Navigating Healthcare – Patient Safety and Personal Healthcare Management

Why Even Radiologists Can Miss A Gorilla Hiding In Plain Sight

Posted in Health, Healthcare, HealthIT by drnic on February 28, 2013

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn’t notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn't notice the gorilla in the top right portion of this image.

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn’t notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

This story begins with a group of people who are expert at looking: the professional searchers known as radiologists.

“If you watch radiologists do what they do, [you’re] absolutely convinced that they are like superhuman,” says Trafton Drew, an attention researcher at Harvard Medical School.

About three years ago, Drew started visiting the dark, cavelike “reading rooms” where radiologists do their work. For hours he would stand watching them, in awe that they could so easily see in the images before them things that to Drew were simply invisible.

“These tiny little nodules that I can’t even see when people point to them — they’re just in a different world when it comes to finding this very, very hard-to-find thing,” Drew says.

 

YouTube

In the Invisible Gorilla study, subjects have to count how many times the people in white shirts pass the basketball. By focusing their attention on the ball, they tend to not notice when a guy in a gorilla suit shows up.

But radiologists still sometimes fail to see important things, and Drew wanted to understand more. Because of his line of work, he was naturally familiar with one of the most famous studies in the field of attention research, the Invisible Gorilla study.

In that groundbreaking study, research subjects are shown a video of two teams of kids — one team wears white; the other wears black — passing two basketballs back and forth between players as they dodge and weave around each other. Before it begins, viewers are told their responsibility is to do one thing and one thing only: count how many times the players wearing white pass the ball to each other.

This task isn’t easy. Because the players are constantly moving around, viewers really have to concentrate to count the throws.

Then, about a half-minute into the video, a large man in a gorilla suit walks on screen, directly to the middle of the circle of kids. He stops momentarily in the center of the circle, looks straight ahead, beats his chest, and then casually strolls off the screen.

The kids keep playing, and then the video ends and a series of questions appear, including: “Did you see the gorilla?”

“Sounds ridiculous, right?” says Drew. “There’s a gorilla on the screen — of course you’re going to see it! But 50 percent of people miss the gorilla.”

This is because when you ask someone to perform a challenging task, without realizing it, their attention narrows and blocks out other things. So, often, they literally can’t see even a huge, hairy gorilla that appears directly in front of them.

That effect is called “inattentional blindness” — which brings us back to the expert lookers, the radiologists.

Drew wondered if somehow being so well-trained in searching would make them immune to missing large, hairy gorillas. “You might expect that because they’re experts, they would notice if something unusual was there,” he says.

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they’re searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

But they didn’t: 83 percent of the radiologists missed it, Drew says.

This wasn’t because the eyes of the radiologists didn’t happen to fall on the large, angry gorilla. Instead, the problem was in the way their brains had framed what they were doing. They were looking for cancer nodules, not gorillas. “They look right at it, but because they’re not looking for a gorilla, they don’t see that it’s a gorilla,” Drew says.

In other words, what we’re thinking about — what we’re focused on — filters the world around us so aggressively that it literally shapes what we see. So, Drew says, we need to think carefully about the instructions we give to professional searchers like radiologists or people looking for terrorist activity, because what we tell them to look for will in part determine what they see and don’t see.

Drew and his co-author Jeremy Wolfe are doing more studies, looking at how to help radiologists see both visually and cognitively the things that hide, sometimes in plain sight.

In a well documented aspect of the human mind and one we have all probably experienced in one form or another:
 

Inattentional Blindness
If you have seen the gorilla video before (there is a whole web site dedicated to this here) and their video

And the original version of this (I think more compelling) can be seen here

So important in so many areas – in the cockpit of airplanes many of the accidents can be traced to failure to identify what may seem clear indications of the fault or problems. The most recent example in the cockpit of air france Flight 447. My favorite detailed report came in Popular Mechanics: What Really Happened Aboard Air France 447 that highlighted the fact the aircraft was in a user induced stall

during its entire 3 minute 30 second descent from 38,000 feet before it hit the ocean surface

Despite multiple warnings from the onboard systems (visual and audible)

In healthcare the same challenges exist and this was aptly demonstrated in this study by Drew who:

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they’re searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

83% of radiologists missed it.

