MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'healthcare delivery'. Sat, 03 Sep 2011 02:27:35 +0100 http://www.medworm.com/index.php?rid=5182343&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F09%2Fnurses-and-physicians-as-exercise-role-models-for-patients.html Everyone seems to be in agreement that most Americans lead lives that are far too sedentary. The solution to this problem, and many of the problems associated with a sedentary lifestyle, is exercise. However, motivating people to pursue a more active life is enormously challenging. Perhaps a good place to start is understanding that nurses (and also physicians) often function as role models for patients. A recent article raises this issue (see: Calling Nurses to Exercise as Role Models for their Patients). Below is an excerpt from it: Nurses, just like many of their patients, struggle to find time and motivation to exercise. But a new study may give these all-important caregivers some additional pressure and responsibility: nurses’ attitudes can influence whether their patients commit to... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5182343 Thu, 01 Sep 2011 12:15:56 +0100 5182343 http://www.medworm.com/index.php?rid=5182344&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fproject-costs-of-obesity-to-crush-us-and-uk-health-systems.html A recent article in Lancet discussed how the global obesity epidemic would "crush" the U.S. and U.K. health systems with its associated increased long-term, disease-associated costs (see: Obesity to crush health care systems globally: study). Although the use of the word "crush" may seem overly dramatic, I think that it's appropriate in this context. Below is a brief summary of the article: Rising prevalence of obesity is a worldwide health concern because excess weight gain within populations forecasts an increased burden from several diseases, most notably cardiovascular diseases, diabetes, and cancers....These trends project 65 million more obese adults in the USA and 11 million more obese adults in the UK by 2030, consequently accruing an additional 6—8·5 mil... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5182344 Wed, 31 Aug 2011 12:53:20 +0100 5182344 http://www.medworm.com/index.php?rid=5182345&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Ftulaboratory-based-genetic-counselors-reduce-the-cost-of-ordered-tests.html Appropriate test ordering by clinicians is a key aspect of clinical laboratory management. It can save time and money. One of the most obvious goals of this approach is to cull out duplicate test orders when the patient in question is clinically stable and the additional results are useless. The number of test cycles to arrive at a diagnosis can also often be reduced by immediately ordering a more specific test rather than repetitive groups of less-specific tests. The more specific test may be more expensive than the others but the total cost of testing may be less. In general, clinicians often require the most advice when ordering molecular and genetic tests. They tend to be the most expensive, most complicated, and require the most interpretive skill. ARUP Laboratories has published a wh... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5182345 Tue, 30 Aug 2011 12:54:47 +0100 5182345 http://www.medworm.com/index.php?rid=5159861&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Ffepic-beaker-ready-or-not.html There is going to be a lot of money made as the result of the potentially large-scale deployment of Epic's immature LIS called Beaker. One of the first in line to shake this money tree will be KLAS. Here is their announcement of a report on this topic by the company (see: Epic Beaker: Ready or Not?): The laboratory market typically sees little movement. Because of the expense and complexity from a laboratory system’s deep penetration into a hospital, laboratory systems are not changed frequently. If providers do change, it is rarely from a more sophisticated solution to a more immature one. One product that seems to be bucking that trend is Epic Beaker, Epic’s newly available laboratory solution. Of surveyed Epic hospitals currently using other laboratory solutions, over half are p... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159861 Fri, 26 Aug 2011 13:19:45 +0100 5159861 http://www.medworm.com/index.php?rid=5159862&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fdoes-epic-have-a-near-monoply-for-large-hospital-emrs.html Joseph Conn, who writes for ModernHealthcare.com, picked up on one of my blog notes about the Epic EMR dominance in larger hospitals (see: Not yet an Epic monopoly or conflict). Here is his note: Bruce Friedman, in a post on Lab Soft News says, "Epic has achieved a near monopoly of the (electronic health-record systems) installed in the largest U.S. hospitals." And writing in the Washington Examiner, Lachlan Markay, an investigative writer with the conservative Heritage Foundation's Center for Media and Public Policy, reveals that Epic Systems Corp. CEO Judith Faulkner not only has made campaign contributions to Democrats but also has served as a member of the federal Health Information Technology Policy Committee, which "holds in its hands the future of health informat... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159862 Thu, 25 Aug 2011 12:51:59 +0100 5159862 http://www.medworm.com/index.php?rid=5159864&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fepic-as-a-victim-of-its-own-success.html Katherine Rourke, who blogs over at Hospital EMR and EHR picked up on one of my recent notes about Epic (see: The Feasibility of Using the Epic EMR as a "Platform" to Extend Its Functionality) and posted the following note: Could Epic End Up The Victim Of Its Own EMR Success? Here is a copy of her commentary with a few minor edits. Boldface emphasis is mine: In essence, the [recent Lab Soft News] post makes three key points: Epic is implemented, or soon will be, in virtually every large U.S. hospital Epic keeps very close control of how its system is implemented and developed in an effort to control performance Given this desire for control, Epic isn’t likely to let other vendors create software to interoperate with its EMR If the Lab Soft News author has his facts right, Epi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159864 Tue, 23 Aug 2011 12:46:33 +0100 5159864 http://www.medworm.com/index.php?rid=5159865&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fsix-major-disruptions-still-to-come-in-halthcare.html Predictions about strategic shifts in healthcare intrigue me. There is always the question in one's mind about whether you agree with the list. A recent article was labeled as a list of healthcare "disruptions" but otherwise caught my attention (see: 6 Major Disruptions Still To Come In Healthcare). Here's the list stripped of the accompanying brief explanations: Conversion of physicians to electronic health records. Removing the responsibility of records-sharing from the patient. The rise of the genomic signature as part of the medical record. Moving the responsibility [for] care and outcomes from the provider location to the consumer location. The rise of health avatars. The change in physician compensation from fee-for-service to fee-for-outcomes. What interested me... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159865 Mon, 22 Aug 2011 12:15:33 +0100 5159865 http://www.medworm.com/index.php?rid=5140318&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fcan-hospitals-become-more-health-outcome-oriented.html I have previously discussed some of the problems associated with fee-for-service and the need for hospitals and physicians to be more oriented to health outcomes (see, for example: Performing Procedures Can Be Lucrative for Physicians). I think that most people understand that the pursuit of outcomes is superior to fee-for-service but the challenge is revamping our reimbursement system to favor the former approach. A recent note by written by Dave Chase, the CEO of Avado.com, a health technology company, made this same point very eloquently (see: Making Newspaper Industry Mistakes).  Below is an excerpt from it: Now consider healthcare in the U.S.: There’s a clear understanding that the industry must shift its focus towards outcomes from “do more, bill more” orientation....Prev... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5140318 Tue, 16 Aug 2011 13:41:41 +0100 5140318 http://www.medworm.com/index.php?rid=5131063&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fdeclining-autopsy-rates.html Discussion About Reinventing the Autopsy; Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure; NYT Highlights the "Virtopsy" Used for All Military Autopsies). The virtopsy would undoubtedly be more accurate than the classic autopsy. It also could be performed less expensively and more quickly. You can refer back to my previous notes for more details about its advantages. It is currently the norm for the U.S. military and also widely adopted in countries such as Switzerland. As noted in the excerpt above, one of the major reasons for the decline in the autopsy rate is that it's time-consuming and thus expensive. It's also an uncompensated hospital service. Needless to say, family members are also often reluctant to allow the procedure on relatives withou... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5131063 Mon, 15 Aug 2011 17:40:33 +0100 5131063 http://www.medworm.com/index.php?rid=5119007&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fethical-questions-posed-by-office-emr-by-epocrates.html Epocrates is a very successful smartphone app for physicians. The company recently announced the availability of an electronic health record (EHR) (see: Epocrates electronic health record raises new possibilities and ethical questions). Below is an excerpt from an article about this new product that may raise some ethical concerns: ...Targeted to small and solo physician practices, the [Epocrates EHR product] is a web-based software-as-a-service platform which will be offered on a monthly-subscription basis. At launch , it includes a native iPhone app that appears to include access to patient records as well as e-prescribing functionality, with iPad support reportedly in the works. Epocrates EHR will also include support for billing/coding, data analysis and reporting, and an interesting t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5119007 Wed, 10 Aug 2011 12:00:00 +0100 5119007 http://www.medworm.com/index.php?rid=5107909&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fwould-the-fda-swallow-an-over-the-counter-lipitor.html Pharmaceutical manufacturers are growing increasingly concerned because so many of their block-buster drugs are coming off patent and reverting to generics (see: Some Interesting Insights into the Use of Generic Drugs). One of Pfizer's responses has been to propose that its well-established Lipitor brand now be sold over-the-counter. This, of course, requires regulatory approval (see: Reader Consult: Would the FDA Swallow an OTC Lipitor?), Below is an excerpt from the article: Pfizer is hoping to milk even more dollars from its blockbuster Lipitor by introducing an over-the-counter version of the cholesterol-lowering drug, the WSJ [recently reported], citing people familiar with the matter. Whether Pfizer can get the FDA to swallow an OTC statin is another matter entirely. The WSJ repo... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5107909 Mon, 08 Aug 2011 12:00:00 +0100 5107909 http://www.medworm.com/index.php?rid=5097117&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fhospitalists-add-to-the-cost-of-healthcare-according-to-recent-study.html This study should come as no surprise to anyone. Here's what I think may be occurring: Hospitalists work for health system CEOs who place a high value on a shorter length-of-stay (LOS) for patients. The will thus tend to discharge patients as soon as possible. CEOs have been conditioned over the past many years to relish shorter LOSs because the measure has attained the status of a quality indicator and also because shorter LOS patients are more profitable. I also assume that hospitalists tend to favor discharge of patients to rehabilitation or nursing facilities rather than to home because they do not know them well and also to ensure a speedier, medically supervised recovery. Almost everyone agrees about the solution to this problem. It is stated clearly in the excerpt above: &quot... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5097117 Thu, 04 Aug 2011 14:35:03 +0100 5097117 http://www.medworm.com/index.php?rid=5097119&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fsome-interesting-insights-into-the-use-of-generic-drugs.html We are obviously in an era in which most drug prescriptions will default to a generic product when available. A recent article discussed how drug prices are about to plummet on the basis of expiring pharmaceutical company patents. Most, if not all, of these patent-protected drugs will be replaced by generic equivalents (see: Drug prices to plummet in wave of expiring patents). Included in the article were some fascinating facts about generic drugs. Below is an excerpt from it: The cost of prescription medicines used by millions of people every day is about to plummet. The next 14 months will bring generic versions of seven of the world's 20 best-selling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix....Between now and 2016, blockbusters with about $2... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5097119 Wed, 03 Aug 2011 00:31:50 +0100 5097119 http://www.medworm.com/index.php?rid=5078059&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fcancer-survivorship-and-the-role-of-pcps.html I have posted a number of previous notes about cancer survivorship (see: Cancer Survivorship, an Emerging Subdiscipline in Oncology; "Chemo Brain" Can Persist for Three to Five Years; Exercise Can Help Reverse; New Research Casts Spotlight on "Chemo Brain"). However, I have not given much thought to exactly which physicians would administer long-term care to cancer survivors. A recent article addressed this topic (see: Study: Doctors differ in how best to care for America's 12 million cancer survivors). Below is an excerpt from it: There are major differences between oncologists and primary care physicians regarding knowledge, attitudes, and practices required to care for American's 12 million cancer survivors. That is the key finding of the first national... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5078059 Thu, 28 Jul 2011 19:00:12 +0100 5078059 http://www.medworm.com/index.php?rid=5069832&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fbetter-quality-services-when-doctors-manage-hospitals.html I have most commonly worked in hospitals where the CEO's major strengths were in financial management -- they were not MDs. Once, in the Army, I worked in a hospital where both the commander and deputy commander were physicians. My general impression has been that the former executives tended to stress the need for quality of care but often had little real understanding about the processes for achieving quality or the true cost of these processes. A recent article caught my attention and asks the question whether hospitals should be run by physicians (see: Should Hospitals Be Run by Doctors?), Below is an excerpt from it: The conventional wisdom is that doctors should focus on patient care, and managers with a business or administrative background are better suited to running the day-t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5069832 Tue, 26 Jul 2011 18:15:43 +0100 5069832 http://www.medworm.com/index.php?rid=5051263&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fa-different-paradigm-for-analyzing-the-competition-between-cerner-and-epic.html In a recent note, I discussed the competition between the Cerner and Epic EMRs and quoted another blog, Chilmark Research, to the effect that Cerner was moving in new strategic direction, emphasizing a network of services to provide communities of care (see: Cerner Fights Back in the EMR Market: A Community Network of Services + PHR). Such an approach is sometimes referred to as the development of a care coordination platform. I concluded that Epic's approach closely coincided with the business model currently favored by hospital executives and would probably continue to succeed in the market. Vince Kuraitis responded to my note with a comment that included a link to a lecture he had recently delivered titled Platform Wars (see: Platform Wars). The presentation can also be accessed at ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5051263 Mon, 18 Jul 2011 13:43:40 +0100 5051263 http://www.medworm.com/index.php?rid=5029239&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Ffemr-based-order-sets-as-a-locus-of-control-of-hospital-based-physicians.html In a recent note, I discussed the evidence-based physician order sets that were being deployed at the University of Kansas Hospital (see: Evidence-Based Order Sets Deployed at the University of Kansas Hospital). At the end of the piece, I commented on the very large number of them and speculated that many of them would probably never be used as a practical matter. Here is the specific quote: Here's what I don't understand about the deployment of standardized order sets. Why develop 240 when most physicians will use only a small number of them? In the current case, I am sure that Zynx Health wants to prove the worth of its product to the University of Kansas Hospital and it provides bragging rights to have 240 of them. Even differentiating them by type of patient, my guess is that p... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5029239 Fri, 15 Jul 2011 14:06:50 +0100 5029239 http://www.medworm.com/index.php?rid=5029240&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fcerner-fights-back-in-the-emr-market-network-of-services-for-a-community-of-care.html In my opinion, Cerner is facing a formidable competitor, Epic, in the high-end, larger hospital EMR space (see: Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion; Is Cerner Modifying Its EMR Business Model?). John Moore who blogs over at Chilmark Research recently posted a long piece suggesting that Cerner is crafting a new strategy in order to compete more effectively with Epic. He suggests, first, that It emphasizes support for "communities of care" (i.e, city, region, state, employer). Cerner also intends to provide a "PHR with an ecosystem of third party apps." This will serve as a replacement for the now departed Google Health product (see: Google Health Calls It Quits; Lessons Learned about PHRs or Not). Here is a link to John's note (see: Steppin... