Navigating Healthcare – Patient Safety and Personal Healthcare Management

Google Glass in Healthcare – Part 1 the Basic Facts

HIMSS was exciting and despite the HIS Talk HISies awarding Google Glass the most over rated technology:

I know I am biased as one of the lucky Google Glass Explorer as can be seen in this post from MedCity Watching for Wearables at #HIMSS14:

I think they are wrong and its not just Glass that will provide better more ready access to essential clinical data.

Not to say that the initial program like many launches have had their problems with early releases of technology not quite ready for prime time – remember the 1987 Apple Newton:

Even the omnipresent iPad struggled initially – most have probably forgotten the initial lukewarm reception of the iPad

had Apple talking about a price reduction.

Mat Honan (one on the same “Epic Hack”) wrote a piece about his early experiences “My Year with Google Glass” that highlighted some early acceptance challenges

  • Glass is socially awkward
  • People get angry at Glass
  • Wearing Glass separates you

and I would add Glass interrupts normal conversations and social behavior – but that is all now and like the mobile phone I believe it will be come a natural part of our technical fabric. Think back to 2007 and how pulling out a phone in a meeting was frowned upon – now it seems part of the fabric of many of the meetings I attend. But it was Mat’s commentary on the impact it had on his perception fo phones that really stuck out for me

Glass kind of made me hate my phone — or any phone. It made me realize how much they have captured our attention. Phones separate us from our lives in all sorts of ways. Here we are together, looking at little screens, interacting (at best) with people who aren’t here. Looking at our hands instead of each other. Documenting instead of experiencing.

Which resonates with me an the Art of Medicine campaign and the struggle clinicians have with focusing on the patient (To learn more, download the eGuide Art of Medicine in a digital world). As Dr. Edward C. Grendys, Jr. said in his article: There’s no room for technology in end-of-life care decisions:

From initial diagnosis through to surgical therapies, chemotherapy treatments and even end-of-life care, my job is to listen, assess and provide educated decisions that ultimately impact the health and wellness of another human being…. it’s my belief that when talking face-to-face with a patient about a care plan aimed at eradicating their body of a disease that threatens to take them away from their family, there’s no room for paper, computers and/or mobile devices. In these most intimate of conversations, the focus has always and must remain on the communication between the caregiver and the patient on the receiving end. That, in its purest essence, is what practicing the art of medicine is truly all about.

That’s not to say that Google Glass can solve this problem and in its current state and acceptance it might cause more challenges – but the potential is there to blend information access and capture into a physician patient interaction that remains all about the patient

Glass will provide improved access to essential clinical data to clinicians but as my friend Chuck Webster has pointed out on several occasions this is not just for clinicians. Patients are already accessing the internet in droves for clinical information, researching their conditions and that of their relatives and communities abound with resources and support for conditions from common to rare.

Before talking about some of the potential medical applications it is worth detailing the technology. Google Glass is basically a computer with 12Gb of memory attached to your head in the form of glasses. It has a heads up display with voice activation and has some apps that can be installed:


  • Google Glass is basically a computer attached to a pair of glasses
  • Google Glass has a display that is projected in front of the Right Eye that is a high resolution display equivalent of a 25 inch high definition screen from eight feet away
  • Google Glass has a camera that points forward and can take pictures (5MP) or video (720p) that is closely aligned with the view you see from your own eyes
  • Google Glass is voice activated using speech recognition to interact with the glass computer
  • Google Glass works best when connected to the internet
  • Google Glass Integrates with an Andorid Phone with a limited set of functions available for the iPhone
  • Google Glass has no built in illumination so pictures or video taken in dark conditions do not work well
  • The screen can be hard to see in bright light

There are many myths circulating:


  • If someone is wearing Google Glass they are recording me
    • False – The device is not set up to record continuously and will only record a video or photo based on an action by the wearer (either a spoken request
      • OK Glass, take a picture
      • or by pressing a button on the google glass device
  • Once Someone Has recorded something on Google Glass it is Publicly Posted
    • False – it requires an action on the part of the Glass owner to post the material to the internet otherwise it resides on the Google Glass device. It will be synchronized with the users Google+ account for automatic backup (much like photos are backed up from the iPhone to iCloud but like iCloud remain private to the user unless they elect to share them)
  • Google Glass is constantly capturing data and transmitting it to the Internet
    • False. Without an internet connection Google Glass simply stores any recorded information in the glass memory. And unless you have set it to record there is no data being captured
  • Google Glass tracks users and unsuspecting bystanders
    • False – Google Glass is not tracking or recording anything unless instructed to do so by the user