A problem when we are asking our radiologists (and doctors) to speed through even more images (and patients in less time)

I suspect technology is going to have to help in catching some of these instances and provide additional backup to the human mind. In fact “Assure” is one example of soem of the steps being taken towards this goal

http://media.npr.org/assets/img/2013/02/07/gorilla-7006721e3016faca7f3682d868491bd78c32d844-s40.jpg

http://drvoice.blogspot.com/2013/02/why-even-radiologists-can-miss-gorilla.html

Tagged with: , ,

Why Even Radiologists Can Miss A Gorilla Hiding In Plain Sight

Posted in EHR, expert systems, HealthIT, Inattentional Blindness, radiology by drnic on February 28, 2013

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn’t notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn't notice the gorilla in the top right portion of this image.

Notice anything unusual about this lung scan? Harvard researchers found that 83 percent of radiologists didn’t notice the gorilla in the top right portion of this image.

Trafton Drew and Jeremy Wolfe

This story begins with a group of people who are expert at looking: the professional searchers known as radiologists.

“If you watch radiologists do what they do, [you’re] absolutely convinced that they are like superhuman,” says Trafton Drew, an attention researcher at Harvard Medical School.

About three years ago, Drew started visiting the dark, cavelike “reading rooms” where radiologists do their work. For hours he would stand watching them, in awe that they could so easily see in the images before them things that to Drew were simply invisible.

“These tiny little nodules that I can’t even see when people point to them — they’re just in a different world when it comes to finding this very, very hard-to-find thing,” Drew says.

 

YouTube

In the Invisible Gorilla study, subjects have to count how many times the people in white shirts pass the basketball. By focusing their attention on the ball, they tend to not notice when a guy in a gorilla suit shows up.

But radiologists still sometimes fail to see important things, and Drew wanted to understand more. Because of his line of work, he was naturally familiar with one of the most famous studies in the field of attention research, the Invisible Gorilla study.

In that groundbreaking study, research subjects are shown a video of two teams of kids — one team wears white; the other wears black — passing two basketballs back and forth between players as they dodge and weave around each other. Before it begins, viewers are told their responsibility is to do one thing and one thing only: count how many times the players wearing white pass the ball to each other.

This task isn’t easy. Because the players are constantly moving around, viewers really have to concentrate to count the throws.

Then, about a half-minute into the video, a large man in a gorilla suit walks on screen, directly to the middle of the circle of kids. He stops momentarily in the center of the circle, looks straight ahead, beats his chest, and then casually strolls off the screen.

The kids keep playing, and then the video ends and a series of questions appear, including: “Did you see the gorilla?”

“Sounds ridiculous, right?” says Drew. “There’s a gorilla on the screen — of course you’re going to see it! But 50 percent of people miss the gorilla.”

This is because when you ask someone to perform a challenging task, without realizing it, their attention narrows and blocks out other things. So, often, they literally can’t see even a huge, hairy gorilla that appears directly in front of them.

That effect is called “inattentional blindness” — which brings us back to the expert lookers, the radiologists.

Drew wondered if somehow being so well-trained in searching would make them immune to missing large, hairy gorillas. “You might expect that because they’re experts, they would notice if something unusual was there,” he says.

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they’re searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

But they didn’t: 83 percent of the radiologists missed it, Drew says.

This wasn’t because the eyes of the radiologists didn’t happen to fall on the large, angry gorilla. Instead, the problem was in the way their brains had framed what they were doing. They were looking for cancer nodules, not gorillas. “They look right at it, but because they’re not looking for a gorilla, they don’t see that it’s a gorilla,” Drew says.

In other words, what we’re thinking about — what we’re focused on — filters the world around us so aggressively that it literally shapes what we see. So, Drew says, we need to think carefully about the instructions we give to professional searchers like radiologists or people looking for terrorist activity, because what we tell them to look for will in part determine what they see and don’t see.

Drew and his co-author Jeremy Wolfe are doing more studies, looking at how to help radiologists see both visually and cognitively the things that hide, sometimes in plain sight.

