#HIT100- The List

Big props go to @theEHRguy for initiating and tabulating this list! I gleaned this info from his tweets, and they are listed in that order. The number after the names is how many times the person was nominated. Folks in the Health IT social media community voted, and here’s the results- the Health IT 100!

1- @ahier = 36
2-@motorcycle_guy = 35
3- @TheGr8Chalupa = 31
4- @ePatientDave = 26
5- @NateOsit = 26
6- @lizasisler = 23
7- @EMRAnswers = 22
8- @janicemccallum = 21
9-@Perficient_HC  = 20
10-@ej_butler = 18
11-@MatthewBrowning = 18
12- @jhalamka =17
13-@ReginaHolliday = 16
14-@2healthguru =16
15-@theEHRGuy = 15
16- @Farzad_ONC = 14
17- @Lygeia = 14
18- @SusannahFox = 14
19-  @boltyboy  = 13
20- @Cascadia  = 13
21- @faisal_q = 13
22-@HealthStandards = 13
23-@aviars = 12
24- @HealthBlawg =12
25-@HITAdvisor =12
26- @VinceKuraitis =12
27- @jimmyweeks =11
28- @HealthyThinker =10
29-@jonmertz =10
30-@HISTalk =9
31- @HITExchange =9
32- @john_chilmark =9
33- @PhilBaumann =9
34- @CLOUDHealth =8
35- @EdBennett =8
36- @ekivemark =8
37- @ftvelasco =8
38- @pjmachado =8
39- @tedeytan =8
40- @westr  =8
41- @MedicalQuack =7
42- @MicrosoftMD  =7
43- @WTeeGreen =7
44- @acowatch =7
45- @bobcoffield =7
46- @Egrunden =7
47- @FairCareMD =7
48- @fredtrotter =7
49- @jasoncolquitt =7
50- @JessPKahn =7
51- @KentBottles =7
52- @kevinmd =7
53- @BarbaraFicarra =6
54- @gnayyar=6
55- @HIMSS =6
56- @jbselz =6
57- @jkedar =6
58- @realworldhl7  =6
59- @RichmondDoc =6
60- @rilescat =6
61- @ShimCode =6
62- @lisacrymes  =5
63-  @omowizard  =5
64- @richelmore =5
65- @RMartinBoulder =5
66- @RossMartin  =5
67- @Andrewspong  =5
68- @ElinSilveous=5
69- @erikpupo  =5
70- @fierceEMR =5
71- @GailZahtz  =5
72- @hitconsultant =5
73- @HITNewsTweet =5
74- @IngaHIStalk =5
75- @HIT_Sonal =4
76-  @HealthEugene =4
77- @HealthIT =4
78- @jimtate  =4
79- @JohnSharp =4
80- @Jsamplesgmt =4
81- @lostonroute66 =4
82-@marxists  =4
83- @meducate =4
84- @poikonen  =4
85- @dirkstanley =4
86- @drjosephkim  =4
87- @EHRoutlook  =4
88- @EMRDailyNews  =4
89- @GovHITeditor   =4
90- @GrahameGrieve  =4
91- @harrygreenspun  =4
92-  @anitasamarth  = 4
93-  @Anthony_Guerra =4
94- @billians  =4
95- @blogbrevity =4
96- @CorepointHealth =4
97- @cristianliu =4
98- @cyberslate =4
99- @danamlewis =4
100- @cindythroop =4

It could be YOU!! (#’s didn’t quite add up…)

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Where’d I Go? Updates on Bio Digital Jazz

So I haven’t posted to this blog for a little while, and figured I would check in to let readers know what I’m up to.

In addition to this blog, I have recently been doing some guest posting on other blogs. Check out these recent articles-

Bridging the Gap- Health Disparities, Health IT, and Social Media

This was an article on the intersection of these Health IT and social media, and how these tools can be utilized to help reduce health disparities. It was written for the blog #HCSMGlobal, a new blog that’s building a global movement dedicated to discussing key health issues that effect us all.

Synergy, Community and Engagement in the #HITsm Community

I posted on HL7 Standards to explain what a great resource the #HITsm community has been to me. I don’t think I would have had the knowledge or passion to pursue my new career in Health IT without their enthusiastic support. I’m extremely grateful for all the hard work of @thegr8chalupa and @jonmertz in creating such an engaged online community.