So who is using this technology, where are they using it and how are they using it in Healthcare. This articlecovered some of the early concepts and featured a short list of potential applications

  • Video sharing and storage: Physicians could record medical visits and store them for future reference or share the footage with other doctors.
  • A diagnostic reference: If Glass is integrated with an electronic medical record (EMR), it could provide a real-time feed of the patient’s vital signs.
  • A textbook alternative: Rather than referring to a medical textbook, physicians can perform a search on the fly with their Google Glass.
  • Emergency room/war zone care: As storied venture capitalist Marc Andreessen proposed in a recent interview, consider ”dealing with wounded patients and right there in their field of vision, if they’re trying to do any kind of procedure, they’ll have step-by-step instructions walking them through it.” In a trauma situation, doctors need to keep their hands free.
  • Helping medical students learn: As suggested by one blogger, a surgeon might live stream a live — and potentially rare — surgery to residents and students.
  • Preventing medical errors: With an electronic medical record integration, a nurse can scan the medication to confirm whether it’s the correct drug dose and right patient

In its simplest form just transmitting images in real time can offer some advantages for diagnosis – in Rhode Island they are planning on implementing Google Glass for the ED doctors to obtain real time consults with dermatologists.

And this from Kareo showing a patient education application that records the physician patient interaction and then makes it available afterwards for additional review:

In this case featured in the ER doctors use Google Glass and QR codes to identify patients which featured Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center which he talked about in his blog detailing their experience (oddly the articletalking about this refers to text that appears to have been changed or taken down):

When a clinician walks into an emergency department room, he or she looks at [a] bar code (a QR or Quick Response code) placed on the wall. Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.

And this concept by the way was top of everyone’s wish list that I talked to in my unofficial survey of engaged and interested observers of my own pair. I’ll paraphrase

If I could get it to recognize someone and provide me with their name when I meet them that would be fantastic!

But it is in urgent care where there is so much potential:

This recent piece on Healium featured in the Seattle King5 News Station: Seattle Doctor testing Google Glass for Surgery in the ER (click on the link if the video does not show below to see it in action)

“If I want to look at for example radiology I can double tap ‘radiology…There’s his chest x-ray, it just popped up, oh he’s got a middle lobe pneumonia”

Part 2 will cover medical applications and how Google Glass technology can be applied in a busy clinical setting

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The Art of Medicine CIO Breakfast – What Needs to Change to Get Doctors Back to the Patient?

Medicine is part science…. Part art.

The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding. We want to reimagine healthcare—where physicians can get back to the art of medicine and were delighted to be joined by panelists:

Dr. Mark Kelemen, Senior Vice President, CMIO, University of Maryland Medical System Dr. Charles H. Bell, Vice President, Advanced Clinical Applications, Hospital Corporation of America (HCA) Stuart James, CIO, Sutter Health Dr. Andrew Watson, CMIO, University of Pittsburgh Medical Center (UPMC) (@arwmd)

The panel was moderated by our very own Dr. Paul Weygandt, Vice President, Physician Services, Nuance Keith Belton, Senior Director, Clinical Documentation Solutions Marketing, Nuance

and attended by some 50 attendees with varying backgrounds and perspectives

The underlying question:

How do return the focus to the patient. How can physicians navigate the changes and challenges of today’s complex healthcare environment while doing what matters most to them – listening and caring for patients?

The panel discussion addresses current physician frustrations with technology and what needs to change to keep them focused on patients and not data entry. It was clear that the physician’s voice and medical decision making is what matters most in practicing the art of medicine and how do physicians and patients both benefit?