In a well documented aspect of the human mind and one we have all probably experienced in one form or another:
 

Inattentional Blindness
If you have seen the gorilla video before (there is a whole web site dedicated to this here) and their video

And the original version of this (I think more compelling) can be seen here

So important in so many areas – in the cockpit of airplanes many of the accidents can be traced to failure to identify what may seem clear indications of the fault or problems. The most recent example in the cockpit of air france Flight 447. My favorite detailed report came in Popular Mechanics: What Really Happened Aboard Air France 447 that highlighted the fact the aircraft was in a user induced stall

during its entire 3 minute 30 second descent from 38,000 feet before it hit the ocean surface

Despite multiple warnings from the onboard systems (visual and audible)

In healthcare the same challenges exist and this was aptly demonstrated in this study by Drew who:

He took a picture of a man in a gorilla suit shaking his fist, and he superimposed that image on a series of slides that radiologists typically look at when they’re searching for cancer. He then asked a bunch of radiologists to review the slides of lungs for cancerous nodules. He wanted to see if they would notice a gorilla the size of a matchbook glaring angrily at them from inside the slide.

83% of radiologists missed it.

A problem when we are asking our radiologists (and doctors) to speed through even more images (and patients in less time)

I suspect technology is going to have to help in catching some of these instances and provide additional backup to the human mind. In fact “Assure” is one example of soem of the steps being taken towards this goal

Bitter Pill: Why Medical Bills Are Killing Us

Posted in Health, Healthcare, HealthIT by drnic on February 26, 2013
Media_httptimewellnes_gazce

THere is something fundamentally wrong and flawed with a system that bills patients at highly variable rates, the highest to those with no “insurance” or poor “insurance”.
Insurance in this instance seems like a poor term to describe a system that even with full standard coverage still costs patients thousands if not tens of thousands of dollars of unexpected cost.

It has gotten worse and as the McKinsey study cited in the article highlights

we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart

There are many drivers but central to them are the disconnect between the payers and the people accessing care. Without any personal accountability it is easy to access the care with no thought of the cost or the possible alternatives and better choices.

Some of the reasons behind this are vested in the history of healthcare and how we got here – but just because that was the way it was done before does not mean it is the way we have to do it now.

There has to be a better way – the same as there has to be a better way of compensating the healthcare providers fairly for the work they do. The system currently is designed to pay for things done not for outcomes and results. And clinicians are locked into a system that forces them to document in great detail, oftentimes repeating information that is already in the medical record – because if they don’t they don’t get paid
Many wi ll tell you the information is unnecessary and we see some of the effects with reports of duplicate data. So much better to capture decision making, real information and allow the documentation to be the communication tool between clinicians (which was always the original intent) and then determine the care provided and a fair compensation for the hospital, the provider and everyone involved for delivering that care (and importantly linked ot results not to just delivering the care)

I know I am hoping this is on a pathway to getting fixed. At some point I will be facing bills and challenges such as these – and since the education system (thats a whole other blog posting on the meteoric rise of education costs) has essentially stripped me of any savings and value in my one big investment (my house) I like many others are probably tapped out and have little to call upon when we will inevitably face these challenges. That puts me rooting for major change in healthcare, the system with a move to pay for performance much of which is embodied in the ACO initiative.

https://navigatinghealthcare.files.wordpress.com/2013/02/media_httptimewellnes_gazce-scaled1000.jpg?w=225

http://drvoice.blogspot.com/2013/02/bitter-pill-why-medical-bills-are.html

Tagged with: , ,

Bitter Pill: Why Medical Bills Are Killing Us

Posted in ACO, EHR, Health Care Costs by drnic on February 26, 2013
Media_httptimewellnes_gazce

THere is something fundamentally wrong and flawed with a system that bills patients at highly variable rates, the highest to those with no “insurance” or poor “insurance”.
Insurance in this instance seems like a poor term to describe a system that even with full standard coverage still costs patients thousands if not tens of thousands of dollars of unexpected cost.