What’s Next

I have left my position as a Transcription Analyst at Tufts Medical Center, and next week I begin my new career at Forerun Systems in Waltham, Mass. I’m extremely excited to get started, as I think it will be an amazing learning experience. I will be starting out as an Implementation Specialist, working with their innovative FlexChart software including Digital Ink technology, as highlighted in John Halamka’s Cool Technology of the Week. I will most likely be assisting in developing a social media strategy, so I’m psyched to be start that as well. I may be less available for a few days while I get settled, but I plan to continue blogging here.

Thanks to all my readers and the Health IT community! I’ve found this to be a very supportive community, and I hope to continue my objective of navigating the complexities of Health IT to create Bio Digital Jazz.

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What took EHR so long?

Recently, I came across a question on Quora- “Would growth in EMR/EHR adoption continue if Meaningful Use stopped?” You can read my short answer to this question there, but I thought that it deserved a more in-depth analysis.

The question of whether EHR implementations would cease if Meaningful Use incentives stopped is a great starting point, but it has limitations. It’s speculative- What if I could fly? What if we changed the national currency to oak leaves? There are answers to these questions, but since it’s something that hasn’t happened yet, any answer would be an opinion based on current objective conditions. The more interesting question this leads to, I believe, is why has it taken so long for the US to adopt electronic health records? For this question, I will delve into the history of electronic records in the U.S. and abroad, and search for a more solid understanding of the current state of the healthcare industry.

For comparison, I first looked into the history of computerized banking records. There are many similarities in terms of the type and volume of data involved, so I thought it would be a useful starting point. In my search, I began to see some similarities in the types of problems the banking industry faced:

“The problem posed by the bank for solution by machine included all accounting that normally attends many thousand commercial checking accounts of a bank. Such a machine must be able to keep record of deposits and withdrawals for each client, make current-balance information available at an instant’s notice, watch for overdrafts, stop payments, and held funds. It must be able to provide, on a strict schedule, periodic statements of the account along with the accumulated checks. The machine must not only handle all necessary arithmetic but also handle the paper documents in whatever physical condition they exist after passage through many hands. All machine operations must, furthermore, be as exact as banking accounting calls for and be in constant step with hourly, daily, and monthly routines of the banking system.” via SRI International

Console of General Electric's commercial ERMA.

Many of these types of problems are what current EHR systems are being designed to solve. However, the banking industry commissioned this system to be designed in 1956. This was a time when the transition from vacuum tubes to transistors was still going on! They designed a system capable of solving all these problems, including character recognition and processing vast amounts of data very rapidly. So, it’s safe to say that what held back the implementation of EHRs in the U.S. was not a lack of technology capable of handling the information.

The U.S. is obviously not the only country to tackle the problem of nationwide EHR implementation. In “Electronic Health Records for Dummies“, 4 countries are recognized as being leaders in EHR adoption. These are the UK, the Netherlands, Australia, and New Zealand. Here are some common criteria these countries had in their approach to EHR Implementation. There’s a lot of information out there about these points, so to simplify I’ll use one for each country. Also, for the sake of brevity, I’ll leave out the Netherlands.

Government Investment/Grants
New Zealand has been a leader in Health IT for decades, due largely in part to Government incentives and forward thinking planning. Some of their accomplishments are:

  • A national health index to identify patients, dating back to the early 1980s
  • A national cancer register, dating back to 1948
  • Almost 100 percent usage of computer systems by general practitioners.

(Source: NZ Health Information Standards Organization)

Interoperability Standards
From www.nehta.gov.au– In Australia, the National E-Health Transition Authority Limited (known as NEHTA) was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. Some goals of the NEHTA include:

  • Establishing standard clinical terms for use by e-health systems, so that systems use consistent terms to describe the same disease, therapy, medicine etc;
  • Designing specifications for secure electronic health records, to enable authorised healthcare professionals to view the collated health history of an individual while maintaining high standards of privacy;

Public Investment in Health Services
From nhshelp.co.uk– “The post World War II labour government created the NHS as part of its sweeping welfare state reform policy. The general hypotheses was that England had just proven, during the war years, that it was capable of employing almost the entire workforce and spend large amounts of money on wartime endeavours, and that those same resources could be focused on the public good … The resulting healthcare system ensured that everyone, regardless of background or income, would have access to medical treatment, and be able to seek the advice and service of doctors as they needed. All of this was funded solely through taxation, the Labour Party in England still touts the NHS as its greatest ever achievement.”

In the US, Meaningful Use has jump-started the drive to EHR implementation by getting us up to speed on the first two criteria listed above. We do not have any any system in place for widespread health coverage, which may be one of the reasons why we are lagging in EHR adoption. Without MU, I believe the adoption of EHR would be significantly hindered. However, what the ONC initiatives have achieved already is the creation of a culture of change in healthcare.