 We know from surveys that

  • 36% of physicians say that EHRs interfere with face-to-face communication during patient care
  • 80% of physicians say “patient relationships” are the most satisfying part of practicing medicine
  • 28% of an average ER physician’s time is spent directly with patients
  • and from a recent HIMSS session interesting Patients prefer doctors to have an EHR
This is about the changing face of healthcare – it’s not just about technology. It’s about how we envision healthcare. How do we explain to providers that this isn’t about technology – this is about a new world order coming to healthcare

Posting every patients Magnesium level multiple times in a note is not good clinical care #artofmedicine #himss14

One of our panelists asked the audience:

How many Docs would go to facility with no #EMR and used paper – no hands went up

We do see value in Health Information Technology

One of the overriding concerns was the need for cultural change. The office or hospital based physician system is struggling to meet the patient needs today. They want to have the right nurse or physician there for them at the right time and indeed at the right place with telemedicine. It’s about cloud-based/consumer-based healthcare.

More consumer-friendly healthcare

We need to get back to that local physician practice – with technology in the middle as a supporting actor but not the main event

Technology cannot be an impediment to taking care of patients

Many physicians are in this field because we are trying to drive change but are struggling with the existing system that fail them. When I see a patient I have to review 10 systems, carry out at least 4 major systems examinations before I can submit a claim that properly reflects the care I delivered:

 I am not taking care of the patient I am taking care of a computer

Dr Andrew Watson told the story of a patient under his care with a terrible antibiotic resistant infection that a patient developed in hospital and he was now under constant supervision adn intensive therapy. But as he said – he never needed to come into hospital – he could have been treated at home. Poignant reminder that Telemedicine is not just about reducing cost – it can be better for the patient and offer better results.

Dr Bell is waiting for the MIDI (musical instrument digital interface) moment so that he can plug into the medical record and go.

As a musician he remembers the implementation of the MIDI interface in the early 1980’s that allowed music manufacturers to create one standard that was royalty free and widely adopted for the benefit of the user musicians and the vendors. He wants that in healthcare – so do I.

Until we change the mandate on clinicians to document 8 of 10 systems to be fairly compensated for the care given  

And importantly the concept of Bring Your Own Device (BYOD) is bringing functional tools into the healthcare setting and will/is revolutionize the care being delivered. As one panelist put it:

my iPad never complains, is always there, has the latest information and access to latest medical updates

To summarize:

  • We need strategies for bringing the focus back to the physician-patient interaction and removing impediments to that relationship
  • Healthcare organizations should be and are encouraging/valuing physician professionalism
  • This is about the changing face of healthcare – it’s not about technology. It’s about how we envision healthcare. How do we explain to providers that this isn’t about technology – this is about a new world order coming to healthcare

Come join the conversation at The Art of Medicine or come to the panel session Thursday, March 27, 2014, 9:00 – 11:00 am EST at the W Hotel,100 Stuart Street, Boston, 02116

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Physician Symposium #DrHIT #HIMSS14

Posted in Healthcare Information by drnic on March 17, 2014

The Physician (#DrHIT) Symposium at #HIMSS14 Opening session was eloquently covered by Robert Wah, MD (@RobertWahMD) detailing the spectrum of issues ranging from the new Healthcare System:

The challenge of SGR “fix(es)” and the evolution of the systems we are implementing and the value proposition. As he put it

Quality of care is improved with better information — saving lives and money

But Health Technology is not easy to implement:

— Wen Dombrowski MD (@HealthcareWen) February 23, 2014And layered on top is the increasing challenge of securing the data with hackers seeing healthcare data as 15x more valuable than financialhacked data!

— HIMSS (@HIMSS) February 23, 2014What we need is coordinated care and Dr Wah offered this visual of the way forward

Christine Bechtel focused on the Activate Evidence Based Patient Engagementand as she reported – Patients like doctors who have an EHR

Patients think EHRs help doctors deliver better care

  • Timely access to information, sharing info across care team, med history, managing health conditions
  • Overall, EHRs were rated between 23%-37% points higher than paper on these elements

Interesting since doctors have been reported as saying they dislike the EHR but patients like seeing their doctors with an EHR

— HIMSS (@HIMSS) February 23, 2014 The sad thing was this session was concurrent with @ePatientDave in another room - The Connected Patient: Learning How Patients Can Help in Healthcare only social media united these sessions