It has gotten worse and as the McKinsey study cited in the article highlights

we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart

There are many drivers but central to them are the disconnect between the payers and the people accessing care. Without any personal accountability it is easy to access the care with no thought of the cost or the possible alternatives and better choices.

Some of the reasons behind this are vested in the history of healthcare and how we got here – but just because that was the way it was done before does not mean it is the way we have to do it now.

There has to be a better way – the same as there has to be a better way of compensating the healthcare providers fairly for the work they do. The system currently is designed to pay for things done not for outcomes and results. And clinicians are locked into a system that forces them to document in great detail, oftentimes repeating information that is already in the medical record – because if they don’t they don’t get paid
Many wi ll tell you the information is unnecessary and we see some of the effects with reports of duplicate data. So much better to capture decision making, real information and allow the documentation to be the communication tool between clinicians (which was always the original intent) and then determine the care provided and a fair compensation for the hospital, the provider and everyone involved for delivering that care (and importantly linked ot results not to just delivering the care)

I know I am hoping this is on a pathway to getting fixed. At some point I will be facing bills and challenges such as these – and since the education system (thats a whole other blog posting on the meteoric rise of education costs) has essentially stripped me of any savings and value in my one big investment (my house) I like many others are probably tapped out and have little to call upon when we will inevitably face these challenges. That puts me rooting for major change in healthcare, the system with a move to pay for performance much of which is embodied in the ACO initiative.

NY Times rewrites Health IT History

Posted in Health, Healthcare, HealthIT by drnic on February 21, 2013

The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand.

But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.

While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.

None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.

Mr. Tullman, who left Allscripts late last year after a boardroom power struggle, characterized his activities in Washington as an attempt to educate lawmakers and the administration.

“We really haven’t done any lobbying,” Mr. Tullman said in an interview. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives.”

Between 2008 and 2012, a time of intense lobbying in the area around the passage of the legislation and how the rules for government incentives would be shaped, Mr. Tullman personally made $225,000 in political contributions. While tens of thousands of those dollars went to the Democratic Senatorial Campaign Committee, money was also being sprinkled toward Senator Max Baucus, the Democratic senator from Montana who is chairman of the Senate Finance Committee, and Jay D. Rockefeller, the Democrat from West Virginia who heads the Commerce Committee. Mr. Tullman said his recent personal contributions to various politicians had largely been driven by his interest in supporting President Obama and in seeing his re-election.

Cerner’s lobbying dollars doubled to nearly $400,000 between 2006 and last year, according to the Center for Responsive Politics. While its political action committee contributed a little to some Democrats in 2008, including Senator Baucus, its contributions last year went almost entirely to Republicans, with a large amount going to the Mitt Romney campaign.

Current and former industry executives say that big digital records companies like Cerner, Allscripts and Epic Systems of Verona, Wis., have reaped enormous rewards because of the legislation they pushed for. “Nothing that these companies did in my eyes was spectacular,” said John Gomez, the former head of technology at Allscripts. “They grew as a result of government incentives.”

Executives at smaller records companies say the legislation cemented the established companies’ leading positions in the field, making it difficult for others to break into the business and innovate. Until the 2009 legislation, growth at the leading records firms was steady; since then, it has been explosive. Annual sales growth at Cerner, for instance, has doubled to 20 percent from 10 percent.

“We called it the Sunny von Bülow bill. These companies that should have been dead were being put on machines and kept alive for another few years,” said Jonathan Bush, co-founder of the cloud-based firm Athenahealth and a first cousin to former President George W. Bush. “The biggest players drew this incredible huddle around the rule-makers and the rules are ridiculously favorable to these companies and ridiculously unfavorable to society.”

This industry, which was pioneered in the late 1970s, first gained widespread attention in 2004 when President Bush in his State of the Union speech called for digitizing national health records.

“After that, every technology C.E.O. wanting a piece of health care would have visited me every day if I had let them,” said David Brailer, whom President Bush appointed as the nation’s first health information czar. Over the next few years, Cerner and many of the other health care data companies increased their presence on Capitol Hill.

The records systems sold by the biggest vendors have their fans, who argue that, among other things, the systems ease prescribing medications electronically. But these systems also have many critics, who contend that they can be difficult to use, cannot share patient information with other systems and are sometimes adding hours to the time physicians spend documenting patient care.