Culture of Change

What Meaningful Use incentives have done in the US is highlight the need for structural change in how we approach healthcare. Physicians were reluctant to embrace a new system until they see the benefits to their workflow and patients. New articles come out every day highlighting the benefits of EHR. There is an explosion in EHR software development, with over 300 vendors producing Health IT solutions. Once the MU incentive period ends, I believe we will see which solutions have real staying power. I also think that ONC initiatives designed to inform the public about EHR benefits will become increasingly important, as it will influence more physicians to embrace EHR adoption.

Creating an EHR Culture of Change


What took EHRs so long in US? I believe it was the lack of government incentives, the failure to embrace industry wide data standards, and the inability of the US to ensure healthcare coverage to its citizens. I initially stated that I thought EHR would continue if MU incentives halted, but now I’m not so sure. Are there any countries that have widespread EHR adoption on the scale that’s necessary that don’t meet any of the criteria listed above? Not that I’m aware of. The question would become whether the incentives already implemented by the ONC would be enough to sustain the momentum in the industry. However, that’s another speculative question. Luckily, there doesn’t appear to be any threat to MU right now, so we are on track to create a truly innovative health IT system that can enhance patient’s experience while cutting down on frustrating administrative tasks for physicians and medical staff. Keep it up!

[Special thanks to Erica Olenski @TheGr8chalupa for posing this question and Keith Boone @motorcycle_guy for pointing me in the right direction when I was researching it.]

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Is Achieving Meaningful Use Asking Too Much?

Are the Meaningful Use criteria set by the ONC too strict? Too complicated? Too… frustrating?

Meaningful Use criteria can lead to confusion & frustration

These are questions being asked by thousands of providers, hospitals, clinics, and healthcare networks across the country. I’m a big believer in reviewing the basics, both for the benefit of my readers and my own education. Meaningful Use was one of the big themes at this year’s HIMSS11 conference, but I think it’s a topic that’s worth re-examining in light of the recent criticism aimed at the complexity and strictness of the MU criteria.

Here are some of the core elements of of the Meaningful Use criteria. These are the elements that I think will give providers the most trouble.

Computerized Physician Order Entry
Criteria– More than 30% of unique patients with at least one medication in their medication list seen by the EP
have at least one medication order entered using CPOE.
Possible Issues– Many providers already use some form of CPOE, but the systems they currently use may not be ONC certified. For those not currently using a CPOE system, they will have to adapt to the workflow changes quickly, in ways that may not have been explained to them yet.

Access to Electronic Copies of Medical Records
Criteria– More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days.
Possible Issues– Many patients have records which span multiple volumes. The quickest way to make this information available is to scan the documents as images, and give the patient a CD with their records. However, this entire process will need to be re-done in order to integrate the patient data into their EHR in a useful way. The criteria requiring a summary of patient visits is much more reasonable, because that information can be taken directly from a newly implemented EHR system.

Criteria– Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Possible Issues– Even if an EHR system has been certified as secure, there may be additional security issues that arise. Many physicians access EHR/EMR systems from home, so even if the setup is secure in their practice, there may be additional risks involved. If the providers do not have a secure system in place on their home computers, your medical records might end up online.

Integrating Structured Data

  • More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
  • For more than 50% of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data

Possible Issues– I’m really excited about the integration of structured data into EHRs. I think this is an area that will really streamline workflows by eliminating redundant information. However, the transition from the unstructured data we currently have to structured data is going to be a challenge, but Dr. John Halamka provided some insight into what will be necessary to achieve this in his recent post, “Freeing The Data“:

“Today’s certified EHRs provided structured vocabularies and specific pulldowns/checkboxes for data entry, but what do we do about past data? Ideally, we’d use natural language processing, probability, and search to examine unstructured text in the patient record.”

Let's celebrate physician champions!

In summary, there are many hurdles that must be overcome in order to achieve Meaningful Use, and we need to make sure that providers have the resources available to make it as easy and painless as possible. We should also be recognizing the great work being done by Physician Champions, providers leading the way in EHR adoption. The more superusers we have in the field, the quicker we can achieve the goals set out by the ONC and achieve Meaningful Use in a way that streamlines the healthcare industry and creates value for patients. Because, in the end, patient health and safety is what it’s all about.

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“Long Live The New Flesh”: Technology and Social Media in David Cronenberg’s “Videodrome”

Media and technology have always been a big part of my life and how I perceive the world around me.