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5029240 Thu, 14 Jul 2011 14:02:53 +0100 5029240 http://www.medworm.com/index.php?rid=5029242&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fffighting-obesity-the-reastaurant-angle.html Eating out frequently, and particularly at fast food joints (see: What Americans Eat; More Calories and Increased Restaurant Food Consumption), can pose a threat to your health. A recent article quantified this threat in a way that I had never seen before (see: Fighting Obesity: The Restaurant Angle). Here it is the article unedited: Guess what? Eating out leads to weight gain. In fact, the USDA calculated that for each weekly meal outside the home, we gain 2 pounds of body weight annually. Here are two more interesting facts: About 30% of our total calories are consumed outside the home This is double what it was just 30 years ago. Why is eating out so hazardous to our waistline? Mostly because portion sizes are much bigger today than in the past. Restaurant owners know that consumers... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5029242 Tue, 12 Jul 2011 16:27:37 +0100 5029242 http://www.medworm.com/index.php?rid=5029243&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fcancer-diagnostic-scandal-at-duke-more-regulation-of-ldts-1.html I have posted a number of previous notes about those diagnostic tests consisting of a set of biomarkers plus an computer algorithm used to interpret the results. This type of lab test was previously referred to as in-vitro diagnostic multivariate indexed assays (IVDMIAs) by the FDA. More recently, they have been called laboratory developed tests (LDTs). Historically, this type of test was also referred to informally in the industry as home-brew. A simple definition for an LDT is that the test reagents are developed by a single lab and all of the testing is performed by that lab. IVDMIAs/LDTs can be used for various purposes including the detection of the presence of a neoplasm in a diagnostic workup using serum. A second purpose has been to analyze the antigens present on a patient's t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5029243 Mon, 11 Jul 2011 14:57:43 +0100 5029243 http://www.medworm.com/index.php?rid=5008681&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fthe-epic-emr-as-a-platform-extending-its-functionality-with-other-products.html For a number of reasons, Epic has achieved a near monopoly of the EMRs installed in the largest U.S. hospitals (see: ShandsHealth Goes Live with Epic; Company Penetration of the Hospital Market; Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion). In my opinion, this trend poses a significant challenge for healthcare in general. Here's a quote from the first of these two notes describing the nature of this challenge: Epic...has a reputation of closely controlling the installation and development of its EMR software products. This is the basis for its record of successful system installations and part of the appeal of the product to hospital CEOs and CIOs. Furthermore, the evolution of clinical hospital systems (e.g., EMRs, LISs, RISs, etc.) is a critical element in the over... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008681 Fri, 08 Jul 2011 13:31:58 +0100 5008681 http://www.medworm.com/index.php?rid=5008682&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fshould-diagnostic-test-scheduling-be-personalized.html I have posted previous notes about the need for periodic mammograms including the frequency of routine screening based on age (see: Shift to Digital Mammography Results in Increased Patient Recalls; Confusion Caused by Conflating "False Positive" and "Overdiagnosis" in Breast Cancer). Now comes news of research suggesting that mammogram screening should be personalized (see: Mammogram scheduling should be personalized, not based on age alone: study). The article caught my attention because of the use of the term personalized. Here is an excerpt from the article: Mammograms should not be done on a one-size fits all basis, but instead should be personalized based on a woman’s age, the density of her breasts, her family history of breast cancer and other factors includin... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008682 Thu, 07 Jul 2011 16:12:55 +0100 5008682 http://www.medworm.com/index.php?rid=5008683&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fstakes-escalate-for-employees-who-smoke.html I keep thinking that the lives of cigarette smokers couldn't get much worse but I always seem to be wrong The spots where you can grab a smoke at work keep getting smaller and at a greater distance from one's desk. It's also getting tougher for smokers to even secure a job (see: Health Systems Use Their Regional Dominance to Muscle Insurance Companies; Cleveland Clinic no-smoking policy has locals talking). Employers are now adding surcharges to smokers' health insurance coverage to offset their higher rate of health problems and expenditures (see: Companies Get Tougher with Employees Who Smoke). Such charges, of course, are in addition to the ever-increasing cost of cigarettes including taxes. States are trying to balance their budgets, in part, on the basis of higher sin ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008683 Wed, 06 Jul 2011 17:10:30 +0100 5008683 http://www.medworm.com/index.php?rid=5008684&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fa-very-bad-idea-health-insurer-to-purchase-troubled-health-system.html We are rapidly transitioning to an era of Big Medicine characterized by most significant decisions being made in concert by Big Payers (insurance companies and the federal government), Big Insurance Companies, and Big Pharma (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"). This trend is accelerating due to the fact that more than half of young doctors are taking salaried positions with health systems (see: Hospitals Use Their Medical Schools, Residencies for Later Physician Recruitment). Small private physician practices will no longer be part of this mix. Now comes the news that, at least in the Pittsburgh area, there are plans for an insurance company to purchase a large health system (see: Health care in the balance: Highmark to buy ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008684 Tue, 05 Jul 2011 15:42:33 +0100 5008684 http://www.medworm.com/index.php?rid=4984704&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Flower-blood-tranfusion-rates-as-a-metric-for-high-quality-care.html Generally speaking, I think that the amount of blood transfused to a patient can and should be used as a metric for the quality of care delivered by physicians, particularly surgeons. I have long been aware of differences in transfusion rates by hospitals or by regions of the country. Much of this can be explained by local customs and norms rather than well defined standards of care. When I was a blood banker back in the 1970's, one of the hospital cardiac surgeons would frequently transfuse six units of blood for a CABG when type-and-screen was the common blood order for the same procedure at the Cleveland Clinic. Once again, or perhaps still, the amount of blood being transfused is in the news. (see: Too many blood transfusions? New standards urged). Below is an excerpt from a recent... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4984704 Thu, 30 Jun 2011 13:03:47 +0100 4984704 http://www.medworm.com/index.php?rid=4984705&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fwupmc-patient-portal.html In a recent post, I speculated about some of the reasons why I thought that Google Health was exiting the personal health record (PHR) business (see: Google Health Calls It Quits; Lessons Learned about PHRs or Not). Shortly after posting this note, an article came across my desk discussing the success of UPMC's patient portal and the fact that it was now going mobile (see: UPMC's patient portal goes mobile). Below is an excerpt from the article: A health portal used by patients and doctors at the University of Pittsburgh Medical Center (UPMC) is now accessible on iPhones and iPads, thanks to the new mobile HealthTrak application. With its innovative approach to managing patient health - through technology like eVisits and tethered records - easy access to the portal is becoming mor... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4984705 Wed, 29 Jun 2011 13:11:10 +0100 4984705 http://www.medworm.com/index.php?rid=4976215&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fevidence-based-order-sets.html I am generally unenthusiastic about the term "evidence-based-medicine" (EBM) because it's often used synonymously with high-quality care. For the most part, however, I do see value for what are called "evidence-based order sets." The University of Kansas Hospital has recently gone live with 240 such order sets developed by Zynx Health’s clinical decision support unit. Here is an excerpt from the press release (see: The University of Kansas Hospital Goes Live with ZynxOrder and ZynxCare Integrated into EHR): ...The University of Kansas Hospital has gone live with 240 evidence-based order sets deployed via computerized provider order entry (CPOE)....The implementation of evidence-based order sets and plans of care within an EHR will enable The University of Kansas H... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4976215 Tue, 28 Jun 2011 13:12:07 +0100 4976215 http://www.medworm.com/index.php?rid=4976216&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fon-the-demise-of-google-health.html I am an unabashed fan of Google. However, if the company suffers from anything, it's a corporate sense of hubris. The founders think that almost any problem can be solved by their engineering mentality and their "search" business model. It turns out that launching a personal health record product was not that easy a nut to crack so the company is now withdrawing from the business (see: Google Shuts Down Medical Records And Health Data Platform). Here's Mr. HIStalk's take on the demise of Google Health (see: Monday Morning Update 6/27/11): Google predictably did what its know-it-all technology company predecessors have done over the years: dipped an arrogant and half-assed toe into the health IT waters; roused a loud rabble of shrieking fanboy bloggers and reporters...... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4976216 Mon, 27 Jun 2011 13:33:50 +0100 4976216 http://www.medworm.com/index.php?rid=4968920&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fhosptals-use-medical-schools-and-postgraduate-training-for-physicians-recruitment.html There is a major trend now occurring with young physicians seeking salaried hospital positions rather than entering private practice (see: More Doctors Giving Up Private Practices; The Increasing Tempo of Physician Practice Purchases by Hospitals). The number of hospitalists is exploding (see: Father of Hospital Medicine Has Mixed Review 15 Years Later). Here's a quote from this article about hospital medicine: Hospital medicine is entering a new growth phase that will capitalize on what it does best, "providing a brand of service and value," according to its founding father, Robert Wachter, MD, ...who established the specialty some 15 years ago....The exponential growth of the specialty was a surprise to many. In 2003, 29% of US medical centers had hospitalists; by 2009, the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4968920 Fri, 24 Jun 2011 11:39:31 +0100 4968920 http://www.medworm.com/index.php?rid=4968921&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fpathology-resident-travel-awards-available-for-pathology-informatics-2011-conference.html The Association for Pathology Informatics is awarding a limited number of stipends of $1,500 to attend the Pathology Informatics 2011 Conference at the Pittsburgh Wyndham Grand hotel in Pittsburgh. The conference will take place on October 4-7, 2011. Awardees must be residents, post-doctoral students, or fellows in accredited teaching programs. This is the premier pathology informatics conference in the country with three workshops, three discipline tracks, multiple keynote plenary lectures, 44 participating faculty members, and more than 40 exhibitors. Last year's PI-2010 presentation marked the first of these events. The conference represents a merger of two long-standing pathology informatics meetings, APIII and Lab InfoTech Summit. The application deadline for awards is August 1, 2... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4968921 Thu, 23 Jun 2011 12:55:56 +0100 4968921 http://www.medworm.com/index.php?rid=4960336&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fpfizer-integrating-telemedicine-into-clinical-trials.html I have a special interest in clinical trials dating back to my five-year stint on the IRB (Institutional Review Board) at my hospital. I therefore read with some interest the news that Pfizer was integrating telemedicine (i.e., remote subject participation) into one of its clinical trials (see: Pfizer Integrating Telemedicine into Clinical Trials). Here is an excerpt from the article Pfizer is starting enrollment of its first ever investigational drug trial with remote patient participation. The trial, aptly named Research on Electronic Monitoring of OAB Treatment Experience (REMOTE), is a study to assess the safety and efficacy of Detrol LA (tolterodine tartrate), a treatment for overactive bladder. The main goal is to determine whether the results of the pilot REMOTE “virtual trial” ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4960336 Wed, 22 Jun 2011 14:59:22 +0100 4960336 http://www.medworm.com/index.php?rid=4953380&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fshands-installs-epic-interesting-facts-about-epic-coverage-in-the-us.html ShandsHealth is a large health system located in Gainsville and Jacksonville, Florida. Like many of the high-end and academic health systems with 500 beds or more, it is converting to the Epic EMR (see: Shands' new records system should simplify things). Here is a brief listing of the new features of this EMR as listed in the press release: Shands patients will no longer have to fill out their medical history and prescription information every time they visit a Shands hospital, faculty clinic or emergency room.... All Shands patient records are instantly available to all Shands health-care providers. Patients will no longer have to fill out their medical history and prescription information every time they visit a Shands hospital, faculty clinic or emergency room. Prescriptions are se... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4953380 Mon, 20 Jun 2011 13:32:33 +0100 4953380 http://www.medworm.com/index.php?rid=4945219&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Foffice-emrs-as-a-risky-investment-for-physicians.html Although some may view physician office EMRs and hospital EMRs as first cousins, I view them in a much different light. In previous notes, I discussed how community-based physicians and the professional societies that represent them are complaining to governmental bodies about the inadequacies and cost of office EMRs, particularly those for small practices (see: Cost of Deployment of EMRs in Physician Offices;  Barriers to the Deployment of Physician Office EMRs; "Usability Failures" of EMRs Frustate Physician Users). Here's a quote from my most recent post regarding physician office EMRs: It's no surprise to me that the "usability of [physician office] EMRs doesn't appear to be the focus of the federal government when establishing meaningful use standards ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4945219 Fri, 17 Jun 2011 12:08:48 +0100 4945219 http://www.medworm.com/index.php?rid=4945220&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fthomson-reuters-to-sell-its-healthcare-unit.html The healthcare unit of Thomson Reuters is up for sale. John Moore who blogs over at Chilmark Research has posted two blog notes about this news (see: Likely Suitors as Thomson Reuters Exits Healthcare; also see Additional Thoughts on Thomson Reuters). Here's an excerpt from the first of them: ...Thomson Reuters (TR) announced that it intends to sell off its healthcare unit. A logical first response is: What they heck, why would they sell right now when the healthcare market is so hot and shows no signs of letting up? Thomson Reuters is a well-respected brand in healthcare and as healthcare organizations (providers and payers) of all sizes look to more effectively run their operations, TR’s portfolio of healthcare solutions are well positioned. This isn’t the first time they have tr... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4945220 Thu, 16 Jun 2011 12:46:36 +0100 4945220 http://www.medworm.com/index.php?rid=4945221&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Falgorithms-as-the-next-generation-of-innovative-laboratory-and-clinical-tests.html I was somewhat surprised by a recent article suggesting that algorithms themselves will constitute a new type of medical test. The short article cited the work of Predictive Medical Technologies as a basis for this claim. The company software generates health predictions based on previous clinical data for ICU patients (see: Algorithms are the new medical tests; How data and algorithms help doctors make use of real-time data). Below is an excerpt from the article: Predictive Medical Technologies claims that it can use real-time, intensive care unit (ICU) monitoring data to predict clinical events like cardiac arrest up to 24 hours ahead of time. Effectively, the startup's algorithms are new types of medical tests that an ICU doctor can take into consideration when deciding on a course ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4945221 Wed, 15 Jun 2011 15:05:24 +0100 4945221 http://www.medworm.com/index.php?rid=4921764&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fmore-on-chemo-brain.html I continue to be interested in the topic of "chemo brain" (see: New Research Casts Spotlight on "Chemo Brain"). I have this vision of cancer patients complaining of foggy thinking but their physicians struggling to understand the nature of the problem and design suitable treatment (see: Cancer survivors can't shake pain, fatigue, insomnia, foggy brain). Here an excerpt from another article about it: When people finish treatment for cancer, they want to bounce back to their former vital selves as quickly as possible. But a new Northwestern Medicine study -- one of the largest survivor studies ever conducted – shows many survivors still suffer moderate to severe problems with pain, fatigue, sleep, memory and concentration three to five years after treatment has ende... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4921764 Fri, 10 Jun 2011 14:48:33 +0100 4921764 http://www.medworm.com/index.php?rid=4921765&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fa-new-take-on-personalized-medicine.html The overarching definition for personalized medicine has always been the following: the right drug for the right patient at the right time (see: Further Consideration of the Definition for Personalized Medicine; Term "Personalized Medicine" More About Business than Healthcare Delivery). Implicit in this definition has been the idea that the "right drug" will exploit the biologic weaknesses of a patient's tumor. The classic example has been the use of the monoclonal antibody trastuzumab, marketed as Herceptin, for breast tumors that overexpress the HER2/neu protein. A recent article discusses a subtle but interesting paradigm shift relating to personalised medicine and the workflow of cancer care (see: Personalized Medicine Redefines How Docs Treat Cancer). Below is ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4921765 Thu, 09 Jun 2011 13:17:43 +0100 4921765 http://www.medworm.com/index.php?rid=4911833&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Ffda-gearing-up-to-regulate-apps-and-social-media-or-not-2.html I have gotten used to a degree of vacillation from the FDA regarding various lab regulatory issues. A  recent chapter in this drama was the agency's ambiguity about lab tests originally called IVDMIAs and subsequently referred to as laboratory developed tests (LDTs). Now comes news that the agency may, or may not, regulate medical smartphone/tablet (i.e., mobile) apps and the use of social media by pharmaceutical companies (see: FDA Reportedly Gearing Up to Regulate Apps). Below is an excerpt from the article: From a no less august source than American Medical News comes a report that the FDA is considering the regulation of medical apps.  See “FDA Signals it Will Regulate Medical Apps“.   The article quotes a source who relayed that at a town hall meeting h... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4911833 Wed, 08 Jun 2011 13:03:11 +0100 4911833 http://www.medworm.com/index.php?rid=4902700&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fweb-vido-chats-as-an-important-component-of-patient-care.html This article instead emphasizes the need for a "more equal dialogue between patient and clinician and improve the nature of the relationship."  Some patients tend to get overwhelmed in a formal medical setting and may not address all of their problems with  the physician. They may also think that "the doctor is too busy to bother with my petty complaints." With video chat, the patient remains on his or her home turf and hence the discussion may be conducted on a more equal footing. (Source: Lab Soft News) Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4902700 Mon, 06 Jun 2011 18:47:23 +0100 4902700 http://www.medworm.com/index.php?rid=4893933&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fpseudo-certification-from-chime-is-anyone-taken-in-by-this.html Mr. HIStalk reports on the CHIME CIO credentialing program (see: News 5/27/11): CHIME reports that 109 individuals have earned Certified Healthcare CIO designation since the credentialing program was launched in July 2009. I said it was a dumb idea then and I’ll stand by that opinion now. Obviously the credential hasn’t exactly gone viral if only 109 out of thousands of hospital CIOs have signed on over two years, voluntarily jumping onto the hamster wheel of spending hospital money on renewals and going to CHIME meetings to earn CE. To each his own, but I’d be embarrassed to use a non-educational  credential earned by passing a multiple choice test of job-specific knowledge (designed by asking CIOs what they do on the job, then testing them to see if they theoretically know ho... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4893933 Thu, 02 Jun 2011 19:06:55 +0100 4893933 http://www.medworm.com/index.php?rid=4883915&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fus-south-poses-greatest-risk-of-cognitive-decline.html A tier of U.S. Southern states is commonly referred to as the "stroke belt" because of its high prevalence of this condition (see: Drop Me Off at the ER as Soon as I Finish My Fried Fish Dinner). Now comes evidence that people in the this same area  also have a higher risk of cognitive decline as a component of this neurologic spectrum (see: U.S. South Has Higher Risk of Cognitive Decline). Below is an excerpt from the article U.S. South Has Higher Risk of Cognitive Decline For decades public health researchers have known that individuals living in the American South displayed an increased risk of stroke and other forms of cardiovascular disease. A new study finds that individuals living in this region also have a greater incidence of cognitive decline compared to other reg... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4883915 Tue, 31 May 2011 11:58:46 +0100 4883915 http://www.medworm.com/index.php?rid=4872494&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fclinical-trials-increasingly-move-offshore.html This article provided me with a new insight into the increased tempo of migration of clinical trials to China. As noted above, China is currently the world's third largest market for pharmaceuticals and by 2015 will become the second largest. Not only can clinical trials be performed for a lower cost in China but the market for pharmaceuticals in the country is also huge. One of the objections to clinical trials overseas for drugs that will be sold in the U.S. is that the research subjects are genetically different than the U.S. population. Here's an excerpt from an article that raises this issue (see: Clinical trials overseas raises quality control issues): [Seth Glickman, M.D., a senior scholar at Duke's Fuqua School of Business] says social ecology and genetics may also play... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4872494 Fri, 27 May 2011 11:43:30 +0100 4872494 http://www.medworm.com/index.php?rid=4872495&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fincidentalomas-revisited-revisited.html I recently posted a note about so-called incidentalomas, lesions often "accidentally" discovered during CT scans that have been ordered on the basis of other diagnostic concerns. You may want to refer to it to refresh your memory about the topic (see: How to Avoid the Risks of a CT Incidentaloma). Dr. Mark Pool who blogs over at The Daily Sign Out has posted a a well-thought-out note that extends this discussion in some interesting ways (see: Incidentalomas revisited). Below is an excerpt from it: Dr. Bruce Friedman posted a thoughtful blog on Lab Soft News recently concerning "incidentalomas" ....This post happened to coincide with a new working committee at my hospital commissioned with developing a virtual clinic for following patients who have incidental lung nodule... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4872495 Thu, 26 May 2011 23:24:39 +0100 4872495 http://www.medworm.com/index.php?rid=4862948&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fshould-hospitals-set-up-private-social-networks-to-server-their-patients.html A recent article about how Toyota is setting up a private social network for its customers stimulated my thinking about how this idea might apply to hospitals and their patients (see: Toyota Owners To Get a Private Social Network). Below is an excerpt from it: Toyota has teamed up with Salesforce.com to create Toyota Friend, a private social network for owners of Toyota cars. The network will be accessible through PCs, tablets and smartphones, giving Toyota customers the ability to connect with their dealerships, cars and Toyota itself. For example, your car could send you an alert when its battery needs recharging, and you would be able to connect to your dealership to get maintenance tips and service information. Toyota Friend will primarily be a private network for Toyota car owners, bu... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4862948 Tue, 24 May 2011 13:57:59 +0100 4862948 http://www.medworm.com/index.php?rid=4841999&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fthe-true-cost-of-implementing-an-emr-or-lis.html Mr. HIStalk came up with another gem of a observation recently: software license fees are often nearly irrelevant to overall project cost, especially on the often-forgotten cost of internal labor (see: Monday Morning Update 5/16/11). Below is his exchange with a reader: From Former CIO: “Re: high price of Epic. In my experience, the price of Epic software is competitive with others (at least the big guys). The difference is that they drive the customer to look at the true cost of implementation and plan for the resources, internal and external, training, etc. The other vendors hope you won’t actually add it all up until you sign the software contract. This is the best part about Epic since it gets the organization to accept the budget, even if difficult. If you are not prepared to spen... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4841999 Thu, 19 May 2011 12:00:00 +0100 4841999 http://www.medworm.com/index.php?rid=4842000&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fsteps-to-prevent-the-progression-of-prediabetes-to-diabetes.html Prediabetes is a common condition in the U.S. as is, of course, the disease itself (see: The Staggering Cost of Treating Diabetes). The so-called metabolic syndrome is one specific form of prediabetes (see: Metabolic Syndrome: The Problem You May Never Have Heard About). Below is an excerpt from an article that discusses prediabetes in a clear fashion (see: Prediabetes: 7 Steps to Take Now): If you’ve just learned you have prediabetes, you’re not alone. According to the American Diabetes Association, there are 79 million people in the U.S. who have elevated blood sugars, but who don’t yet qualify for a diagnosis of diabetes. About 11% of people with prediabetes go on to develop type 2 diabetes within three years. The same factors that cause prediabetes also cause diabetes. That inclu... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4842000 Wed, 18 May 2011 12:00:00 +0100 4842000 http://www.medworm.com/index.php?rid=4842001&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Foveruse-of-colonoscopy-in-medicare-cohort.html It probably will not come as a surprise to veteran observers of our healthcare delivery system that colonoscopies are overordered. This particular procedure is a major source of revenue for gastroenterologists and many healthcare consumers understand the advantages of preventive medicine. The key question, then, revolves around the question of how often to perform the procedure by age group. A recent article addresses this overutilization topic (see: 'Large' Overuse of Screening Colonoscopy in Medicare Cohort), Below is an excerpt from it: About half of a sample of 24,071 Medicare patients who had a negative screening colonoscopy were rescreened again in less than 7 years — well before the recommended interval of 10 years, according to a new study. And nearly half of the retested... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4842001 Tue, 17 May 2011 13:09:01 +0100 4842001 http://www.medworm.com/index.php?rid=4829329&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fmanage-raw-data.html A recent article I came across examines how the mining and analysis of "raw data" in various industries will provide an opportunity for innovation (see: New Ways to Exploit Raw Data May Bring Surge of Innovation, a Study Says). Below is an excerpt from it: Math majors, rejoice. Businesses are going to need tens of thousands of you in the coming years as companies grapple with a growing mountain of data. Data is a vital raw material of the information economy, much as coal and iron ore were in the Industrial Revolution. But the business world is just beginning to learn how to process it all. The current data surge is coming from sophisticated computer tracking of shipments, sales, suppliers and customers, as well as e-mail, Web traffic and social network comments. The quantity of ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4829329 Mon, 16 May 2011 13:54:52 +0100 4829329 http://www.medworm.com/index.php?rid=4821173&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fphysicians-and-the-two-screen-revolution.html In a recent note, I discussed the two-screen revolution that seems to be gaining traction (see: iPad Helping to Launch a "Two-Screen Revolution"). The basic idea is that many of us we will soon be operating with two screens, the large one being a TV or PC monitor and the small one being a tablet computer such as an iPad for simultaneously browsing the web. The large screen provides generalized, standard content and the smaller one provides customized, complementary information. I have been thinking about how this computing model relates to physicians and I think I can now describe how it may work in a hospital or large clinic. Consider the process that occurs when a physician accesses the electronic medical record of a patient using a computer monitor. He or she, using an iPad, c... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4821173 Fri, 13 May 2011 12:58:48 +0100 4821173 http://www.medworm.com/index.php?rid=4821174&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fwgeneral-internal-medicine-does-not-pay-off-for-recent-graduates.html We are undergoing major changes in the choices being made by young physicians in terms of how they practice medicine after their completion of training. The most striking change has been the large percentage that are accepting salaried positions with large health systems, many as hospitalists. A recent article provides evidence of the continuing trend away from general internal medicine (see: Young doctors find general internal medicine doesn't pay), Below is an excerpt from it: Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4821174 Thu, 12 May 2011 12:53:12 +0100 4821174 http://www.medworm.com/index.php?rid=4789649&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fsurveillance-of-older-men-with-low-grade-cancer-of-the-prostate.html A gnarly problem for patients with a low-risk cancer of the prostate is whether to opt for surgery and also what constitutes adequate monitoring if they do not undergo surgery (see: Solid Advice for Older Men Regarding PSA Screening for Prostate Cancer). A recent article address this issue in a very clear fashion (see: Closely Monitoring Low-Risk Prostate Cancer, With Biopsy, Does Not Raise Risk Of Death And Discourages Overtreatment). Below is an excerpt from it: A Johns Hopkins study of 769 men from across the United States recently diagnosed with low-grade prostate cancer shows that forgoing immediate surgery to remove the tumor or radiation poses no added risk of death.  Delaying treatment is fine, the results show, so long as the cancer’s progression and tumor growth are close... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4789649 Wed, 04 May 2011 12:00:00 +0100 4789649 http://www.medworm.com/index.php?rid=4775612&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fdangers-of-the-ct-incidentaloma.html Pathologists use the suffix -oma to designate a tumor. Hence, a so-called incidentaloma is a lesion discovered by a radiologist during a CT exam. Here's a common scenario that patients may encounter. The treating physician is trying to diagnose lesion A. The radiologist discovers lesion B while seeking to confirm lesion A. Lesion B is perhaps a small lung mass that may be clinically significant (e.g., an early cancer) but may also be benign and better off undiscovered. Once discovered, the physician treating the patient may react "defensively" and seek to pin down the diagnosis. This new diagnostic goal may be associated with its own set of morbidities and even mortalities. A recent article discussed the dangers of incidentalomas (see: Dangers of the Incidentaloma: Why to Thi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4775612 Mon, 02 May 2011 12:00:00 +0100 4775612 http://www.medworm.com/index.php?rid=4768261&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fmedical-students-as-emr-scribes.html In two recent posts, I have reported on the growing use of EMR scribes in hospitals (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes; Medical Students Recruited to Serve as EMR Scribes in Toledo). It makes no sense to use physicians and nurses as data entry clerks for the EMR. The user interfaces of these systems are still too awkward for these personnel to perform the necessary tasks quickly and efficiently. Hence, hospitals associated with medical schools are turning to medical students to serve as EMR scribes. These students bring to the job some knowledge of medical nomenclature and benefit from the early exposure to the patient care environment. Other hospitals are turning to college students or other suitable candidates in the community after some training. A Google s... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4768261 Fri, 29 Apr 2011 12:00:00 +0100 4768261 http://www.medworm.com/index.php?rid=4753978&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fexhibitors-sought-for-pathology-informatics-2011-october-4-7-in-pittsburgh.html We are seeking exhibitors for the Pathology Informatics 2011 conference that will take place at the Wyndham Hotel in Pittsburgh on October 4-7, 2011. This conference resulted from a merger of two previous pathology informatics conferences, Lab Infotech Summit and APIII. The inaugural merged conference was held in Boston last September. A total of 41 exhibitors participated in that event with about 250 paid registrants in attendance. A total of twenty-five companies have signed-up thus far to participate in Pathology Informatics 2011. They are the following: Aperio, Apollo PACS, ARUP Laboratories, Aurora Interactive, Beckman Coulter, Cerner, Dawning Technologies, Definiens, Elekta, General Data, Haemonetics Software Solutions, Halfpenny Technologies, McKesson Corporation, Milestone Medical,... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4753978 Tue, 26 Apr 2011 15:07:51 +0100 4753978 http://www.medworm.com/index.php?rid=4747908&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fradiology-job-market-trends-downward-blame-technology-and-reimbursement.html Here are summaries of three conversations that I have had recently: A newly graduated physician tells me that her colleagues widely understand that the radiology job market is lousy with the exception of interventional radiology (IR), for which there are plenty of openings. A mid-career, highly specialized  academic radiologist tells me that there would be few, suitable positions available for him if we were to change positions. A very senior radiologist in a large, midwest hospital tells me that he is working twice as hard to simply maintain his expected income; he cites digital pathology and PACS as the enabling technologies that allow him to ramp-up his personal efficiency and effectiveness. All of this caused me to search the web for some further discussion of the current radio... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4747908 Mon, 25 Apr 2011 12:12:55 +0100 4747908 http://www.medworm.com/index.php?rid=4734681&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fexactly-who-are-served-by-medical-professional-societies.html As a result of the political flap around Dr. Lazar Greenfield and the American College of Surgeons (ACS), he has resigned as the incoming president of the society. Here's an excerpt from the latest article (see: Head of Surgeons Group Resigns Over Article Viewed as Offensive to Women): The president-elect of the American College of Surgeons resigned his position Sunday after weeks of controversy surrounding a Valentine’s Day editorial he wrote touting the mood-enhancing effects of semen on women during unprotected sex....Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; the entire issue of the newspaper was withdrawn. He is an emeritus professor of surgery at the University of Michig... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4734681 Wed, 20 Apr 2011 12:54:48 +0100 4734681 http://www.medworm.com/index.php?rid=4724275&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fthe-value-of-self-management-for-many-chronic-diseases.html Participatory healthcare is one of the so-called "Four P's" of modern medicine -- the other three are preventive, predictive, and personalized (see: The Future of Healthcare and the Four P's: Preventive, Predictive, Personalized, Participatory). This approach to healthcare was covered in a recent article that referred to it as self-management of chronic diseases (see: Moving to Self-Management for Arthritis — and Other Chronic Diseases). The reason that patient participation in chronic diseases is so appealing is that it reduces costs and, more importantly, requires patient buy-in to the process. This inevitably results in more effective care. Here's an excerpt from the article: With obesity, sports injuries and the aging of the baby boomers all driving an increase ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4724275 Mon, 18 Apr 2011 11:39:28 +0100 4724275 http://www.medworm.com/index.php?rid=4709428&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Ftypes-of-cloud-computing.html I have been commenting about the feasibility of cloud computing for more than three years. The technology has now reached a state of maturity such that CIOs, at least outside of healthcare, are seriously considering deploying this architecture. Healthcare computing tends to trail that in most other fields so most hospitals continue to run their own "machine rooms" with dedicated servers. A recent article provides some useful definitions of the various types of cloud computing (see: Here's Why Cloud Computing Is So Hot Right Now). Below is an excerpt from it: What is cloud computing? At its simplest, cloud computing means that users are connecting to applications that run on a set of shared or pooled servers, rather than running on a single dedicated server. This is a subtle b... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4709428 Wed, 13 Apr 2011 12:14:23 +0100 4709428 http://www.medworm.com/index.php?rid=4704967&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Ftighter-integration-of-cvs-minuteclinic-with-chicagos-advocate-health-care.html There has always been some challenges associated with the business model for walk-in clinics located in retail pharmacy chain stores. Commonly staffed by nurses, they were only prepared to deal with minor health problems and routine procedures. This approach often did not generate enough business. Therefore, some began to place physicians in these clinics who were then able to treat more significant health problems. Once some of these clinics started in this direction, it made sense to contract with local hospital systems to both provide physicians and also to integrate the clinic records with those of the health system. This provided a referral network for the more seriously ill patients who were being turned away from the nurse-staffed clinics. The Cleveland Clinic was an early participa... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4704967 Tue, 12 Apr 2011 14:08:34 +0100 4704967 http://www.medworm.com/index.php?rid=4696963&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fmedicare-billing-rife-with-fraud-need-open-access-to-claims-database.html How badly do we want to reduce the cost of Medicare? For me, one of the most important steps will be to provide public access to the Medicare claims database and use it to root out fraud. This is the goal of two senators who have introduced some new legislation (see: Senators Push to Open Database on Medicare). Below is an excerpt from the Wall Street Journal article about this topic: Two senators have introduced legislation to overturn a 1979 court injunction that bars the government from revealing what individual physicians earn from Medicare. That information is stored in the Medicare-claims database, widely considered one of the best tools for finding fraud and abuse in the $500 billion federal health-insurance program for the elderly and disabled. Soaring Medicare costs threaten to ov... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4696963 Mon, 11 Apr 2011 13:03:48 +0100 4696963 http://www.medworm.com/index.php?rid=4658629&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fmost-big-urology-groups-now-utilize-and-in-office-lab-and-pathologist.html Laboratory Economics covered in its March issue the increasing tempo of the acquisition of in-office histology labs and pathology services by large urology groups (see: MOST BIG UROLOGY GROUPS NOW HAVE IN-OFFICE LABS). Here is a link to a previous note in Lab Soft News about this shift (see: Corrected Definition for a Pod Lab and a Look at In-Office Labs). Below is an excerpt from the Lab Economics article: Laboratory Economics contacted 20 big urology groups (i.e., 5+ doctors per group) to try to determine the infiltration rate of in-office histology labs. Fifteen urology groups from our mini-survey indicated they had opened their own histology lab. These 15 groups employ 205 urologists, or more than three-quarters of the total 250 urologists from the 20 groups. Our survey suggests that t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4658629 Wed, 30 Mar 2011 18:37:05 +0100 4658629 http://www.medworm.com/index.php?rid=4643005&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Ffwhy-and-how-hospitals-should-market-themselves.html For the most part and in my opinion, hospitals don't don't do a very job of marketing themselves. This is not surprising given that most of them are non-profit and most such organizations do not seem to be proficient in this area. However, the use of social media for marketing is free of cost and relatively simple to engage for this purpose. According to a recent study, even here most hospitals don't always get their message out (see: Study: Hospitals' Facebook use is poor). Below is an excerpt from the article: U.S. hospitals are not taking advantage of the opportunities Facebook creates to better engage patients, build healthcare communities or develop their hospital brands, according to a new study....According to the study, only a few hospitals across the the country ar... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4643005 Mon, 28 Mar 2011 13:04:31 +0100 4643005 http://www.medworm.com/index.php?rid=4631655&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fcolonoscopy.html Hospital charges are largely a fiction (see: Comparing the Details of Hospital Charges in the State of Oregon; Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant). They are set at exorbitantly high levels because the actual reimbursement received by the hospitals from Medicare and private insurance companies is a much smaller and negotiated percentage of hospital charges. The hospitals keep increasing these charges so that the amount actually received from payers covers their costs. Below is a guest blog written by a reader of this blog, Joe Plandowski, about his recent experience with a bill for a routine colonoscopy. He has authored a number of previous guest blog notes (see, for example: Major Increases in Pathology RVUs for 2011) ---BAF The economics of medicine alway... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4631655 Thu, 24 Mar 2011 13:02:14 +0100 4631655 http://www.medworm.com/index.php?rid=4611009&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Ffhp-unveils-new-business-strategy-cloud-and-business-analytics.html If I were an investor in HP, I would be discouraged to learn that the new CEO has only now discovered that software has a higher profit margin than software and also that there's money to be made in the cloud. Here's a report of his remarks about these topics (see: Hewlett-Packard Chief Unveils Strategy for Expansion) Léo Apotheker, chief of Hewlett-Packard, said Monday that the company would expand its software business and venture into cloud computing. He finally unveiled his strategy to investors on Monday, saying that H.P. would build out its tiny software business and expand into the cloud — a term used to describe products and services delivered online. Mr. Apotheker’s plan is not so much to reinvent H.P., but to help it evolve. Mr. Apotheker said he planned to use the c... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4611009 Fri, 18 Mar 2011 10:58:39 +0100 4611009 http://www.medworm.com/index.php?rid=4600803&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Foffice-based-specialists-abandon-hospital-call-responsibilities.html The inexorable transition toward more salaried, hospital-based physicians, hospitalists, is accelerating. Many physicians favor these positions because they can avoid the burden of managing an office practice. They are also seeking a more tolerable, and predictable, work-week. Hospital executives like to hire hospitalists because this allows them to exercise more control over the physicians on the hospital staff (see: The Emergence of the Surgicalist). One of the consequences of this shift is that many office-based physicians are losing their ability to perform various medical procedures. This void is being filled by proceduralists in hospitals (see: The Emergence of the Proceduralist in Hospitals; Two Definitions for the Physician Proceduralist). All of these changes are resulting in a ma... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4600803 Wed, 16 Mar 2011 11:53:08 +0100 4600803 http://www.medworm.com/index.php?rid=4592704&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Ffcreating-the-i-patient-bedside-diagnostic-skills-continue-to-deteriorate.html According to one prominent physician, Dr. Abraham Verghese, electronic records and our sophisticated diagnostic tools are causing physicians to increasingly focus on the electronic records and diagnostic images (i.e., the iPatient) and ignoring their flesh-and-blood patients (see: Treat the Patient, Not the CT Scan). Put another way, we are treating the iPatients rather than the physical patient. Below is an excerpt from the article: [The expanding reliance on electronic medical records] creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record. Imaging the body has become so easy (and profitable, too, if you own the machine). When I was ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4592704 Tue, 15 Mar 2011 21:19:45 +0100 4592704 http://www.medworm.com/index.php?rid=4570766&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Finstitutional-zeitgeist-with-high-level-of-particiipation-by-pathologists.html Infopathic submitted a comment in response to a recent note in Lab Soft News (see: Should Pathologists Make "Cameo Appearances" in Patient Units and Surgeon's Lounge). In this note, I raised the topic of "cameo" appearances by pathologists versus the significant integration of them into the hospital clinical care processes. Below is his comment: As with most issues of true best practice, there optimally is an institutional zeitgeist underlying expected care. For years at our institution, pathologists are active participants in surgery, radiology and oncology conferences, not to mention multi-discipline care conferences and M&M. Moreover, with a remarkably active hospital autopsy service, we are routinely joined by clinicians during the case. None of this behavio... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4570766 Thu, 10 Mar 2011 14:41:08 +0100 4570766 http://www.medworm.com/index.php?rid=4560612&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fhimss-booth-fees.html There is no question that the HIMSS annual conference is a huge cash-cow for the organization. With about 30,000 registrants and 1,000 vendors, it's generally a mandatory appearance for all but the smallest HIT companies. Want to know what it costs a company to participate?. A recent guest blog by a vendor representative on HIStalk spells out some of the details (see: More HIMSS Wrap-Up 3/2/11). Below is an excerpt from it: First, we vendors pay a fortune to exhibit at these shows. At more than $33/square foot for just the footprint (a small 20 x 20 booth is over $13k), plus between $15,000 and $1,000,000 for the booth construction, the tab is just beginning. Don’t forget all the rental furniture, phones, and $1,500/day for Internet hookup (can you believe that?). Shipping each booth... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4560612 Tue, 08 Mar 2011 13:35:36 +0100 4560612 http://www.medworm.com/index.php?rid=4549943&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fmost-physicians-inept-when-dealing-wiht-overweight-patients.html Although obesity is one of our major public health problems, we have not yet developed a comprehensive and integrated strategy for addressing it. A recent article highlighted for me the inability of most physicians to effectively treat obese and even overweight patients (see: Too few docs tell patients they're overweight). Below is an excerpt from it: Many people who are overweight and obese either don't realize it or are in denial -- and too few doctors are setting them straight, according to a new study in the Archives of Internal Medicine....If a doctor did comment on a patient's weight, it seemed to make an impression. Nearly 20% of obese people whose doctors hadn't brought up their weight described themselves as "not overweight," compared with just 3% of thos... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4549943 Fri, 04 Mar 2011 13:48:33 +0100 4549943 http://www.medworm.com/index.php?rid=4545259&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fthepic-converts-its-academic-health-system-customer-into-franchisees.html I had not heard anything about this before but Mr. HIStalk alerts us to a new strategic initiative on the part of Epic's CEO and founder, Judith Faulkner (see: News 3/2/11). Below is a Q and A exchange posted recently: From HISJunkie: “Re: Texas Health Resources offering HIT consulting services (see: Texas Health Resources offering HIT consulting services). Epic is doing what IBM did 35 years ago, turning every client into a hosting site (see SHAS circa 1975). Epic is allowing / encouraging the large medical centers to distribute its app on a host basis to almost any remote client (particularly if they are under 150 beds) without incurring a new acquisition or license fee. Just add more work stations and pay a small seat license increment and you can buy them in ‘bulk’. I spoke t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4545259 Thu, 03 Mar 2011 13:57:16 +0100 4545259 http://www.medworm.com/index.php?rid=4536494&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fpathologist-making-cameos-in-patient-units-and-surgeons-lounge.html A common criticism of some hospital pathologists is that they hole-up in their offices to diagnose the day's pathology slides and sometimes fail to develop meaningful relationships with hospital physicians and nurses. As an antidote to this problem, they are sometimes urged to visit the surgeon's lounge and make clinical "lab rounds" to correlate test results with clinical data. One clever pathology trainee has come up with a name for this phenomenon -- cameo appearances. I learned about this in a note posted on the Student Doctor Network (see: Pathology is the Future?). Below is the key passage: [S]uggesting we round or otherwise make [pathologist] cameos on the floors is ridiculous. Perhaps the surgeons should spend half of their days double scoping with us too. I'm... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4536494 Wed, 02 Mar 2011 14:11:17 +0100 4536494 http://www.medworm.com/index.php?rid=4532579&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fsee-drugmakers-create-mobile-phone-apps-to-track-diabetes-cancer-drugmakers-led-by-novartis-ag-and-merck-co-boosted-in.html This article highlights three major reasons why Big Pharma is starting to invest in smartphone apps. If patients are non-compliant, the various drugs that are being prescribed for them may be judged to be non-efficacious in retrospective, post-market studies. This non-compliance problem has arisen in response to pressure from government-run health plans. The article provides two more reasons for companies to invest in the development of smartphone apps. The FDA is breathing down their necks about direct-to-consumer (DTC) ads on television (see: It's Time for the FDA to Prohibit Direct-to-Consumer Advertising by Pharmaceutical Companies). If and when such ads are banned, the companies will have another trick up their sleeves -- drug marketing via smartphone apps. However, there is a dow... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4532579 Tue, 01 Mar 2011 14:45:25 +0100 4532579 http://www.medworm.com/index.php?rid=4532580&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fpublic-health-alerts-to-physicians-via-office-emrs.html The objective is to identify episodes of food born illness by assessing symptoms recorded in EMRs and then alert physicians via these same systems. Below is an excerpt from the article: The Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago Community Health Services are collaborating on a project that aims at testing the efficacy of actionable health alerts, delivered instantly to a physician's electronic medical record. Officials made the announcement at [the recent] HIMSS and said the project will begin with a six-month prospective study, seeking to determine if the alerts are triggered often enough or too often, and if doctors take the advice displayed within the alerts. As a foundation, the study will utilize GE Healthcare's densely popu... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4532580 Mon, 28 Feb 2011 15:00:06 +0100 4532580 http://www.medworm.com/index.php?rid=4507593&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Ftutype-of-breast-biopsy-often-determined-by-physician-speciality.html All women should keep this fact in mind. If they have a suspicious breast mass and they are referred to a breast surgeon, they will be more likely to have an unnecessary open biopsy as opposed to a needle biopsy, which is much less invasive. The background for this assertion was provided in a recent article (see: Study of Breast Biopsies Finds Surgery Used Too Extensively), Below is an excerpt from it: Too many women with abnormal mammograms or other breast problems are undergoing surgical biopsies when they should be having needle biopsies, which are safer, less invasive and cheaper, new research shows....A study in Florida found that 30 percent of the breast biopsies there from 2003 to 2008 were surgical. The rate should be 10 percent or less, according to medical guidelines....Many of t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4507593 Tue, 22 Feb 2011 13:31:28 +0100 4507593 http://www.medworm.com/index.php?rid=4489991&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Frationale-for-the-increasing-tempo-of-physician-practices-by-hospitals.html One consequence of the recent federal healthcare reform initiative has been the purchase of physician-owned private practices and specialty clinics by hospitals (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"; Health Systems Use Their Regional Dominance to Muscle Insurance Companies). I have attributed this trend to the greater access to capital by hospitals, the increasing paperwork required from accountable care organizations (ACOs) (see: Hospital Executives Search for the Formula for an Accountable Care Organization), and the interest of hospitals in beefing-up their ambulatory care programs. Below is an excerpt from a blog written by a physician commenting on the purchase of physician practices (see: Dr. Manoj Jain: Hospitals taking ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4489991 Thu, 17 Feb 2011 17:09:06 +0100 4489991 http://www.medworm.com/index.php?rid=4482977&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fa-pathologist-recounts-his-experience-with-a-demonstration-of-epics-beaker-lis.html An anonymous academic pathologist describes below, as a guest blog note, his experience with Epic and its LIS, Beaker. A number of previous notes have been posted in Lab Soft News about Beaker (see: Introducing the Epic Laboratory Information System (LIS); It's Called Beaker; An Update on Epic's LIS, Called Beaker, from HIStalk; More Information about Epic's Beaker LIS and Its Sibling; Assessing the True Cost of Serving as a Beta Test Site for the Beaker LIS; Details about Epic's Beaker LIS, Supplied by the Company). Over the last several months, there have been a few posts in Lab Soft News which have shed some light on a relative newcomer to the LIS party that goes by the name Beaker. Beaker, as you may recall from the earlier stories, is the latest development from Epic. ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4482977 Wed, 16 Feb 2011 13:42:08 +0100 4482977 http://www.medworm.com/index.php?rid=4478169&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Ftobacco-free-hiring-take-hold-is-this-fair.html Hiring practices in hospitals and medical businesses are now moving from "no smoking" to "no smokers." Details about this change were presented in a recent article (see: Tobacco-Free Hiring in Workplaces). Below is an excerpt from it: More hospitals and other medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living. The policies reflect a frustration that softer efforts — like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers — have not been powerful-enough incentives to quit. The new rules essentially treat cigarettes like an illegal narco... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4478169 Tue, 15 Feb 2011 15:12:38 +0100 4478169 http://www.medworm.com/index.php?rid=4460190&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fthintroducing-the-eicu-what-is-it-and-why-is-it-now-being-introduced.html I recently stumbled upon a successful example of telemedicine about which I was unaware -- the enhanced intensive care unit (eICU). Provena Health, with six hospitals in Illinois, has a web page explaining the concept which I quote from below (see: eICU - enhanced ICU): Initially one of only a handful of health systems to implement eICU technology, the Provena eICU Connection is one of 43 eICUs of its kind in the country, which collectively monitor approximately 10 percent of ICU beds nation-wide and lead the way in innovative patient care....It's a revolutionary service that utilizes enhanced computer software and physiology monitoring technologies to get immediate critical care physician and nurse input about any change in a patient's condition....eICU technology adds to current ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4460190 Thu, 10 Feb 2011 13:02:49 +0100 4460190 http://www.medworm.com/index.php?rid=4455262&cid=t_99762_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-major-health-systems-could-make-things-worse%2F2011.02.09 Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control. To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power. To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455262 Wed, 09 Feb 2011 22:00:58 +0100 4455262 http://www.medworm.com/index.php?rid=4455492&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fidentifying-impaired-physicians.html We need a more efficient and comprehensive method for identifying "impaired" physicians. It has become apparent to me that our dependence on the reporting of these problems by other physicians is not effective (see: Reporting of Impaired Physicians by Their Colleagues). For various reasons, many physicians are not inclined to point fingers at their colleagues. A recent article highlighted for me another aspect of this problem: the high proportion of older physicians who are still practicing and sometimes performing complex surgical procedures (see: As Doctors Age, Worries About Their Ability Grow). Here's an excerpt from the article:   One-third of the nation’s physicians are over 65, and that proportion is expected to rise. As doctors in the baby boom generatio... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4455492 Wed, 09 Feb 2011 15:04:02 +0100 4455492 http://www.medworm.com/index.php?rid=4436948&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fbehavioral-economics-and-the-clinical-labs.html Financial incentives for the pursuit of wellness or adherence to medical regimens can occur in various forms (see: Paying Patients to Stay Healthy; Discrimination Against the Poor?; A Lottery to Improve Patient Adherence to Warfarin Therapy). One type of such incentive is for employers to offer two kinds of health insurance: a "regular" type and a second that requires qualification on the basis of certain health parameters or goals such as BMI, blood pressure, cholesterol level, and periodic physical exams. A recent note in Dark Daily referred to such programs as being based on behavioral economics, a new perspective for me (see: Behavioral Economics Likely to Push Up Utilization of Clinical Pathology Laboratory Tests). Below is an excerpt from it: Pathologists and clinical labor... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4436948 Fri, 04 Feb 2011 15:24:10 +0100 4436948 http://www.medworm.com/index.php?rid=4429234&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fdetails-about-epics-beaker-lis-supplied-by-the-company.html I have published previous notes about Epic's Beaker LIS (see: Introducing the Epic Laboratory Information System (LIS); It's Called Beaker; An Update on Epic's LIS, Called Beaker, from HIStalk; More Information about Epic's Beaker LIS and Its Sibling). Because of the popularity of the Epic EMR, extensive pressure is being placed on pathology departments to install Beaker as a component of the enterprise solution that Epic offers and many CIOs seem to lust after (see: Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion; Are You an Enterprise or Best-of-Breed CIO? Access to Cash May Make the Difference). It's important for pathology personnel to understand the relative immaturity of this product and that key components are lacking (see: Assessing the True Cost ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4429234 Wed, 02 Feb 2011 14:33:32 +0100 4429234 http://www.medworm.com/index.php?rid=4424487&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Ftelerehab-after-total-knee-replacement.html One of the challenges of telemedicine for the past several decades has been the tendency for its supporters to align it with some health services without a natural fit. This is to say, those requiring one-on-one, live physician and nurse interactions. I have now come across one type of service, post-operative physical therapy, that seems to be a natural for telemedicine. A recent article discusses an example of a successful telerehab program (see: Telerehab Works After Knee Surgery) In a noninferiority trial, telerehabilitation fared at least as well as conventional therapy on all study outcomes after six weeks, including the primary outcome...according [a reesearcher in the field]. In fact, telerehabilitation resulted in greater improvement on the WOMAC stiffness subscale and the Patient-... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4424487 Tue, 01 Feb 2011 13:26:30 +0100 4424487 http://www.medworm.com/index.php?rid=4419460&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fepic-employee-turnover-keeping-up-with-the-huge-number-of-new-contracts.html In a recent note, I quoted Mr. HIStalk describing how Epic manages its sales process (see: Some Details about the Epic Sales Force and Sales Process). In the same blog note that I linked to, he also cites the recent success of Epic in writing new EMR contracts (see: Monday Morning Update 1/24/11) Until 2009, Epic was making just 10-15 new sales a year and many of those were just for ambulatory or inpatient alone, but the percentage of enterprise sales has increased each year. In 2010, they supposedly made around 40 new sales .... Continuing on in this same vein regarding Epic staffing and personnel issues, Mr. HIStalk responds to a query for a reader, QPFC, about some sour grapes from ex-employees on the web (see: News 1/26/11): From QPFC: “Re: Epic. On Glassdoor.com, ex-employees have s... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4419460 Mon, 31 Jan 2011 12:58:51 +0100 4419460 http://www.medworm.com/index.php?rid=4394757&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fmthe-overdiagnosis-problem-in-our-health-system.html One of the "hazards" in our country with its sophisticated healthcare delivery system and well trained physicians is overdiagnosis. This is a logical consequence of broad health insurance coverage, a multitude of physicians (particularly in urban areas), and physician training oriented to the identification of disease. I have previously referred to this latter phenomenon as the disease model (see: Wellness, Preventive Medicine, and the Classic Disease Model; Predisposition to Disease and Pre-Disease on the Health Continuum). It turns out that one physician-author has studied this problem (see: Health Blog Q&A: H. Gilbert Welch, Author of ‘Overdiagnosed’). Below is an excerpt from a blog note about him and his ideas: At the beginning of his new book, “Overdiagnosed,” D... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4394757 Mon, 24 Jan 2011 14:16:18 +0100 4394757 http://www.medworm.com/index.php?rid=4382956&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fhow-healthy-is-e-health.html Here's a definition for e-health from Canada: {A]n overarching term used to describe the application of information and communications technologies in the health sector. It encompasses a range of purposes from purely administrative through to health care delivery. This definition seems to me to provide a good start but, in my opinion, is insufficient. It doesn't touch on the notion of health information acquisition by consumers via the web, which is one of the most far-reaching aspects of e-health. This pursuit of knowledge by healthcare consumers is critical because it it allows them to educate themselves and prepares them to take more responsibility for their own health. Keeping all of this in mind, I now want to turn to a recent article that raises the issue of the "health&... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4382956 Fri, 21 Jan 2011 14:43:39 +0100 4382956 http://www.medworm.com/index.php?rid=4372253&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fus-supreme-court-to-review-prescription-privacy-laws.html The days of the "detailing" of physicians by sales personnel from the pharmacy companies are numbered (see: How E-Detailing May Lead to Greater Knowledge by Physicians about Drugs; E-Sampling: Another Blow to the Future of Pharma Sales Reps). Nevertheless, an important case is now before the U.S. Supreme Court relating to access by pharmacy reps of the prescribing history of the physicians whom they call on (see: Prescription Privacy Laws Get U.S. High Court Scrutiny). Below is an excerpt from the story: The U.S. Supreme Court accepted a case that pits medical privacy interests against speech rights, agreeing to consider whether states can limit how drugmakers use data about the prescription-writing practices of doctors. The justices ...will review a Vermont law being challenged ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4372253 Wed, 19 Jan 2011 14:20:18 +0100 4372253 http://www.medworm.com/index.php?rid=4361314&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fhealthy-days-per-month-as-a-measure.html A recent article about racial health disparities in the New York Times using CDC data was fascinating and I recommend it for anyone interested in general health issues (see: Broad Racial Disparities Seen in Americans’ Ills). To whet your interest, here are three short statements extracted from it: Babies born to black women are up to three times as likely to die in infancy as those born to women of other races. American Indians and Alaska Natives are twice as likely to die in car crashes as any other group. More than 80 percent of all suicides are committed by whites, but young American Indian adults have the highest suicide rates by far — 25 per 100,000 population at age 21, compared with 14 for whites, 10 for blacks and 8 for Asians and Hispanics. Compared with whites, blacks have d... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4361314 Tue, 18 Jan 2011 14:35:11 +0100 4361314 http://www.medworm.com/index.php?rid=4361315&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fis-meditech-dooomed-becasue-of-lack-of-robust-ambulatory-product.html Until about ten years ago, there was only minimal interest in IT support for ambulatory care. Successful EMR vendors such as that of Cerner were focused on inpatient care although their forward-looking "vision" statements always included ambulatory care. In terms of their major product focus, however, they were following the lead of the hospital executives who derived the bulk of their revenue from the inpatient side of the hospital. Many physicians shared this view at this time. Academic surgeons, for example, operated on mainly inpatients and then saw them as outpatients mainly to ensure that the surgical incisions were healing. All of this is now changing. Epic, for example, initially focused on IT support for ambulatory care. We all know how this has ended up (see: Why Does E... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4361315 Mon, 17 Jan 2011 15:19:55 +0100 4361315 http://www.medworm.com/index.php?rid=4338271&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fwfewer-hospital-admissions-for-health-failure-among-better-educated.html I have long been interested in the correlation between good health and level of education (see: Correlation of Sociodemographic Status with Personal Engagement in Cancer Screening Programs). Here's a quote from an article in the NYT that succinctly summarizes this issue (see: A Surprising Secret to a Long Life: Stay in School): James Smith, a health economist at the RAND Corporation, has heard a variety of hypotheses about what it takes to live a long life — money, lack of stress, a loving family, lots of friends....But what, he asks, is cause and what is effect? And how can they be disentangled? He is venturing, of course, into one of the prevailing mysteries of aging, the persistent differences seen in the life spans of large groups....But the questions for researchers like Dr. Smi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4338271 Wed, 12 Jan 2011 14:29:39 +0100 4338271 http://www.medworm.com/index.php?rid=4318553&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fcerner-lowering-lis-prices.html This article on Idaho hospital EMR projects describes Cerner, being implemented at North Canyon Medical Center for $2 million, as “an economical system that works well for smaller rural hospitals.” Syringa Hospital (a strangely satisfying hospital name) paid $1.3 million. What? The Cerner EMR as “an economical system that works well for smaller rural hospitals.” I, like Mr. HIStalk, was surprised by this description and had to think about the idea for a while. Then some of my thoughts started to come together. First of all, and as I noted in a previous note, Epic is winning most of the contracts for the highest-end hospital contracts, which was one of Cerner's sweet spots (see: Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion). Also, and as suggested in a previous... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4318553 Thu, 06 Jan 2011 14:19:00 +0100 4318553 http://www.medworm.com/index.php?rid=4309862&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fwho-among-older-patients-thrives-after-surgery.html As our population ages, a question that arises more frequently is whether to perform surgery on octogenarians and nonagenarians.Which among them are robust enough to withstand the stress of the procedure? I found that a recent article offered practical advice about this issue. (see: Who Thrives After Surgery?). Below is an excerpt from it: Martin A. Makary, a surgeon and public health researcher at Johns Hopkins Hospital in Baltimore, had a long talk with a patient last week. The man had a tumor in his pancreas that was probably benign but might not be. Should Dr. Makary remove it? Or should the man have regular scans to see whether it grew?....