“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center, which eight months ago turned on its $160 million digital records system from Epic. Michael Blum, the hospital’s chief medical information officer, said a majority of doctors there like the Epic system.

Whatever the case, the legislation has been a windfall to top executives at the leading health records companies. Neal L. Patterson, who grew up on a farm near Manchester, Okla., population 100, co-founded Cerner in 1979. As Cerner’s sales have soared in recent years, so have Mr. Patterson’s fortunes. From 2007 to 2011, he received more than $21 million in total compensation, according to the executive compensation research firm Equilar, and his stake in the company is worth $1 billion.

In recent years, Mr. Patterson and his wife, Jeanne Lillig-Patterson, who ran as a Republican for Congress in 2004, have emerged as social and business leaders in the Kansas City, Mo., area. Mr. Patterson is also co-owner of a real estate development firm whose ventures include a 1,200-acre community near Kansas City called the Village of Loch Lloyd, featuring a Tom Watson-designed golf course.

A spokeswoman for Cerner said Mr. Patterson was unavailable for comment.

The medical records industry did not have much of a presence in Washington before President Bush highlighted it in 2004. Then in November that year, the industry created its first association, the Healthcare Information and Management Systems Society EHR Vendor Association, to make the case for electronic records. Its founding members included Allscripts, Cerner and Epic.

Four years later, in December 2008, H. Stephen Lieber, chief executive of the group, wrote an open letter to President-elect Obama calling for a minimum government investment of $25 billion to help hospitals and physicians adopt electronic records. The industry ultimately got at least $19 billion in federal and state money.

In the months after that windfall arrived, sales climbed for leading vendors as hospitals and physicians scrambled to buy systems to meet tight timetables to collect the incentive dollars. At Allscripts, Mr. Tullman soon announced what looked like a game-changing deal: the acquisition of another records company, Eclipsys, for $1.3 billion.

“We are at the beginning of what we believe will be the fastest transformation of any industry in U.S. history,” Mr. Tullman said when the deal was announced.

Last spring, some of the Eclipsys board members left after a power struggle; Mr. Tullman left in December. He is now at a company he co-founded that focuses on solar energy — another area that, after Obama administration and Congress expanded government incentives in the 2009 stimulus bill, has been swept by a gold-rush mentality, too.

This article has been revised to reflect the following correction:

Correction: February 20, 2013

An earlier version of this article omitted part of the name of the institution that employs Michael Callaham and Michael Blum. It is the University of California, San Francisco Medical Center, not the San Francisco Medical Center.

To use Paul Harvey’s line….now here’s the rest of the story
Yes the stimulus has increased uptake of technology but in so many respects money well spent – would anyone challenge that our old system of single access paper records that were full of redundant, duplicate information, much of it inaccessible and certainly of limited value to the care of complex clinical conditions and management of patient health….this time borrowoign from Monty Python…if we were lucky

No comment about the significant positive job impact – big increase in healthcare jobs and employment

And as one commentator put it in another thread:

There’s a good bit of history rewriting in this article

As they pointed out much of the competitive landscape had been formed prior to the Act and they were delivering profits long before the stimulus package

We are seeing the benefits and value of these technologies. Many forget it was not the government that sent us down this track
1999 – To Err is Human
2001 – Crossing the Quality Chasm
2006 – Preventing Medication Errors
Not to mention other countries who have demonstrated the value of Healthcare Technology.

Is it perfect – probably not but if this was the tipping point to push everyone towards the same goal then it has had the desired effect, and like many technologies, its good for you on its own, but so much better if everyone participates.

I’m excited to be part of this “Tipping Point” and glad to be working with one of the top 50 disruptive companies in this space.

http://ifttt.com/images/no_image_card.png

http://drvoice.blogspot.com/2013/02/ny-times-rewrites-health-it-history.html

Tagged with: , ,

NY Times rewrites Health IT History

Posted in EHR, Health Care Costs, HealthIT, Nuance by drnic on February 21, 2013

The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand.

But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.

While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.