— Susan Shaw (@drsusanshaw) February 23, 2014As for Jonathan Teich and his session Improving Outcomes with CDS- he used his personal experience where peer pressure (as he described it 3rd time he was pressured to take on an expert triple diamond ski slope) he finally agreed and ended up in a serious ski accident fracturing multiple vertebrae. Interesting analogy relative to the Clinical Decision Support System and the pressure this applies to clinical practice sometimes inappropriately… Interesting look at alerts and the potential for providing more than just alerts but actually providing intelligent data that distill down to 10 types of CDS interactions

  1. Immediate Alerts: warnings and critiques
  2. Event-driven alerts and reminders
  3. Order Sets, Care Plans and Protocols
  4. Parameter Guidance
  5. Smart Documentation Forms Improving Outcomes with Clinical Decision Support: An Implementer’s Guide (HIMSS, Second edition, 2011)
  6. Relevant Data Summaries (Single-patient)
  7. Multi-patient Monitors and Dashboards
  8. Predictive and Retrospective Analytics
  9. Filtered Reference Information and Knowledge Resources
  10. Expert Workup Advisors

And the important summary slide was the CDS Five Rights (Right information, people, formats, channels and times)

And returned to one of the core opportunities – Patient Engagement with a a session by Henry Feldman, MD FACP: Informatics Enabling Patient Transparency. He asked the same questions as another presenter – how many fo the audience considered themselves a patient (Still only a shabby 80%) and then took this further asking

  • You feel that you know exactly what your provider was thinking in making his decisions
  • You think the clinical systems helped your provider understand comprehensively everything about you
  • You build clinical systems or are a provider
  • With the inevitable decline in hands up
  • You think your (or anyone else’s) software truly helps the patient or even the provider understand comprehensively or transparently what is going on

Sadly we are not near this and the reality is much further with physicians thinking patients are unsophisticated. Yes at he pointed out the airline industry gets it and even the DMV/MVA gets it offering customer engagement models: Their experience and stats blow the unfounded resistance out of the water

  • Only 2% of patients found notes more confusing than helpful
  • Only 2% found the note content offensive
  • 92% said they take better care of themselves
  • 87% were better prepared for visits

Importantly we need to turn data into information for patients and he cited the Wired example of a Laboratory test (Blood Test Gets a Makeover Steve Leckart) and the makeover for Basic Labs

Cardiology Result

and the PSA result

I know where I’d like to be receiving my care (and lab results) from! Great finish to the session. So as he summarized where we should be with patient engagement an data

  • Open your data to your patients
  • Patients understand more than we think
  • Teach patients how to use data effectively – This can save you time in the long run
  • Put your patients to work on their own health!
  • Vendor work on how patients will view big data
  • It’s a new drug, research the risks and benefits

Great start to what will be a busy HIMSS

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Art of Medicine at #HIMSS14

Posted in Art of Medicine, Healthcare Information by drnic on March 6, 2014

The new Art of Medicine campaign is focused on getting physicians back to their original roots – the reason we all stepped over the threshold of medical education and into an honorable profession to serve our community. Its all about the patient but changes in the healthcare system and in particular changes with technology have taken the focus away from our patients and onto the technology in our office. Recent study conducted by Northwestern University highlighted the distraction physicians feel away form their patients by the EMR

As Steve Schiff, MD a practicing cardiologists puts it

As far back as I can remember, there was never a time when I didn’t want to be a physician. It’s a choice in which there is no equivocation: either you want to be a doctor or you don’t.

The campaign includes an e-Guide: The Art of Medicine in A Digital World replete with thoughts, suggestions and concepts to manage the digital world while remaining focused on the most important person in the examination room – the patient. The release was covered in this piece by HIT Consultant and referenced the panel taking place next month in Boston. Many of the thoughts and ideas were captured in the Top 38 lessons from Digital Health CEO’s from Rock Health. I picked a few choice quotes that capture the spirit and intent of the Art of Medicine for me:

“Healthcare is yet to be transformed by technology.” – Joshua Kushner “You need a degree of foolishness to cause disruptive change in healthcare. Dare to dream.” – Vinod Khosla “If you’re going to re-invent healthcare you have to start from scratch.” - Vinod Khosla “The key to good product is invisibility for the user.” “Partnership is going to be absolutely key to taking healthcare to the next transition in evolution.” - Sue Siegel

The campaign kicked off this week with this resource page - The Art of Medicine and a short video highlighting the challenges and opportunites

There will be much discussion at HIMSS14 around the topic and we are looking forward to hosting the panel on Thursday, March 27, 2014, 9:00-11:00 a.m. at Boston’s W Hotel. You can find out more and/or register here or come by our booth 3765 at HIMSS14.

