
the list and perhaps the easiest to attain. Some may disagree with that statement of being "easy to
attain" however if a provider has been given a clearly painted picture of the benefits of EMR
implementation, then it should be a no brainer on their end. As for the customization...providers do
your homework, there are wonderful systems out there that you will be amazed to find how easily
adaptable they are to any practice.
December 16,2009


CT scans don't cause cancer, Radiologists who overuse CT's increase risk

Two studies were published in the Archives of Internal Medicine this past Monday showing "The risk of
cancer associated with popular CT scans appears to be greater than previously believed".

I originally read this article in the WSJ and they included a nifty graph showing the increase in CT scans
over the years (1993-2006, and included projected 2007 numbers). I can't say I was shocked. Obviously
there will be an increase, population increases year over year.

As expected, the American College of Radiology (ACR), released their own statement in response to the
recent studies. The ACR statement was wonderfully put together and basically stated that if an imaging
center abides by the standards put forth, then there should be no increased risk as the benefit of the
scan outweighs the risk. Seems like common sense to me.

This is where I believe that patients need to take more responsibility for their own health by asking
questions instead of just going along with whatever their physician says. After all, when you break it
down, its a business that strives to make a profit. I am not putting down all clinicians who perform CTs, I
am putting down the clinicians who abuse the system to make the money to pay for their fancy state-of-
the-art equipment. Those machines come with a hefty price tag and the ROI must be met somehow.
Some clinicians go about it the right way, others don't unfortunately. They are human after all.

Now for the other issue with this...clinicians have to protect themselves. If a patient comes in
complaining of a mild condition that a CT may show, its up to the doc to determine the severity of the
situation. This is a very fine line due to the liability involved. Unfortunately we live in a world of money
hungry individuals who are willing to sue if their coffee if too hot. This is where the relationship of the
physician and patient comes into play. There has to be a level of understanding and trust for the
situation at hand.

Personally, I have a wonderful relationship with my GP and others specialists that I see because I feel
comfortable with them. If you don't feel comfortable asking the hard questions with your provider,
maybe its time to look into a different one. Good ones are out there, more good than bad fortunately
for us. But it is up to us to sift through the population to find one that fits best. Unfortunately for
doctors now a days, it is getting harder and harder to make money and that is unfortunate because I
believe that some of the "good" docs may be susceptible to becoming more focused on business side
rather than patient care, which I can't say I don't necessarily blame them, they have bills to pay too, big
ones like student loans, salaries, mandatory EMR adoption etc.

Now for my cynical comment....I wonder which diagnostic test or treatment or whatever will be next to
take some heat in order to cut healthcare costs? Keep in mind this is at the expense of the public who
desperately wants change, but I have to ask, at what price? So far it has been more about money than
human lives.

December 11,2009


National Consortium of Breast Centers just announced stance on new Mammography guideline changes

The National Consortium of Breast Centers (NCBC) has just released their position statement regarding
the recent mammography guideline changes:

“The National Consortium of Breast Center's Board of Trustees has given their consent to the following
position statement reflecting their stand on the issue of mammographic screening, in response to the
recommendations made by the US Preventive Services Task Force.

National Consortium of Breast Centers, Inc.

Position Statement regarding the Mammography Screening Recommendations of the United States
Preventive Services Task Force (USPSTF)

The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the
inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on
mammography screening.

The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of
potential benefits and harms to women screened for breast cancer with mammography.1 They provided
an updated USPSTF recommendation statement on screening for breast cancer for the general
population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening
mammography leads to early detection which leads to improved survival.3 In every country starting
population screening, mortality declines coincide with onset of screening, not systemic therapy. These
USPSTF models are not based on sound data, namely different denominators in the “harms” vs.
“benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal
significant mortality reductions evident approximately five years after screening programs were
initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening
program benefits not seen in the prior six decades. In the United States, these mortality declines
continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable
public health achievement.

In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include
breast imaging specialists nor was it represented by any of the multiple other specialists who
collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical
oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators,
educators and others.

The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the
cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed
literature, which supports currently accepted breast cancer screening guidelines.

We would also like to note that quality of life has a significant value, not just survival. It is well
established that if we discontinue mammography for women in their 40’s, the cancers eventually
detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and
more likely lead to other significant socio-economic concerns.