None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.

Mr. Tullman, who left Allscripts late last year after a boardroom power struggle, characterized his activities in Washington as an attempt to educate lawmakers and the administration.

“We really haven’t done any lobbying,” Mr. Tullman said in an interview. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives.”

Between 2008 and 2012, a time of intense lobbying in the area around the passage of the legislation and how the rules for government incentives would be shaped, Mr. Tullman personally made $225,000 in political contributions. While tens of thousands of those dollars went to the Democratic Senatorial Campaign Committee, money was also being sprinkled toward Senator Max Baucus, the Democratic senator from Montana who is chairman of the Senate Finance Committee, and Jay D. Rockefeller, the Democrat from West Virginia who heads the Commerce Committee. Mr. Tullman said his recent personal contributions to various politicians had largely been driven by his interest in supporting President Obama and in seeing his re-election.

Cerner’s lobbying dollars doubled to nearly $400,000 between 2006 and last year, according to the Center for Responsive Politics. While its political action committee contributed a little to some Democrats in 2008, including Senator Baucus, its contributions last year went almost entirely to Republicans, with a large amount going to the Mitt Romney campaign.

Current and former industry executives say that big digital records companies like Cerner, Allscripts and Epic Systems of Verona, Wis., have reaped enormous rewards because of the legislation they pushed for. “Nothing that these companies did in my eyes was spectacular,” said John Gomez, the former head of technology at Allscripts. “They grew as a result of government incentives.”

Executives at smaller records companies say the legislation cemented the established companies’ leading positions in the field, making it difficult for others to break into the business and innovate. Until the 2009 legislation, growth at the leading records firms was steady; since then, it has been explosive. Annual sales growth at Cerner, for instance, has doubled to 20 percent from 10 percent.

“We called it the Sunny von Bülow bill. These companies that should have been dead were being put on machines and kept alive for another few years,” said Jonathan Bush, co-founder of the cloud-based firm Athenahealth and a first cousin to former President George W. Bush. “The biggest players drew this incredible huddle around the rule-makers and the rules are ridiculously favorable to these companies and ridiculously unfavorable to society.”

This industry, which was pioneered in the late 1970s, first gained widespread attention in 2004 when President Bush in his State of the Union speech called for digitizing national health records.

“After that, every technology C.E.O. wanting a piece of health care would have visited me every day if I had let them,” said David Brailer, whom President Bush appointed as the nation’s first health information czar. Over the next few years, Cerner and many of the other health care data companies increased their presence on Capitol Hill.

The records systems sold by the biggest vendors have their fans, who argue that, among other things, the systems ease prescribing medications electronically. But these systems also have many critics, who contend that they can be difficult to use, cannot share patient information with other systems and are sometimes adding hours to the time physicians spend documenting patient care.

“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center, which eight months ago turned on its $160 million digital records system from Epic. Michael Blum, the hospital’s chief medical information officer, said a majority of doctors there like the Epic system.

Whatever the case, the legislation has been a windfall to top executives at the leading health records companies. Neal L. Patterson, who grew up on a farm near Manchester, Okla., population 100, co-founded Cerner in 1979. As Cerner’s sales have soared in recent years, so have Mr. Patterson’s fortunes. From 2007 to 2011, he received more than $21 million in total compensation, according to the executive compensation research firm Equilar, and his stake in the company is worth $1 billion.

In recent years, Mr. Patterson and his wife, Jeanne Lillig-Patterson, who ran as a Republican for Congress in 2004, have emerged as social and business leaders in the Kansas City, Mo., area. Mr. Patterson is also co-owner of a real estate development firm whose ventures include a 1,200-acre community near Kansas City called the Village of Loch Lloyd, featuring a Tom Watson-designed golf course.

A spokeswoman for Cerner said Mr. Patterson was unavailable for comment.

The medical records industry did not have much of a presence in Washington before President Bush highlighted it in 2004. Then in November that year, the industry created its first association, the Healthcare Information and Management Systems Society EHR Vendor Association, to make the case for electronic records. Its founding members included Allscripts, Cerner and Epic.