“The science of medicine goes nowhere if you leave the human element out of the equation. Curing our patients starts with listening to them.”

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Are Physicians the Cure to Healthcare’s Bugs?

Posted in Art of Medicine by drnic on March 5, 2014

This post originally appeared on HIT Consultant

During a recent and troubling discussion with a physician friend, he described to me a new ailment he’s been experiencing: waking up in the morning, and not looking forward to going to work.  The reality is that he is not alone.  It’s no secret that physicians across the country, regardless of their specialty or location, are reaching their limit for juggling new requirements, technology upgrades,  and policy changes, all while trying to deliver personalized, quality care to their patients.  As a result, busy physicians are, quite understandably feeling pressured and pulled away from direct patient care and critical clinical-decision making, and, at the end of the day, that is what matters most to patients and physicians alike.   It is easy to imagine the impact overloaded and dissatisfied physicians could have on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and how these regulatory pressures and so many new healthcare technologies could be linked to the decline of the “art of medicine.”  But are we, in fact, misdiagnosing the problem?

A recent study from Johns Hopkins University found that internal medicine interns are lacking proper bedside etiquette, which is not only essential to providing quality care, it directly impacts medical outcomes and patient satisfaction scores.  Focusing on five key elements of proper patient-physician decorum, researchers tracked whether or not hospital interns:

  1. Introduced themselves, 
  2. Explained their role in the patient’s care,
  3. Touched the patient,
  4. Asked open-ended questions, or
  5. Sat down with the patient during the visit.  

Results revealed that interns touched their patients (either during a physical exam, handshake or gentle, supportive touch) 65 percent of the time and asked open-ended questions 75 percent of the time, but introduced themselves only 40 percent of the time, explained their role merely 37 percent of the time, and actually sat down during only nine percent of the visits.  Such results are disconcerting, at best, and reveal a more pressing truth: These basic and critical communication deficiencies that are essential to providing holistic patient care are not being taught.

The study exposes the reality that the shift away from patient focus and the “art of medicine” isn’t just stemming from increased physician workloads caused by new policies and changing technologies.  It is infiltrating our profession through a change in training, as well.  While we have reduced junior doctors’ work hours for safety reasons, we have not adjusted the overall length of training they receive.  Medical students, our future physicians, are not receiving the holistic education that helps them balance keen scientific skills with compassionate delivery.

But, as they say, “knowledge is power,” and now that we are starting to pinpoint conditions that are tearing at our profession, we can start to heal them.  We can’t expect our medical interns to know how to handle difficult and emotional situations unless we show them.  We need to teach them how to engage with patients, earn their trust, really listen and understand them.  They need to be able to view what their patients say through both a  lens of science and medicine, as well as  a  lens of compassion and caring, in order to help them get and stay well.

And what of the technology challenges that are driving wedges between patients and physicians?  While there is no denying that much of health information technology is putting pressure on physicians and forcing them to adapt to new methodologies, these challenges are a necessary to revolutionizing patient care.  They are, in essence, the basis of growth and the very nature of science.  If it weren’t for boldly trying new approaches, we might still be relying on leeches and blood-letting to cure melancholia.   Just as we can’t expect a patient with heart disease to know intrinsically to maintain a low-sodium diet, we can’t expect the healthcare industry to know how to fix everything unless we speak up and advocate for change (especially with the other loud voices of insurers and politicians speaking on “our behalf”).

We must be mindful that as physicians, it is our sworn duty to defend the practice of delivering the best care to our patients from anything that threatens to impinge on that quality.  We need to stay engaged and be responsive; and that also means we need to assist with diagnosing major technology pain points and identify when something isn’t working.  We have the rare opportunity to shape the future of healthcare infused with technology and I, for one, want to be part of developing a solution that helps the next generation of physicians offer that comforting touch as they deliver an even greater level of care to their patients.