The NCBC requests input into future guideline development and vows to work with government,
scientists and industry to keep the process transparent and keep the focus on the patient. We
recommend further efforts target screening, risk assessment, education and awareness regarding the
implications of positive and negative screening findings. Funding for further research is imperative and
supported by the controversy these articles have generated.

Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the
existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with
this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many
women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request
the Task Force rescind their position on this specific women’s healthcare screening policy.


About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization
devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote
excellence in breast care through a network of diverse professionals dedicated to the active exchange of
ideas and resources including: 1) To serve as an informational resource and to provide support services
to those rendering care to people with breast disease through educational programs, newsletters, a
national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in
activities related to breast disease; 3) To encourage the development of programs and centers that
address breast disease and promote breast health; 4) To facilitate collaborative research opportunities
on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain
quality standards in comprehensive breast programs and centers.


1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.

2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.

3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic
screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.

4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.

All content and design © 2009 by the National Consortium of Breast Centers, Inc.”

As mentioned in the recent post, "Scrapping the Barrel to Support Health Reform", it seems like
the current Health care reform plan is costing the nation a trillion dollars yet is taking away
money from preventative care of deadly diseases, mainly its been cancer that has been hit the

The optimist in me at first said that with these changes, maybe techniques and other medical
procedures will be forced to improve based on this change. I still believe this will be the case, but
does one outweigh the other? The best approach would be to do both of course. Maintain the
guidelines that have been proven effective through various published trials, and allocate ARRA
funds to increase R&D of new treatments or improved quality of current techniques. Who
knows, there may be money left over from the HITECH stimulus funds by ARRA if physicians
are unable to collect the 44k in order adopt EMR.

Once improved procedures allow for a change in the guidelines, then the change is warranted. If
not, guidelines should not be altered.

The National Consortium of Breast Centers (NCBC) is currently the largest national organization
devoted to the care of Breast Disease. Through their quality measures program, the National
Quality Measures for Breast Centers™ (NQMBC™), breast care centers have the opportunity to
collect and standardized data to the NCBC in hopes to improve clinical care of Breast Cancer
December 7,2009

Leavitt Out, Drummond In?
As usual, its been a busy few weeks in the Health IT world and things continue to get shaken up
with many recent announcements.

In a press release on 10/22/2009 the Certification Committee for Health Information Technology
(CCHIT) announced that they are seeking candidates to serve as Trustees and Commissioners.

Another press release on 11/13/2009, announced that CCHIT's well known Chair, Mark Leavitt
will be retiring in March of next year after 5 years of service.

Once the first press release came through on my feed, I thought it was only a matter of time
before this happened. Changes need to be made by the CCHIT to gain acceptance by many
skeptics. Then I received the second feed, an interesting decision made by Dr. Leavitt to
announce his retirement, especially since the CCHIT has been under major scrutiny lately for
being the sole certifier of EMR systems and carrying a rather large price tag, so large in fact that
most of the smaller vendors are unable to afford the certification. I'm just not sure if leaving his
organization now, especially announcing it, was the greatest business decision for the CCHIT.

The CCHIT has also been accused by it's critics for catering to the larger EMR vendors that also
conveniently sit on their Board of Trustees and Commissioners.

I find it quite coincidental that after undergoing such a large amount of scrutiny for favoritism
that the CCHIT is now holding interviews to replace some of it's Board Members. I know that
you are probably thinking, damned if you do damned if you don't. Thats not where I'm headed. I
want to give kudos to the CCHIT and Dr. Leavitt for their accomplishments in the past years as
well as the realization, or wake up call, that changes need to be made their board, specifically the
board member ratio, which I'm sure will be affected. The positions are open to members of
physician practices and hospitals, payers, health care consumers, vendors, safety net providers,
public health agencies, quality improvement organizations, clinical researchers, standards
development and informatics experts and government agencies. I would imagine that the vendor
to healthcare provider ratio will be severely affected.

As for Dr. Leavitt leaving, personally I don't think this is the greatest time the CCHIT during this
critical time, especially when the certification business is open for business according to Health
and Human Services. Who know's, maybe its a career move...he would be a perfect candidate to
head up a start-up certifying company.
That brings me to my next topic, the Drummond Group may prove to be a worthy alternative.
They had their own press release on 11/02/2009 that they will submit to become a certifying
body. I haven't heard of any progress, but if anyone out there has heard anything, please let me
know. For those of us who are new to the Drummond Group, they are a company specializing in
interoperability testing. Rik Drummond, CEO of Drummond Group was quoted in the press
release saying, "Drummond Group has been supporting Fortune 500 industries and government
by certifying the transfer, identity and cybersecurity of their internet information flow over the
last ten years. We have also done testing for the CDC, DEA and GSA. Certification of EHR is a
natural extension of our testing program, and we believe we can provide great value for the
medical community. We look forward to the publishing of the ONC requirements in the days
ahead so we can get started."