Technology has been a part of my life as far back as I can remember. As the son of two mechanical engineers, computers have been omnipresent part of my reality since my childhood. I remember my dad’s huge UNIX terminal located in our basement, and my constant curiosity as to what it did.

My Dad's terminal wasn't quite this old, but it was close!

In the third grade I was given the task of creating a science project.  Other kids made the standards- baking soda volcanoes, seeds growing in water, and potato powered lights galore.

When people came to my project, they didn’t quite know what to make of it. I had a laptop on my desk with a Netscape browser opened on it.  I had written a very basic interactive website. It was a Toy Story quiz, which when you clicked the right answer would play a WAV file that was locally stored. This was before 56k modems, so it probably wouldn’t have worked as an online site. Still, I was quite proud of my accomplishment,

From my technophile origins, I eventually became somewhat disillusioned with the promise of technology. Once I entered college, I abandoned my tech focused major, and was accepted into the English program. My main focus, however, was not English.

During my first semester I became involved in the college radio station, WUML. Everyone who wanted to become a station staff member had to go through an internship process, which included weekly meetings, 10 hours of intern service hours, and a final exam. By the end of my semester, I had attended all weekly intern meetings, aced my exam, racked up over 100 intern hours, and been voted in as assistant General Manager. I was hooked.

Check out WUML.org

At the end of the next semester, I was elected to become the station’s General Manager (GM) by the general membership. I spent the summer immersed in FCC regulations, technical manuals, and engaged in online discussions with our members. I came to appreciate the value that the station provided to the local community. The best example of this value was the Khmer language (Cambodian) programming we offered. In Lowell, Massachusetts there is a large population of Cambodian immigrants. They tuned in to WUML because it offered them a connection to the world around them, either locally based news or the latest happenings in Cambodia.

What I learned during my time as GM at WUML was the importance of using media and technology for the good of humanity. During this time I was inspired by Buckminster Fuller, whose long lectures I watched during my midnight-5am radio shifts. Fuller embarked on “an experiment, to find what a single individual [could] contribute to changing the world and benefiting all humanity.” I believe that technology in general, and social media in particular, have the potential to bring us closer to Marshall McLuhan’s concept of “The Global Village”.

This brings me to the title of this post. It’s tough to single out my favorite movie, but I can say that Videodrome is the movie I find most intriguing because of its message, themes, and its “a philosophy”. The film helped solidify my views on the positive role media and technology can have in society.  

Beyond the gore and guts of the film’s sensational appeal lies a serious examination of the role media and technology has in our lives. The films protagonist, Max Renn, runs an independent TV station, Civic TV, which features controversial programming that Max is constantly seeking out from the depths of underground cinema and pirated broadcasts.

In one of the opening scenes, Max appears on a talk show to defend the programs he broadcasts. He gives a weak, superficial response about providing an outlet for maladjusted individuals. This scene introduces the character of Brian O’Blivion, who represents media visionary Marshall Mcluhan, who explains appears on a television set beside the host. He explains:

“The television screen has become the retina of the mind’s eye. That’s why I refused to appear on television. Except on television. Of course, “O’Blivion” was not the name I was born with. That’s my television name. Soon, all of us will have special names — names designed to cause the cathode ray tube to resonate.”

Replace “television” with “internet”, which wasn’t developed at that point in time, and this becomes a profoundly prophetic idea. He envisions a world where people use technology to create meaningful connections with each other. One where our identification with technological personae becomes an integral part of our personality. We’ve seen this evolve from USENET groups, ICQ, and AIM into the Twitterverse, Blogosphere, and Facebook phenomena of today.

In the film, Brian O’Blivion runs an establishment called the “Cathode Ray Mission”. The Mission is filled with men and women who look run down, tired, and disconnected. They are given access to television, which seems to energize them. The philosophy of this facility is that “watching TV will help patch them back into the world’s mixing board.” I found this to be an extremely intriguing concept. As an introvert, I see social media as a the most direct medium available to engage with like-minded people in a meaningful way. I feel that how I interact through social media offers me a comfortable, focused channel through which I can perceive the world and affect change.

More broadly, we see the effect of O’Blivions mixing board changing the techno-political landscape.  Whether it’s the effect of Twitter in Egypt, Facebook in elections, or Wikileaks on diplomacy and foreign policy, social media is changing our world in ways we could never have predicted.