Four years later, in December 2008, H. Stephen Lieber, chief executive of the group, wrote an open letter to President-elect Obama calling for a minimum government investment of $25 billion to help hospitals and physicians adopt electronic records. The industry ultimately got at least $19 billion in federal and state money.

In the months after that windfall arrived, sales climbed for leading vendors as hospitals and physicians scrambled to buy systems to meet tight timetables to collect the incentive dollars. At Allscripts, Mr. Tullman soon announced what looked like a game-changing deal: the acquisition of another records company, Eclipsys, for $1.3 billion.

“We are at the beginning of what we believe will be the fastest transformation of any industry in U.S. history,” Mr. Tullman said when the deal was announced.

Last spring, some of the Eclipsys board members left after a power struggle; Mr. Tullman left in December. He is now at a company he co-founded that focuses on solar energy — another area that, after Obama administration and Congress expanded government incentives in the 2009 stimulus bill, has been swept by a gold-rush mentality, too.

This article has been revised to reflect the following correction:

Correction: February 20, 2013

An earlier version of this article omitted part of the name of the institution that employs Michael Callaham and Michael Blum. It is the University of California, San Francisco Medical Center, not the San Francisco Medical Center.

To use Paul Harvey’s line….now here’s the rest of the story
Yes the stimulus has increased uptake of technology but in so many respects money well spent – would anyone challenge that our old system of single access paper records that were full of redundant, duplicate information, much of it inaccessible and certainly of limited value to the care of complex clinical conditions and management of patient health….this time borrowoign from Monty Python…if we were lucky

No comment about the significant positive job impact – big increase in healthcare jobs and employment

And as one commentator put it in another thread:

There’s a good bit of history rewriting in this article

As they pointed out much of the competitive landscape had been formed prior to the Act and they were delivering profits long before the stimulus package

We are seeing the benefits and value of these technologies. Many forget it was not the government that sent us down this track
1999 – To Err is Human
2001 – Crossing the Quality Chasm
2006 – Preventing Medication Errors
Not to mention other countries who have demonstrated the value of Healthcare Technology.

Is it perfect – probably not but if this was the tipping point to push everyone towards the same goal then it has had the desired effect, and like many technologies, its good for you on its own, but so much better if everyone participates.

I’m excited to be part of this “Tipping Point” and glad to be working with one of the top 50 disruptive companies in this space.

Khan Academy Approach Poised to Solve a “Wicked Problem” in Healthcare

Posted in Health, Healthcare, HealthIT by drnic on February 20, 2013
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Khan Academy Approach Poised to Solve a "Wicked Problem" in Healthcare

Posted in education, Health Care Costs, HealthIT, Patient Engagement by drnic on February 20, 2013

Nuance joins a who’s who in 50 Most Disruptive Companies for 2013

Posted in Health, Healthcare, HealthIT by drnic on February 20, 2013
Media_httpwww2technol_ywbgd

This is really cool – Nuance made the list for top 50 disruptive companies in technology. We join other great and innovative leaders like
SpaceX
Google
IBM
Square
Toyota
Apple
Amazon
Corning
Facebook
….to name a few

But also some neat Healthcare focused companies like
Diagnostics for all
Foundation Medicine
Illumina
UniQure

Congratulations to all the others but should out to Nuance – proud to be a part of this team

https://navigatinghealthcare.files.wordpress.com/2013/02/media_httpwww2technol_ywbgd-scaled500.png?w=300

http://drvoice.blogspot.com/2013/02/nuance-joins-who-who-in-50-most.html

Tagged with: , ,

Nuance joins a who’s who in 50 Most Disruptive Companies for 2013

Posted in Disruptive, Innovation, Nuance, Technology by drnic on February 20, 2013
Media_httpwww2technol_ywbgd

This is really cool – Nuance made the list for top 50 disruptive companies in technology. We join other great and innovative leaders like
SpaceX
Google
IBM
Square
Toyota
Apple
Amazon
Corning
Facebook
….to name a few

But also some neat Healthcare focused companies like
Diagnostics for all
Foundation Medicine
Illumina
UniQure

Congratulations to all the others but should out to Nuance – proud to be a part of this team