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Clinical Documentation in the Electronic Health Record

Posted in Uncategorized by drnic on February 28, 2014

Many years ago I remember an excited friend who worked for one of the vendors of electronic medical records (really this was more of a billing and patient tracking and management system than and Electronic Health record) desperate to show me some of their new applications – in particular a module they had developed to capture clinical data. He pulled out his “laptop” (it was more of a luggable)

Fired up the application, selected a patient and proceeded to enter a blood pressure: click, click, click, click, click, click, click, click…..some 20 clicks later he had entered a blood pressure of 120/80. He was excited and I was not. I am constantly reminded of this as I watch doctors interact with systems and especially with the ongoing focus on blood pressure (Did you know that May is the National High Blood Pressure Education Month) and the video challengefrom ONC

“To create an under 2 minute compelling video sharing how they use health IT or consumer e-health tools to manage high blood pressure”

The winners can be seen here Key to the challenge is having the data for monitoring as emphasized in the Six Sigma techniques of DMAIC

  • Define
  • Measure
  • Analyze
  • Improve
  • Control

Capturing that data without burdening our clinical staff who should be focused on the patient not on intrusive and distracting tasks of data entry. I made this point a number of years ago “Doctor Please Look at Me not Your EMR” that came from a personal experience in our local practice and as my then 10 year old succinctly put it at the time

“I wish the doctor had spent as much time with me as she did with her PC”

But data is essential and getting this into our medical record is essential to derive the value from these systems. So the study published in Journal of the American Medial Informatics Association (JAMIA): “Method of electronic health record documentation and quality of primary care” who’s conclusion implied that dictating clinical notes “appeared to have worse quality of care than physicians who used structured EHR documentation”.

Digging into the details suggested this was based on old data (2004 – 2008), measured the quality of documentation not the care and that choice in tools is the key to success in EHR implementations and clinicians satisfaction

There are good reasons that dictation as a means of capturing clinical documentation has been so successful for such a long time – it is easy to do, efficient and saves time. But the gap between the narrative text created and the clinical data we need to manage our patients widens with each report created. The JAMIA report highlighted the impact this can have on care, offering some insight into the potential decrease in the quality of care that results in disconnecting the clinician from the interaction and clinical decision support tools and data that is built into the EHR. But the process of entering this data must not intrude into the clinical interaction with patients. All is not lost – Natural Language Processing (NLP) tools are bridging this divide allowing clinicians to use their preferred method to capture the patient’s clinical information in narrative form and extracting out the discreet data that is essential for the EHR systems that need the data to drive the decision support tools and workflow processes.

So clinicians can have their cake and eat it too and best of all it allows them to return to the art of medicine and focus on the patient not the technology.

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Vaccines Don’t Cause Autism – Vaccinate your Kids

Posted in Myths, Preventative Healthcare by drnic on January 30, 2014

It can be frustrating to be a clinician in the era of the internet and instantaneous availability of data especially when the reliability and accuracy is variable. But this is the world we live in and there is plenty of data showing that patients are accessing information in ever increasing numbers. The challenge has been helping patients filter the data for both relevance and accuracy.

Vaccination has been at the epicenter of a these challenges for some years – in fact long before the wide spread use of the internet thanks to a piece published in The Lancet in 1998  and unusually retracted. In fact the BMJ published a paper in 2011 declaring the paper fraudulent – as they noted in the discussion the lead author (now stripped of his medical degree and academic credentials) was clearly actively perpetrating the fraud

Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Moreover, although the scale of the GMC’s 217 day hearing precluded additional charges focused directly on the fraud, the panel found him guilty of dishonesty concerning the study’s admissions criteria, its funding by the Legal Aid Board, and his statements about it afterwards

Sadly despite repeated studies and investigations. Despite the retraction of the original article by the Lancet. Despite the other authors personally retracting the paper we still hear about a “link”. Sadly some high profile individuals continue to perpetrate the fraud (notably the model Jenny McCarthy and most recently the “reporter” Katie Couric).

I saw the posting by Aaron Carroll MD, MS is a Professor of Pediatrics and Assistant Dean for Research Mentoring at Indiana University School of Medicine (the Incidental Economist) last week when he posted this map of the real effects of this in Vaccine Preventable Outbreaks (click on the map button on the left if necessary)

In fact Dan Munro posted his own take on this piece: Big Data Crushes Anti-Vaccination Movement. As he sadly notes

Add a well known celebrity (or two) and the effects can be powerful, long term and hard to refute.