There seems to be a lot of progress within the Certification realm. My only other questions and
worries are targeted towards getting everything in place in time for physicians to get their

November 20,2009

Scrapping the Barrel to Support Health Reform?
What a past couple of days in the Healthcare realm. First of all, the Health Reform bill passed in
the House with a price tag of $1 trillion. The money has to come from somewhere and it seems
like it is coming down to the preventative care of women as for now. In other releases, separated
by one day each, new guidelines came out for mammograms and pap smears. Another release
just came out regarding a 5% tax on non-elective plastic surgery procedures.

I have to wonder who is influencing these recently altered guidelines and their research findings.
I have my opinions on can be manipulated to prove a desired point. I have to
assume this is what is going on in these recent releases regarding the preventative care for
serious cancers that specifically target women. For the past year I have heard more news to
promote preventative care than ever before. Why? Because it saves lives and yes money too. So
now, why are they changing these guidelines that promote a higher level preventative cancer?
Has anyone thought that the numbers may be down because of the preventative measures that
have been in place?

With a $1 trillion price tag, one has to wonder is its to free up funds to pass this bill.
Unfortunately, these changes are going to be just the beginning I believe.
As for the elective plastic surgery procedures, in 2008 it was reported that $10.3 billion was
spent on these procedures. People choose to get certain procedures to benefit their quality of life
in some way, which can ultimately change certain mental conditions such as depression and
anxiety which both play an enormous factor in the progression of other serious health factors.
Not everyone who elects to get plastic surgery are the typical "trophy wife" getting a different
nose every 5 years, its also those people that have little money to pay for a procedure to correct
something that may have been caused by an accident for example. Now, these people who have
to spend thousands of dollars, that may have had to scrape it together, are expected to spend 5%
more. Is that fair to the little girl who was in a car accident and suffered injuries to her face that
left her scarred for life without plastic surgery? This is just an example, but it is also a reality of
how people are going to be affected by this health care reform push.

I believe something has to change in Healthcare, but at what cost? Certainly not time, after all
the current administration is rushing this thing out without the proper time to think of how it will
actually pan out in the future.

Its going to be an interesting couple of years to say the least.

October 19,2009

HIT Stimulus Money: Boom or Bust?
Since the inception of ARRA, there has been mixed emotions of whether or not throwing money
at a situation will benefit the struggling incumbent health care system. Having only worked in
Healthcare IT for a limited amount of time I believe I can shed some light on the subject from an
outsider's perspective rather than a biased, perhaps jaded, insider's view.

First lets talk some basics. Approx $19.2 bill in incentives available to physicians who adopt a
certified, meaningful use EMR system. This breaks down to around $44k/provider on up to
$64k/provider depending on Medicaid/Medicare patient ratio (the more CMS customers, the
higher stimulus awarded). Incentives start this 2010 and penalties start 2015.

The main debates have been lying in the "certified" and "meaningful use" or simply "MU"
realms. Let's first talk about certification. The only certifying body to date is the CCHIT which
was spawned off of HIMSS and even has a former HIMSS member as its leader. For those of
you that are new to this area, the Certifying Commission on Health Information Technology
(CCHIT) is a non-profit group based out of Chicago, near HIMSS HQ, that is comprised of
different executives who have vested interest in the large EMR vendors...because they run and/or
work for them. That is all I will rant about for this post on the CCHIT.

The next big issue, which needs to be radically simplified is MU. Every practice and specialty
are different. Meaningful use may vary from specialty to specialty. This needs to be a simplistic
model, not a complicated matrix that was originally released, for everyone to understand. There
also has to be a lot of gray area as well in this definition to allow for proper payment if a practice
is able to show that they use MU.

These 2 criteria, certification and MU, have yet to be decided on. Deadlines are set, but as we all
know and have experienced, they may be moved again.

So back to the original question in the title, has the stimulus money caused a boom for HIT or
has it been a bust thus far?