However, the film also shows how media can be used for destructive, anti-social purposes.  Max Renn discovers a program called Videodrome being broadcast on a pirate signal. The show is simply torture- no plot, no scene changes, just raw brutality with no discernible purpose. Max becomes obsessed with the show, and it begins to cause horrific hallucinations. I don’t want to spoil it for those who haven’t seen the film, but it turns out that Videodrome was being used to control Max, and also caused the death of Brian O’Blivion as a result of a tumor created through watching it.

The imagery of the tumor being created by those who sought to use media and technology for selfish, manipulative aims applies to social media as well. This sort of anti-social behavior can spread like cancer, metastasizing into the far reaches of cyber culture. We need to call out this behavior when it appears if we want to create a true global village. In the film, Brian O’Blivion’s daughter Bianca is able to “re-program” Max, and use the new power he has gained by plugging into the world’s mixing board to eradicate the corruption of Videodrome.

His final words are “Death to Videodrome- Long Live The New Flesh!” The New Flesh refers to the power media and technology have as they become part of how we perceive reality. New Flesh can also refer to scars, which can be a constant reminder of past mistakes. Again, I believe that this film was profoundly insightful in its analysis of the role media has in our lives, and underneath all the horror and surrealism lies an inspiring message about the ability of media and technology to empower us and create a true global village.

“Long Live the New Flesh” parallels  my own experience with media, and my desire to use innovative technology to connect with the world. Whether it’s keeping up with the latest Health IT news on Twitter, contributing to Open Source Software, connecting with friends on Facebook, or connecting with my community through local radio, I believe in the power of social media to make our lives better. I hope you do too.

Connect with me on Twitter

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HIMSS11 Updates- Follow the Action!

Another day of HIMSS11 has passed, and there’s a lot of great info being posted online. Here are some of the highlights-

Keynote speaker– C. MARTIN HARRIS, MD Update from the Chairman
As I mentioned during this week’s #HITsm chat this week, it was inspiring to see a vision of integrated workflow redesign, EBM, ACO, EHRs, and MU in a single, cohesive message

Patients are clamoring for mobile healthcare, and Fierce Healthcare held a breakfast discussion on mHealth’s Evolving Role in Achieving Meaningful Use. I’m excited about the EHR mobile apps that have been developed, but there’s still room for improvement and innovation. Here are some articles outlining progress being made in mHealth-
5 Surprising Things Healthcare Apps Can Do

Social Media
I’m especially excited about the inclusion of social media in this years conference. SM is a great model to look at when developing ACOs and HIE. Companies embracing SM are able to keep up with the latest tech news, ONC initiatives, and other industry updates. It also offers the opportunity to become thought leaders in the Health IT community, and reach an audience that wouldn’t otherwise be available. Here’s a great article from Eileen Rivera on Social Media and Lee Aase’s presentation on Social Media-

Start Small. Thing Big. Move Fast.

I’m excited by all the developments coming out of HIMSS 11, and I hope we keep the momentum going after everything wraps up!

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HIMSS Highlights

I’ve been following the #HIMSS11 action through the channels mentioned in my previous post. Here are some of the highlights and useful links that have been posted-

Yesterday, in a session on Social Media, Kenneth Kleinberg was quoted as stating “if you are social media savvy, your company has a leg up in the #Healthcare industry, esp with #ACO” This is great news for us in the HITsm community! Hopefully we will see more physicians and other providers adopting social media tools to enhance the patient experience.

When asked about the impact of negative comments Lee Aase, Director of Social Media at the Mayo Clinic, replied “the solution is dilution”. This is a concise, helpful suggestion, as anyone involved in social media knows that the best way to build your reputation is to engage with people in a meaningful, productive way.

I’ll be posting more updates as they develop, but stay tuned! HIMSS11 is a game changer

To follow on Facebook, check out www.facebook.com/himss

For a full list of presentations and handouts, check out the HIMSS Handout Page

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links for 2011-02-20

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links for 2011-02-19

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HIMSS 11- How to follow the action

I’ve recently become a member of HIMSS, and so far I’ve been impressed with the plethora of resources they make available to members. I won’t be making it down to the conference this year, but I will be following the action through a variety of online channels. Here are some of the ways I’ll be keeping up:

Twitter is a great way to stay up do date with the latest news in Health IT, and HIMSS 11 is no exception. I will be following these Twitter users closely for updates:

To follow along with me, just subscribe to the HIMSS11 list I’ve created on twitter:

There are also several websites that will be posting updates from the conference. Here are the best ones I’ve found:

I’ll continue to post more updated info as it becomes available- stay tuned!

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