[T]his patient was 89....Surgeons eyeball their patients all the time to try to evaluate whether they can recover well from the stress of an operat... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4309862 Tue, 04 Jan 2011 14:15:12 +0100 4309862 http://www.medworm.com/index.php?rid=4305114&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fdelaying-ellective-surgery-after-hospital-admission.html It's not an uncommon occurrence for a scheduled elective surgery to be delayed because the case gets crowded-out by emergency procedures or unexpected longer cases. This can be uncomfortable for the patient in question who has gotten ready psychologically for the surgery. But what can you do -- just wait your turn? It turns out that there are even more serious consequences of delayed elective surgery on the basis of recent research (see: Delaying elective surgery raises risks, costs: new study). Below is an excerpt from an item I recently came across: Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs....The occurrence of infection following surgical procedures co... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4305114 Mon, 03 Jan 2011 13:53:06 +0100 4305114 http://www.medworm.com/index.php?rid=4298804&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fprediction-for-2011-apps-go-corporate.html In an end-of-the-year article discussing IT trends, the WSJ tucked-in what I consider a highly significant and insightful prediction under the "apps" category (see: The Rise of Apps, iPad and Android; subscription required). I copy it below: Coming next: Apps go corporate. AT&T, business-software developer SAP AG and other companies are working on apps that can help their employees track sales, monitor systems or check-out customers without being tied to their stations. The quick adoption of tablets by business users is helping fuel the trend. I have posted a number of notes about the usefulness of smartphones in healthcare delivery and health education. I have also discussed previously the type of programs that run on smartphones -- generally referred to as apps (see: New De... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4298804 Wed, 29 Dec 2010 16:25:21 +0100 4298804 http://www.medworm.com/index.php?rid=4281554&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fhealth-insurance-companies-jump-into-healthcare-software.html Mr. HIStalk comments below on the recent acquisition of Medicity by the health insurance company Aetna (see: Healthcare IT From the Investor’s Chair 12/9/10). Medicity is an HIE (health information exchange) company. Speaking from my usual perch in the peanut gallery (as I’ve done work for neither company), I’m fairly astounded by the price [of Medicity’s acquisition by Aetna]. Rumor has it that $500 million (twice what Ingenix paid for Axolotl) is approaching 8x revenues, a princely multiple that dwarfs, say, Allscripts’ purchase of Eclipsys for 2x revs or even Ingenix’s purchase of Picis for 3x revs. Medicity appears to be the leader in its space, with over 750 hospitals and 125,000 physicians using its system. Still, it’s a huge bet on the HIE market that’s not quite eme... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4281554 Wed, 22 Dec 2010 13:00:00 +0100 4281554 http://www.medworm.com/index.php?rid=4266285&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fe-sampling-by-pfizer.html If I were a sales rep working for a pharmaceutical company, I would be dusting off my resume and scanning the help-wanted ads. A great salesperson can always make a very comfortable living. I envision that most of the sales efforts of these companies will be moving to the web. I have covered this transition in a number of previous notes (see: How E-Detailing May Lead to Greater Knowledge by Physicians about Drugs; Effectiveness of "Direct-to-Consumer" Drug Advertisements; Growth of Online CME Interpreted as Bad News for Pharma Marketers; Pharma-Free CME Activities: Is This the Right Approach?). Below is an excerpt from an article discussing this new facet of this trend -- e-sampling  (see: Pfizer Joins the E-Sampling Crowd: How it Assuaged Sales Reps’ Concerns): Big pharm... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4266285 Fri, 17 Dec 2010 13:26:33 +0100 4266285 http://www.medworm.com/index.php?rid=4266286&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fdifference-between-software-born-in-the-cloud-and-software-moved-to-the-cloud.html I have posted a number of notes about cloud computing but have not paid particular attention to differences between applications born in the cloud as opposed to those that are moved to the cloud. Luckily, the Forbes blog Quicker, Better, Tech has reprinted a column on this topic by Aaron Levie who is the co-founder and CEO of Box.net. Below is an excerpt from his musings (see: The Open Social Enterprise). Read the whole thing if you have time. It's worth the effort. When Steve Ballmer declared that Microsoft was “betting the company” on cloud computing earlier this year, he cautioned that “the goal can’t be to throw out all the world’s software and start again.” Microsoft and the other enterprise technology behemoths may be embracing the cloud, but in many cases they’re d... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4266286 Thu, 16 Dec 2010 14:07:04 +0100 4266286 http://www.medworm.com/index.php?rid=4266287&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fwmajor-shifts-in-use-medical-imaging-in-emergency-departments.html It will come as a no surprise to readers of this blog that the practice of medicine is changing radically, particularly the use of CT scans and other diagnostic studies. Part of the shift is due to the fact that younger physicians are losing their ability to diagnose at the bedside. Part is due to the increasing sophistication of imaging technology itself. Certainly part is due to the pressure to practice defensive medicine. A recent article puts some real numbers to this shift in the use of CT scans in hospital emergency departments (see: Use of CT Scans in Emergency Departments 'Skyrocketing'). Below is an excerpt from the article: The use of computed tomography (CT) scans in emergency departments (EDs) throughout the United States has increased dramatically in recent years, and ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4266287 Wed, 15 Dec 2010 15:10:55 +0100 4266287 http://www.medworm.com/index.php?rid=4259217&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fhospitals-said-to-withhold-clinical-data-from-phrs.html It may strike you as sour grapes that the president of a personal health record (PHR) company, is griping about hospital CEOs holding hostage the clinical data that they control. Mr. HIStalk recently published the following tidbit, quoting Colin Evans of Dossia (see: News 12/8/10): Colin Evans, president and CEO of PHR vendor Dossia says ...HHS and the FTC need to make big providers and health plans stop holding the medical information of their patients hostage and using liability or privacy concerns as an excuse. He says they refuse to share patient information even when patients request it, hoping to forestall competition based on service, price, and quality. He also points out that lots of them are selling the data of their patients anyway or are using PHR information to display targete... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4259217 Tue, 14 Dec 2010 14:13:24 +0100 4259217 http://www.medworm.com/index.php?rid=4233431&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Flapband-surgery-proposed-for-the-less-obese.html I have a serious concern that bariatric surgery, particularly the use of the Lap-Band, is becoming the preferred alternative to gradual weight loss programs for the obese. Many patients prefer this quick-fix surgical approach as do hospital execs because of its revenue-generating potential. Allergan, the manufacturer of the device, recently proposed to the FDA that the use of the device be allowed for the less obese. Here is an excerpt from the first article about this topic (see: Obesity Surgery May Become Option for Many More): An advisory committee to the Food and Drug Administration will consider...a request by Allergan, the pharmaceutical company, to significantly lower how obese someone must be to qualify for surgery using the company’s Lap-Band device, which restricts intake to th... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4233431 Mon, 06 Dec 2010 13:03:33 +0100 4233431 http://www.medworm.com/index.php?rid=4207511&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fma-fresh-look-at-epic-from-a-financial-and-strategic-perspective.html The financial health and strategic goals of Epic are of great interest to those large healthcare systems that are totally dependent on the company for their EMR software (see: How to Avoid Software Vendor Lock-in and Account Control). Mr. HIStalk alerted me in a recent blog note to coverage of the company in a Milwaukee newspaper (see: Monday Morning Update 10/18/10). Here's his take on the company: The Milwaukee newspaper profiles  Epic with some interesting facts, with the most interesting one being confirmation of our June report that Aurora is dumping its $150 million Cerner system for Epic, which will cost them an additional $100 million. A quarter billion dollars seems like a lot for an EMR considering that Aurora showed a $50 million loss two years ago and a $116 million l... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4207511 Mon, 29 Nov 2010 12:20:57 +0100 4207511 http://www.medworm.com/index.php?rid=4203320&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fwill-large-health-systems-embrace-preventive-medicine-and-wellness.html In response to a recently posted blog note (see: Risk for Consumers as Healthcare Systems Rapidly Expand), Dr. Doug Mitchell submitted the following comment: Data suggest the "common wisdom" that preventive care saves tons of money is wrong. If one assumes the consolidation of systems is unstoppable, how might the above study be good news? The feds could more easily -- and with less push-back --heavily incentivize preventive care from these systems. Why? Fewer entities are easier to monitor. And if the study is right, the systems could make as much $$$ preventing disease as treating it. Costs being equal, is it better for a woman to die at age 80 because years earlier she was (a) repeatedly stented, or (b) put on statins? Of course, this scenario wouldn't decrease total expe... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4203320 Fri, 26 Nov 2010 14:22:03 +0100 4203320 http://www.medworm.com/index.php?rid=4197374&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fwimaging-superior-to-biopsy-in-cases-of-suspected-hepatocellular-carcinoma.html I believe that radiologists will soon be rendering many more definitive diagnoses than "impressions" in their reports due to improvements in imaging technology. This will place them increasingly in competition with pathologists. A recent report about the diagnosis of hepatocellular carcinoma reinforced this idea in my mind and also presented other interesting facts (see: Imaging Instead of Biopsy for Most Suspected Hepatocellular Carcinomas). Below is an excerpt from the it: Although cross-sectional imaging is recommended by several well-respected societies as the standard of care for the diagnosis of hepatocellular carcinoma (HCC), many physicians still rely on a liver biopsy for diagnosis....[A radiologist and expert on this topic recently] discussed the importance of cross-sec... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4197374 Wed, 24 Nov 2010 13:27:12 +0100 4197374 http://www.medworm.com/index.php?rid=4197375&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fhow-labs-can-avoid-the-dreaded-vendor-lock-in-.html People new to the field of lab computing may be unaware of the risk of vendor lock-in and account control in their purchase of software. According to the Wikipedia, vendor lock-in, also known as proprietary lock-in or customer lock-in, makes a customer totally dependent on a single vendor for products and services and unable to use other products without substantial switching costs. A recent article discussed how to avoid such a situation (see: How to Protect Against Vendor Lock-In). Below is an excerpt from it: It appears that Oracle CEO Larry Ellison is aggressively either buying or putting out of business potential competitors. SAP and HP look to be his latest targets on the latter path and his goal appears to be total account control, that is, a situation in which one vendor single-han... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4197375 Tue, 23 Nov 2010 12:01:12 +0100 4197375 http://www.medworm.com/index.php?rid=4190533&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Frisks-for-consumers-as-healthcare-providers-consolidate.html At a social event in Ann Arbor two nights ago, much of the talk centered about how a regional health system had just announced the purchase of a large physician cardiology group just a few months after the purchase of an even larger private group of internists. The rationale apparently was to provide the hospital system with more expertise in ambulatory care and also because the CMS is ratcheting down reimbursement for outpatient visits.The physician groups think that their revenue will be increasingly squeezed. Here are some other similar announcements (see: Kentucky's Louisville Cardiology Group Joins Baptist Hospital East; Chicago-Area Cardiology Group Joins NorthShore University Health System). I have previously commented about the emergence of "big medicine" which consis... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4190533 Mon, 22 Nov 2010 12:24:30 +0100 4190533 http://www.medworm.com/index.php?rid=4183562&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fnew-malamoma-detection-device-narrowly-apporoved-by-the-fda.html MelaFind, a device designed for use by dermatologists for in-vivo detection of suspicious pigmented skin lesions, has been narrowly approved by an FDA advisory panel. Here is an excerpt from the article (see: Panel Splits over Skin Cancer Detection Device): An FDA advisory panel has voted 8-7, with one member abstaining, to recommend approval for an experimental skin cancer detection system called MelaFind. A vote so close generally is not considered an endorsement in the eyes of FDA officials, who have the final say in whether to approve the device. The FDA does not have to follow the advice of its advisory committees, but it often does. Some panelists on the [committee] were concerned that relying on a device to detect melanoma could lead to unnecessary biopsies, or worse: missed skin ca... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4183562 Fri, 19 Nov 2010 17:06:09 +0100 4183562 http://www.medworm.com/index.php?rid=4175980&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Fhimss-virtual-conference.html HIMSS seems to be up to one of its revenue-generating, marketing, and sleight-of-hand tricks according to a report by Inga who blogs with Mr. HIStalk (see: News 10/29/10). Here's her account about registration for one of its virtual conferences: HIMSS is hosting another virtual conference November 3-4. I “attended” the first one two or three years ago, mostly because I was curious about the virtual format. The conference is free for “qualified” participants and $99 for “non-qualified” HIMSS members. I can’t find anywhere on the HIMSS site that clarifies what it takes to be qualified, but I can say that when I tried to sign up for a conference a year ago, I didn’t have the secret requirements. I am mildly amused because my status must have recently changed, having receiv... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4175980 Wed, 17 Nov 2010 13:00:00 +0100 4175980 http://www.medworm.com/index.php?rid=4152288&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F11%2Ftusame-day-histopathology-services.html I have been promoting the idea of integrated diagnostics in this blog (see: Revisiting Integrated Diagnostics and the Integrated Diagnostic Report) and suggested that the goal of no more than a three-day turnaround time for breast cases would be a suitable goal. In a recent note, I presented evidence that the current diagnostic-delay-time (DDT) for breast lesions from the time of initial screening until a definitive diagnosis is about 16 to 60 days (see: Diagnostic Delay Time (DDT) and Integrated Diagnostics). The Dark Daily recently ran a story about the University of Nebraska-Omaha and the technology they were deploying in surgical pathology. The lab is generating reports for a significant number of patients on a same-day basis. (see: Lean and New Diagnostic Technologies Fuel Innovations... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4152288 Wed, 10 Nov 2010 13:00:00 +0100 4152288 http://www.medworm.com/index.php?rid=4134277&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fwphysician-work-hours-a-major-change-in-healthcare-delivery.html The Dark Daily recently covered some news that may have an effect on healthcare delivery in the future. It's all about the average number of hours that physicians, particularly younger ones, are willing and able to spend on the job (see: Dartmouth Researchers Say that Doctors Now Work Fewer Hours Than Lawyers). Here's a link to the original article in JAMA (see: Trends in the Work Hours of Physicians in the United States) and below is an excerpt from the Dark Daily story: [The Dartmouth] researchers...found no statistical support for two common beliefs within the physician community. First, that the aging physician population may be reducing their work hours, and second, that the increased number of female physicians who might leave to start families, is responsible for the decreas... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4134277 Sat, 30 Oct 2010 18:03:00 +0100 4134277 http://www.medworm.com/index.php?rid=4119739&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fthipad-as-the-owner-manual-for-hyundai.html I picked up, by chance, on a recent reference to the fact that a "free" iPad is delivered with each Hyundai Equus, substituting for the normal hardcopy user manual for the vehicle. Here is an excerpt from the article (see: A Week In The High-Tech Hyundai Equus Super Sedan): There’s enough technology within the driver’s (and backseat passenger’s) reach to require a few trips to the manual, which just so happens to be an app on the included iPad. Yep, this is the car that comes with an iPad as the user manual. It makes sense, too. Instead of following a series of step-by-step instructions to, say, change the audio settings, you can just refer to the app for a quick demonstration. It’s genius from a user experience and marketing standpoint. OK, OK! This is a car with a $96,0... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4119739 Thu, 28 Oct 2010 16:45:25 +0100 4119739 http://www.medworm.com/index.php?rid=4119740&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fquality-collaboration-arranagments-in-surgical-pathololgy-between-small-and-large-hospitals.html We need to take some steps to ensure that our smaller hospitals continue to be viable both financially and in terms of the quality of care that they provide. This may be difficult for some of them in this new era of accountable care organizations (ACOs) with complex performance standards required by the government and insurance companies. One of the challenges facing smaller hospitals, from the perspective of surgical pathology, is that the number of pathologists working in such a setting will be small -- perhaps one or two in many cases. It is impossible in such a small group to solicit multiple opinions about a challenging surgical pathology case. In a large academic pathology department, there are numerous colleagues close-at-hand to consult, all of whom will have sub-speciality experti... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4119740 Mon, 25 Oct 2010 15:43:59 +0100 4119740 http://www.medworm.com/index.php?rid=4106080&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fquality-collaboration-arranagments-in-surgical-pathololgy-between-small-and-large-hospitals.html We need to take some steps to ensure that our smaller hospitals continue to be viable both financially and in terms of the quality of care that they provide. This may be difficult for some of them in this new era of accountable care organizations (ACOs) with complex performance standards required by the government and insurance companies. One of the challenges facing smaller hospitals, from the perspective of surgical pathology, is that the number of pathologists working in such a setting will be small -- perhaps one or two in many cases. It is impossible in such a small group to solicit multiple opinions about a challenging surgical pathology case. In a large academic pathology department, there are numerous colleagues close-at-hand to consult, all of whom will have sub-speciality experti... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4106080 Mon, 25 Oct 2010 15:43:59 +0100 4106080 http://www.medworm.com/index.php?rid=4098477&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fonocology-concession-under-attack-by-health-insurance-companies.html The oncology concession is the percentage of the cost of chemotherapy (i.e., the drug markup) that is retained by the oncology group for prescribing the drug (see: Academic Oncology and the "Chemotherapy Concession"). These are a number of problems associated with such a payment not the least of which are the following: (1) there is an incentive for an oncologist to treat the patient with advanced disease with little hope of significant amelioration of it; and (2) there is an incentive to treat the patient with newer, non-standard biotech drugs that are frequently more expensive. Health insurers are now evaluating new oncology payment systems in order to remove these perverse incentives (see: Insurers Test New Cancer Pay Systems). Below is an excerpt from the article: The insurer... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4098477 Fri, 22 Oct 2010 16:40:50 +0100 4098477 http://www.medworm.com/index.php?rid=4098478&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fbreaking-up-the-health-insurance-cartel.html The "retail prices" that hospitals charge for inpatient care are largely made-up numbers. They are set purposely high so that the discounted rates that are then negotiated with the health insurance companies are sufficient to cover costs and possibly earn a profit (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant). These higher prices are only paid by the unfortunate minority who require care, lack health insurance, and have some assets. Some states like Oregon are launching web sites to provide some transparency regarding the substantial differences in the cost of an inpatient stay by hospital depending, in part, on the extent of competition in the local market (see: Comparing the Details of Hospital Charges in the State of Oregon). Here's a quote fr... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4098478 Thu, 21 Oct 2010 19:21:05 +0100 4098478 http://www.medworm.com/index.php?rid=4077614&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fmwho-will-build-the-diagnostic-emr.html I have just come back from Washington G-2 Report's Lab Leaders' Summit and Lab Institute in Arlington, Virginia, just outside Washington, DC. This was the 28th annual presentation of the latter. Both were well received and highly successful. I personally spoke at the Lab Leaders' Summit, summarizing in my lecture what I perceived to be the current top ten IT trends in healthcare. One of the items in my top-ten list was the Diagnostic EMR (D-EMR), which I believe will now evolve on a parallel track to the clinical EMR (C-EMR). These are not terms now in common usage but I hope to make them so in the upcoming months. One of the questions that I posed during my lecture was which of the current LIS vendor(s) will decide to build a D-EMR. I envision that such a system will be cloud-... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4077614 Mon, 18 Oct 2010 17:39:35 +0100 4077614 http://www.medworm.com/index.php?rid=4061083&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Ffdiagnostic-delay-time-ddt-and-integrated-diagnostics.html One component of Diagnostic Adverse Events (see: New Attention Being Directed toward Diagnostic Adverse Events (DAEs)) is the Diagnostic Delay Time (DDT). I discussed the topic of diagnostic delays in a recent note, comparing them to Clinical Adverse Events (CAEs) (see: Breast cancer diagnostic delay depends more on race than insurance). Below is an excerpt from the DDT article as it relates to breast cancer: Race and ethnicity appeared to affect diagnostic delay more than insurance status for women with breast abnormalities, as revealed by data presented at [a recent conference].... Findings revealed that non-Hispanic black and Hispanic women with government or private insurance waited more than twice as long for a definitive diagnosis than non-Hispanic white women with government o... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4061083 Tue, 12 Oct 2010 11:50:43 +0100 4061083 http://www.medworm.com/index.php?rid=4045401&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fimproved-survival-from-simpler-cpr.html Here is some important health information that will be very important to disseminate. A new study found that people who suffered cardiac arrest and received chest compressions from bystanders had higher survival rates than those given standard resuscitation that included mouth-to-mouth breathing (see: Study Backs Simpler CPR for Patients).  Below is an excerpt from the article: About 300,000 people in the U.S. collapse each year from cardiac arrest, which can be brought on by a heart attack or other reasons, and fewer than one-third get CPR from bystanders, according to American Heart Association estimates. The breathing part of CPR is a big barrier for many people, the AHA says. Growing evidence has suggested that skipping the mouth-to-mouth breathing in favor of rapid, chest-only c... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4045401 Fri, 08 Oct 2010 13:26:25 +0100 4045401 http://www.medworm.com/index.php?rid=4040798&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fwhy-some-orgeon-hospitals-charge-three-times-as-much-as-others.html Here's the standard dogma. Some hospitals charge much more than others in a city for similar services because we have a market economy, they are allowed to set their charges at whatever level they like, and most patients don't foot the bill themselves so don't seek the lowest cost provider. I came across an interesting article on the topic of hospital billings in Oregon (see: Why some Oregon hospitals charge three times more than others). It's chock-full of interesting tidbits so take a look at the excerpt below: When Oregon began disclosing details of hospital billing three years ago, officials hoped to spur competition that would hold back costs and reduce the huge variations in rates from hospital to hospital. The latest data from 2009 suggest that little has changed. Ho... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4040798 Thu, 07 Oct 2010 12:25:43 +0100 4040798 http://www.medworm.com/index.php?rid=4036953&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fproper-care-and-feeding-of-consultants.html I have been writing about hospitalists for about three years. These are physicians from a number of different specialities who are full-time hospital employees and who manage hospital inpatients, taking over this responsibility from community physicians. This is in contract to the older model where these latter physicians managed their own patients when hospitalized. I frequently browse the on-line publication Today's Hospitalist to get a feeling of physician attitudes and mode of practice in this rapidly growing sector of healthcare. Here's a sample of an article focusing on the "care and feeding" of consultants by hospitalists (see: Consultants: their proper care and feeding). To get you oriented, the article is written by a hospitalist and discussing issues pertaining ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4036953 Wed, 06 Oct 2010 12:38:31 +0100 4036953 http://www.medworm.com/index.php?rid=4031513&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fmin-search-of-an-accountable-care-organization.html Mr. HIStalk, in his Monday Morning Update 10/4/10, highlights a YouTube animated video entitled In Search of an Accountable Care Organization. As most of you will know by now, an ACO or Accountable Care Organization is a key requirement in the recent healthcare reform legislation. Hospital executives are searching for the secret sauce about how to transform their organizations into one. Information technology, and particularly EMRs, are critical elements in the recipe. Watch this short video -- very enlightening and uncomfortably funny. KevinMD, a well-known and highly respected blogger about health issues, has this to say about ACOs: Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government....Mu... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4031513 Mon, 04 Oct 2010 12:31:47 +0100 4031513 http://www.medworm.com/index.php?rid=4023144&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fmobile-phr-not-the-answer.html I came across an article recently about the relationship between mobile devices such as smart phones and healthcare and the word conflation immediately came to mind (see: Deloitte Report Finds Major Role for Mobile Devices in Health Care). It can be defined in the following way: conflation occurs when the identities of two or more individuals, concepts, or places, sharing some characteristics of one another, become confused until there seems to be only a single identity — the differences appear to become lost. Read the extract below and see if you agree with me: The Deloitte Center for Health Solutions has released a report showing how mobile technology can improve people's health and reduce health-care costs....Considering that treating chronic disease accounts for more than 70 perc... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4023144 Fri, 01 Oct 2010 14:14:31 +0100 4023144 http://www.medworm.com/index.php?rid=4013589&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fhealth-insurance-companies-try-financial-incentives-with-insured-patients.html The idea that health insurance companies should pay or reward their customers to lead healthier lives poses a set of moral conundrums. Those opposed to such a policy correctly state that a health insurance company should not need to pay individuals to improve their own health. Are not such benefits so appealing in and of themselves that no additional incentives are required? Supporters of such plans will often respond in the following way: Use whatever means that work because the end justifies the means in terms of cost savings and the pursuit of wellness. Here is an excerpt from an article on this topic as it relates to medication compliance (see: Insurers Try Incentives to Improve Medication Adherence): The poor compliance not only affects quality—nonadherent patients have higher hospi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4013589 Wed, 29 Sep 2010 14:51:26 +0100 4013589 http://www.medworm.com/index.php?rid=3999307&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fassessing-the-true-cost-of-being-a-beta-test-site-for-beaker-lis.html I have been trying to keep abreast of the news relating to the Beaker LIS, given that Epic is closing most contracts in high-end hospitals and their labs are sure to get caught up in this process (see: Introducing the Epic Laboratory Information System (LIS); It's Called Beaker; An Update on Epic's LIS, Called Beaker, from HIStalk; More Information about Epic's Beaker LIS and Its Sibling). I have been told that Beaker is now live in a a number of physician offices labs and a few hospitals with the 500-bed Sanford Health in Sioux Falls, SD, as one of the major show sites. Two hospital systems are now considering the installation of Beaker, Allina and OHSU. The latter, previously running GE's Ultra LIS, is apparently seeking a replacement for this system with some degree of u... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3999307 Fri, 24 Sep 2010 13:53:51 +0100 3999307 http://www.medworm.com/index.php?rid=3981023&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fthe-unitedhealthcare-business-model-comparison-with-roche-and-siemens.html The New York Times of September 16, 2010, carried a full page ad sponsored by UnitedHealthcare. I have posted a number of previous notes about this large company, some of which have not been very flattering. Emblazoned across the midriff of a running woman in the ad is the following slogan: Knowledge in numbers, Strength in numbers, Humanity in numbers, Comfort in numbers, Health in numbers. Get it -- the business model for UnitedHealthcare must have something to do with numbers, as in the management of administrative, financial, and clinical data in healthcare. The company's web site is HealthinNumbers. I am not exactly sure with whom this motto resonates, but let's move on. About a month ago, Mr. HIStalk opined about UnitedHealthcare from an investor's perspective (see: Healt... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3981023 Fri, 17 Sep 2010 12:03:23 +0100 3981023 http://www.medworm.com/index.php?rid=3969191&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Facademic-medicine-and-the-oncology-concession-1.html I recently came across an article discussing the difficulty in recruiting academic oncologists that brings to light some issues that are not commonly discussed in the literature (see: Why Academic Divisions of Hematology/Oncology Are in Trouble and Some Suggestions for Resolution). Below are two excerpts from it:Academic divisions of hematology/oncology seem to have difficulty recruiting and retaining excellent productive clinicians. A major reason for this is that salaries do not compete with the private sector for similar work....The academic salaries are approximately one third of practice because the chemotherapy concession has been given to the academic hospital. In addition, there may be substantial problems in under-billing, lack of attention to detail in billing, and poor collect... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3969191 Tue, 14 Sep 2010 12:48:11 +0100 3969191 http://www.medworm.com/index.php?rid=3965710&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fmrevisiting-integrated-diagnostics-and-the-integrated-diagnostic-report.html In previous notes, I have been a strong advocate for integrated diagnostics, defined as closer collaboration, and perhaps eventual merger, of pathology, lab medicine, and radiology (see: The Evolution of Integrated Diagnostics into Integrated Diagnostic Centers)). A key central concept of this idea is the integrated diagnostic report (see: New Attention Being Directed toward Diagnostic Adverse Events (DAEs)). As currently conceptualized, such a report consists of a "super" or "bottom-line" diagnosis for a patient. It would be created by the integration of all of the "sub-diagnoses" for a patient that are generated serially and independently within the radiology sub-specialties (e.g., CT, MRI, PET) plus surgical pathology diagnoses plus data/diagnoses from the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3965710 Mon, 13 Sep 2010 13:24:16 +0100 3965710 http://www.medworm.com/index.php?rid=3954489&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fshift-of-emr-entry-tasks-from-mds-to-scribes-.html Hospitals are the only large enterprises I know that require their most skilled and frequently highest paid employees, physicians, to act as data entry clerks. This policy made some sense in the case of physician trainees who were not in a position to push back and were still learning the ropes. In the case of community physicians who admit their patients to the hospital, they are not hospital employees and their work efficiency is not of major concern to hospital executives. This situation is changing rapidly with the much broader deployment of EMRs and the rapidly expanding ranks of hospitalists. These latter personnel are physicians on the hospital payroll and hospital executives are now more interested in how they spend their time. Enter the "medical scribe" into this mix, a ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3954489 Thu, 09 Sep 2010 12:15:21 +0100 3954489 http://www.medworm.com/index.php?rid=3933271&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fi-recently-got-a-copy-of-the-book-that-kaiser-just-published-about-their-multi-billion-dollar-epic-deploymentconnected-for.html I received an email narrative from Dr. Bob Miller who is the Director of Pathology Informatics at Johns Hopkins. It was full of very useful information so I am posting it below as received. I am sitting on some other emails from him in a similar vein that I will also post in upcoming days. (BAF)I recently got a copy of the book that Kaiser just published about their multi-billion dollar Epic deployment: [Connected for Health: Using Electronic Health Records to Transform Care Delivery]. Unlike many similar tomes, which typically contain theories and grandiose plans, Kaiser's book contains hard facts and descriptions of what they have actually accomplished.  