 And ss Dr Carroll notes the impact can be seen in the chart above:

  • All of that red, which seems to dominate? It’s measles. It’s even peeking through in the United States, and it’s smothering the United Kingdom.
  • If you get rid of the measles, you can start to see mumps. Again, crushing the UK and popping up in the US.
  • Both measles and mumps are part of the MMR vaccine.
  • Almost all the whooping cough is in the United States.

But the best part of this post is his accompanying video – included below – well worth watching the full 8 minutes

Expertly and accurately put.

Vaccinate your kids….please.









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Security, Security, #Security…..Encrypt your Drives by Default #HIT #hcsm #privacy

Posted in Healthcare Information, Personal Health Record by drnic on January 27, 2014

I was reminded of there Jerry Maguire movie clip when I read the latest in a long line of security breach stories – this one emanating from Canada where this group is in hot water over a massive 620,000 patient data breach…taking 4 months to notify authorities. Apparently Canada does not have a national Breach notification rule like the US and the public “Wall of Shame

Canada does not have a federal health data breach notification requirement. But the Canadian provinces have their own rules, including some that mandate notification. Under Alberta’s Health Information Act, which was enacted in 2001, the reporting of health data breaches is voluntary, privacy experts say.

 They might want to change that…

In this latest release Medicentres Family Health Care Clinics, a 27-clinic medical group in Western Canada had an unencryptedclinic laptop stolen from one of the clinic’s IT consultants.

The laptop contained 620,000 patient names, dates of birth, health card numbers, medical diagnoses and billing codes, officials said.

Here in the US the chart of complaints is depressing

How many more data breaches will we see before everyone understands the need to pay close attention to security. Encrypting your hard drives for all machines that contain patient information and demanding all staff and consultants and anyone that has access to patient data encrypts their drive and data would have prevented this.

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Are you “Under Observation”

Posted in Healthcare Insurance by drnic on January 23, 2014

This is not news for many in the healthcare profession as they face the challenges of billing rules and regulations and the sometimes obscure idiosyncrasy – but as you can see form this piece on NBC for many patients this is a surprise and a costly one at that

Visit for breaking news, world news, and news about the economy

Hospitals are told that they “have to” use this status (Under Observation) if the patient doesn’t meet a host of criteria for “Admission” all being driven by a series of guidelines that are publicly available although not well known and much of it in response to the RAC audits All this is set to get worse with the “Two Midnight” rule (you can see some guidance here and some of the issues on this here)

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Just what the Doctor Offered #NLP #artofmedicine #hcr #HealthIT #hcsm

Posted in Art of Medicine, Healthcare Information, Preventative Healthcare by drnic on January 10, 2014

This piece in Wired Natural Language Tech and Medicine: Just What the Doctor Ordered by our very own Joe Petro (SVP of Engineering) as he puts it


Somethings gotta give!

Yes it does. Healthcare and in particular doctors are juggling far too many changes
And like the picture of Aaron Gregg who achieved the world record of the most catches of chainsaws in 2008 (88 btw) doctors are doing their best to keep up but they are reaching their limits. We continue to ask doctors to do more with less, their focus is forced further away from the physician-patient interaction.
Technology can help and Natural Language Processing is transforming how consumers interact with technology in a more conversational, natural way. And in Healthcare we have taken this approach and applied it calling it Clinical Language Understanding (CLU) and importantly will allow physicians to get back to the Art of Medicine
Amongst other things we can:
  • Simplify Interactions with the EHR
  • Balance the Need for Patient Narrative and Structured Data
  • Increase Documentation Specificity in Real-Time

Much like NLU has helped drive intelligent, natural interactions between consumers and technology, CLU will help re-humanize healthcare. By enabling physicians to focus on the patient, not the technology, providers can begin to embrace a next-generation approach to healthcare that will drive efficient, intelligent clinical decisions that impact each and every facet of patient care.

It’s an exciting time with CLU and NLP as a critical enabler in helping doctors be more productivity in the new digital era of healthcare and maintain focus on what matters most: patient care.

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