Certain areas of the HIT market has seen an increase due to the stimulus funds for HIT for sure,
but on the same note, many HIT vendors have seen a lull in sales. Why, when there is at least
44k on the table and adoption needs to happen quickly in order to qualify for the 1st and biggest
stimulus handout.

The stimulus money has put providers on a bit of a "wait and see" mentality. There are far too
many providers who do not see the value of EMR. Should this stimulus money have been
allocated differently? Should more money have went to education and research rather than
purchase and implementation?

EMR is not a thing of the future. It is a technology that has been around and in use for over a
decade. They have time over time proven effective, efficient and reliable. I am not going to go
into detail because the case studies are out there. The only problems that I have seen are due to
bad matches between vendor and customer, not the idea or technology itself.

Look at our world now, smartphones that allow us to answer emails while out of the office,
telecommuting from home to save on overhead costs etc. Technology will continue to improve
upon quality. Be it quality of care or quality of life.

EMR is a way to do both. The incentive from ARRA is there yes, but treat it as a bonus for
adopting a new way of patient care and reporting to improve the overall quality of care and
patient health for futures to come by adopting and embracing a sound technology that you may,
or may not, get some extra cash from.
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News and Views
MedTech and Devices

Galen Healthcare Solutions: Allscripts Consultants
Enterprise EHR
January 16,2012

Using Finish Note tasks? How a change in workflow might affect you…
Does your practice utilize the Finish Note task in Allscripts Enterprise EHRTM? If you
answered yes, then this blog is for you. In this article, I wanted to show you two possible
outcomes when working in your v11 Note. You will notice that there are two similar workflows
to add and commit clinical data in the [...]

January 13,2012

The Costs of HL7 Interfaces
In the past on this blog, we’ve addressed the top data integration challenges as well as the ROI of
a results interface. Recently, Health Management Technology featured a related article on the
economics of interfaces. The key points from the article were as follows: Opportunity Cost
True Investment Integration is not simple Pitfalls of proprietary Features [...]

January 9,2012

Allscripts Enterprise EHR and RelayHealth Portal Integration
 In this demo, we will present Allscripts Enterprise EHR and RelayHealth Portal
integration capability. This solution facilitates seamless integration between the two applications,
offering single sign-on, messaging between provider and patient,and patient online indicator
functionality. Contact us today so your organization can realize the compelling benefits of
Enterprise EHR RelayHealth Portal integration.

January 5,2012

CMS Updates Regarding Meaningful Use
 CMS released a couple of updates last month regarding Meaningful Use and the EHR incentive
program. I wanted to pass this information along to our readers. In their December 7 update,
CMS indicated that “HHS announced its intention to delay the start of Stage 2 meaningful use
for the Medicare and Medicaid EHR Incentive [...]

December 21,2011

Does Your Interface Engine Perform Like a Clunker or a Ferrari?
Often times, clients take the approach that their interfaces are functioning as designed and don’t
want to risk “breaking” the interfaces by making adjustments. However, these interfaces may
not be performing at maximum efficiency and/or may not be optimized to prevent errors. This
issue is magnified for larger clients with a high volume of transactions. [...]

December 19,2011

Why your In-Office Labs Default to a Billing Location of ‘Touchworks Clinic’
Recently, I’ve seen several clients struggle to understand this issue and I’d like to give some
information about what causes it and how to correct it. There are several levels at which a
Requested Performing Location (RPL) can be linked to a Billing Location. The highest such
level is in the Requested Performing Location Dictionary [...]
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Healthcare IT, also known by       are demanding better          or acquisitions. Healthcare IT is
the acronym HIT, is all about      service from care providers   in even worse shape because
using information technology       and healthcare IT is a good   outdated infrastructure, legacy
solutions such as hardware,        way to improve service.The    architectures, and monolithic
networking, and software to        healthcare system,            applications prevent positive
help improve healthcare, save      especially in the USA, has    change from occurring.
lives, reduce costs, and improve   some critical problems such   Healthcare IT can, if used
profit margins for healthcare      as nurse and physician        properly, help reduce costs,
organizations. Healthcare IT       shortages, spiraling costs,   improve care provider
has always been important but      poor consumer (patient)       productivity (which can then
recently it has been receiving     service, and lower revenues   alleviate some of the shortages),
more attention because the         which lead to mergers         and significantly improve
government and consumers                                         customer service to patients.

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