I would encourage you to look at a copy. I had a fascinating time a couple of weeks ago attending the VA's "VeHU con... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3933271 Fri, 03 Sep 2010 13:34:43 +0100 3933271 http://www.medworm.com/index.php?rid=3907792&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Fp4-medicine.html I have posted a number of previous notes on the topics of preventive, predictive, personalized, and participatory medicine (see: Preventive and Predictive Medicine as Components of the Healthcare Continuum; Some Encouraging News About New Federal Funding for Preventive Medicine Initiatives; Wellness, Preventive Medicine, and the Classic Disease Model; The Need for a Preventive Medicine Infrastructure in the U.S.; A Key Link Between Predictive and Preventive Medicine; Further Consideration of the Definition for Personalized Medicine; Recruiting Office Patients into a Participatory Model of Healthcare Delivery; "Participatory Medicine" and Its Relationship to Clinical Lab Testing). There are more but you get the idea.Putting it all together, they together constitute a blueprint for... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3907792 Thu, 26 Aug 2010 11:54:35 +0100 3907792 http://www.medworm.com/index.php?rid=3903139&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Fbariatric-surgery-may-reduce-need-for-diabetes-treatment-.html Three years ago, I discussed early reports that bariatric surgery can cure adult-onset diabetes through a mechanism not solely related to weight loss (see: "Curing" Diabetes with Bariatric Surgery). Now comes more information confirming these initial observations (see: Study: Surgery May Reduce Diabetics' Need for Drugs; subscription required). Below is an excerpt from the articleThe majority of people with diabetes who had bariatric surgery to lose weight were able to stop taking their diabetes medications, which led to a significant decline in health-care costs, according to a [recent] study....Researchers at Johns Hopkins in Baltimore, looked at 2,235 adults who had the stomach-reducing surgery and who also had Type 2 diabetes, a common form of the disease often associated... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3903139 Wed, 25 Aug 2010 11:48:11 +0100 3903139 http://www.medworm.com/index.php?rid=3881093&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Fbig-pharma-and-net-innovation-trends.html Think quickly when I say "innovation" in relation to healthcare. What types of organizations come quickly to your mind. Hospitals? No. The pharmaceutical industry? No. I personally think of sectors such as medical devices, molecular diagnostics, genomics, medical imaging, biotech. Well, recent trends in the market cap of various healthcare sectors bear out this conclusion (see: The Net Innovation Trend), Below is an excerpt from the article making this point, including pie charts illustrating the comparative value of sectors for 2000 compared to 2008:The relative absence of innovation set against a bloated cost structure has led to a rapid decline in value of large-cap pharmaceuticals, from nearly two-thirds of the market cap of healthcare in 2000 to less than one-third today. Ov... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3881093 Wed, 18 Aug 2010 14:11:47 +0100 3881093 http://www.medworm.com/index.php?rid=3876906&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Ftuepic-staffing-guide-transfering-the-epic-culture-to-hospital-clients.html When hospitals purchase the Epic EMR, they may get more than they bargained for. One of the fascinating aspects of Epic is the extent to which the company attempts to put its own spin on the culture of its hospital clients. One such example relates to the hospital personnel who will install/manage their software and also interact with Epic personnel. This is quite different than the usual healthcare IT company that usually tries, when feasible, to accommodate to the hospital client culture. A case in point is illustrated by the Epic staffing guide, a set of recommendations from the company to newly-signed clients in preparation for the deployment of Epic software. Mr. HIStalk discussed this topic in as recent blog note. Here is the item:Epic Staffing Guide: A reader sent over a copy of the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3876906 Tue, 17 Aug 2010 13:15:39 +0100 3876906 http://www.medworm.com/index.php?rid=3872556&cid=t_99762_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-foreign-medical-graduates-doctor-better%2F2010.08.16 Yes, according to a study in today’s Health Affairs. (The full text of the study is available only to subscribers, but Kaiser Health News Daily has a good summary of its findings and links to other news reports.) The study compares inpatient death rates and lengths of stay for patients with congestive heart failure or acute myocardial infarction when provided by U.S. citizens trained abroad, citizens trained in the United States, and non-citizens trained abroad. Treatment was provided by internists, family physicians, or cardiologists. The differences were striking, according to the authors: “Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered... Better Health blogs http://www.medworm.com/rss/comments.php?id=3872556 Mon, 16 Aug 2010 14:00:00 +0100 3872556 http://www.medworm.com/index.php?rid=3854758&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Ftudefining-downtime-for-the-mainframe-the-devil-is-in-the-details.html When I first broke into the lab computing area in 1982, I attended a meeting with the central IT manager of the hospital. This was before the era of the CIO and we used the term hospital rather than health system. Our IT manager was an IBM retread. The software running on the IBM mainframe computer in those days was referred to as the hospital information system (HIS). This software suite was used mainly for business rather than clinical applications and consisted of two major modules called PA/PM (patient accounting/patient management). Patient management included patient admission and discharge.At this meeting, she was bragging about 95% up-time for the mainframe computer. My eyes popped out of my head. I said, "Wait a minute. You take the computer down for four to five hours every ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3854758 Tue, 10 Aug 2010 12:25:31 +0100 3854758 http://www.medworm.com/index.php?rid=3845294&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Fnext-gen-emr-emphasis-on-coordination-and-communication.html I came across a recent interview of Dr. Peter Stetson, CMIO, Columbia Doctors, in which he discusses, in part, the "next generation" of electronic health records (EHRs) (see: HIStalk Interviews Peter Stetson, CMIO, Columbia Doctors). Columbia Doctors is a multi-specialty physician group of about 1,000 physicians in New York. The company has about 150 practice sites in the Tri-State area of New Jersey, Connecticut, and New York, with its primary base at Columbia University Medical Center. Here's the portion of the Q and A interview that interested me the most:Q: What should the next generation of EHRs do that the current generation doesn’t?A: I think that the challenges that we face are specifically in coordination of care. If you imagine trying to infuse an EHR with the ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3845294 Mon, 09 Aug 2010 11:27:06 +0100 3845294 http://www.medworm.com/index.php?rid=3816778&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F08%2Fshould-patients-be-allowed-to-read-their-medical-records.html First of all, let me dismiss the idea that there is much room for debate about whether patients should be allowed to review their own medical records. HIPAA gave them the right to read, and even amend, these records years ago. Whether this is a good idea is being addressed in an ongoing study (see: Should Patients Read the Doctor’s Notes?). Regardless of whether it's a good idea, I don't think that the law will be reversed on the basis of one or more current studies. Below is an excerpt from a recent article discussing this topic:In 1996, despite ...concerns [about patient access to their own medical records], the Health Insurance Portability and Accountability Act, or HIPAA, gave all patients the legal right to read and even amend [these documents]. At the time, a group of nat... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3816778 Tue, 03 Aug 2010 12:41:02 +0100 3816778 http://www.medworm.com/index.php?rid=3802593&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fth-introducing-the-the-epic-laboratory-information-system-lis-beaker.html In response to yesterday's note, Infopathic provided us with a key piece of intelligence via a comment -- the status of Epic's LIS:The Epic solution for EMR has has indeed been judged to be superior. And for those searching for a superior LIS, one with a seamless integration to this EMR would be epic! or, at least...superior. A recent peek into the EPIC LIS entry - Beaker, reveals that the search is far from over. This LIS newcomer is certainly not ready for prime time. Whereas several basic workfolows are in place and appear to be well designed, in my humble opinion, the Beaker is half-empty as a product for large, complex health systems. The search goes on...How quaint! The name "beaker" sounds to me like it was the product of a coffee klatch attended by creative, marke... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3802593 Thu, 29 Jul 2010 11:40:16 +0100 3802593 http://www.medworm.com/index.php?rid=3798839&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fwhy-does-epic-keep-hammering-cerner.html Mr. HIStalk addresses the ongoing Cerner-Epic competition in a comprehensive and insightful manner. Here's the complete text of a question and his response from a recent blog note:Question from reader: “Re: Epic. They’re winning deals like Cerner did 15 years ago when they were small. Cerner seems to be a revenue-churning machine that the public can participate in by buying stock. The only people who benefit from Epic are the owners and/or Judy. Which company has made more millionaires? Which company will change the face of HIT for the long run?” Answer from Mr. HIStalk: Here’s the real question: why can’t Cerner, with all its billions in market capitalization and name recognition, compete with Epic for new sales? As has been asked of other Goliaths (Microsoft, GM, Dell, GE, ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3798839 Wed, 28 Jul 2010 13:03:11 +0100 3798839 http://www.medworm.com/index.php?rid=3795064&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Ftugoogle-microsoft-compete-for-the-cloud-mail-business.html There is no question is my mind that nearly all corporate and individual email accounts will soon be managed in the cloud, a model that is referred to as cloud mail. This will be a major change for many  corporate email users whose support now comes mainly from Exchange servers managed locally by their employers. Google is competing with Microsoft for this cloud mail business and the latest account up for grabs is that of the federal government's GSA (see: Microsoft, Google Vie to Sell U.S. Cloud Mail). Below is an excerpt from the article:A new front has opened in the battle between Google and Microsoft: selling Web-based email and other software to the federal government. The two technology giants already compete to win contracts from private businesses as well as state and loc... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3795064 Tue, 27 Jul 2010 12:45:22 +0100 3795064 http://www.medworm.com/index.php?rid=3784507&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fnyt-breast-cancer.html A recent article in the New York Times about errors being made by pathologists in the diagnosis of ductal carcinoma in-situ (DCIS) of the breast has been very controversial (see: Prone to Error: Earliest Steps to Find Cancer). Here's a passage from the article with a short summary of DCIS:D.C.I.S., which is also called Stage 0 or noninvasive cancer, was a rare diagnosis before mammograms began to be widely used in the 1980s. Until then, breast pathology typically involved reading tissue from palpable lumps....Today, D.C.I.S. is diagnosed in more than 50,000 women a year in this country alone....Concerned about the accuracy of breast pathology, the College of American Pathologists said it would start a voluntary certification program for pathologists who read breast tissue. Among its re... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3784507 Fri, 23 Jul 2010 12:31:27 +0100 3784507 http://www.medworm.com/index.php?rid=3776623&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fbyomd-bring-your-own-md-to-the-hospital.html As a physician, I have often been drawn into situations by family and friends in which I have served as an informal medical consultant about care and treatment issues. This has usually involved only telephone calls but, for immediate members of the family, hospital visits were commonly involved. On some occasions, I engaged in discussions with the treating physicians. On a small number of occasions, some of these conversations grew heated regarding the type and quality of care being given. One incident in particular stands out in my mind when a family member was clearly expressing a choice which was ignored by the treating physician who was interested. and insistent, on performing a procedure. He backed off reluctantly when I told him that my family member did not want the procedure and ha... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3776623 Wed, 21 Jul 2010 11:44:42 +0100 3776623 http://www.medworm.com/index.php?rid=3767331&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fiphone-and-the-walled-garden.html App phones (see: Does the Smartphone/App Phone Provide More Functionality Than the PC?), also commonly referred to as smart phones, have rapidly become a critical tool for professionals of various types but particularly for physicians. Think of the devices as mobile computers. Then combine this concept with the increasing accessibility of on-line medical records as well as the complete medical literature and medical textbooks. Newer cell phones can support video conferencing, enabling on-line visits with patients from anywhere in the world. The cell phone was quickly adopted by most physicians and the next-gen app phone will enjoy even greater success.Most people will concede that the iPhone was the first and best app phone. However, Apple has established a significant barrier to new app a... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3767331 Mon, 19 Jul 2010 12:03:46 +0100 3767331 http://www.medworm.com/index.php?rid=3761642&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Ffreporting-of-impaired-colleagues-by-physicians.html A recent JAMA article reported on the extent to which physicians were willing to report their colleagues to the appropriate authorities when affected by mental illness, substance abuse, or just plain old incompetence (see: Survey: 36% of Docs Don’t Believe in Reporting Impaired Colleagues). Below is an excerpt from the article:Physicians have an ethical obligation to notify authorities in those cases, but 36% of respondents in a newly published study said they didn’t agree they should always do so. The study, by researchers from the Mongan Institute for Health Policy at Massachusetts General Hospital, reflects the responses of 1,891 doctors in various specialties....Most of the respondents — 69% — said they felt prepared to deal with colleagues who were significantly impaired, and ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3761642 Fri, 16 Jul 2010 12:46:14 +0100 3761642 http://www.medworm.com/index.php?rid=3754096&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fenterprise-versus-bestofbreed-cio-money-as-the-distinguishing-factor.html My blog note of yesterday focused on how a large health system had converted to a single EMR vendor, primarily to achieve system-wide integration (see: Integration as the Major Driver for the Epic Conversion at Carilion Clinic). I subsequently discovered a column by Anthony Guerra in Information Week Healthcare describing what he views as a division of hospital CIOs into two different camps -- the single-vendor enterprise camp and the best-of-breed camp (see: Guerra On Healthcare: A Tale Of Two CIOs), He goes on to suggest that the former have more access to cash and therefore able to pony-up the estimated, stiff $100M price for an enterprise-wide EMR solution. Below is an excerpt from his article:In what's become an epic battle for the heart and soul of sound CIO strategy, I continual... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3754096 Wed, 14 Jul 2010 12:28:48 +0100 3754096 http://www.medworm.com/index.php?rid=3750310&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fintegration-issues-in-the-conversion-to-epic-at-carilion.html In a blog note posted yesterday, I quoted an interview of Daniel Barchi, SVP/CIO of Carilion Clinic, by Mr. HIStalk regarding the health system's conversion to Epic (see: What's Up With Soarian; CIO Barchi of Carilion Clinic Responds). There was another portion of the interview that caught my attention in which Barchi discusses the goal of system integration as the major driver for the deployment of the new software. Below is an excerpt from the interview:Q: You just finished your massive Epic project, with eight hospitals and 100 practices brought live over a couple of years. Tell me about that project.A: When we decided that we wanted to integrate from 11 different medical records — 10 electronic and one paper — down to one integrated system, it was 2006. At the time, we wer... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3750310 Tue, 13 Jul 2010 12:20:00 +0100 3750310 http://www.medworm.com/index.php?rid=3747000&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fwhats-up-with-sorian.html A recent interview of Daniel Barchi, SVP/CIO of Carilion Clinic, Roanoke, Virginia, was filled with interesting tidbits (see: HIStalk Interviews Daniel Barchi). One that caught my attention related to the conversion of the entire health system from Siemens' Soarian to Epic. Relevant to any discussion these days about the future of the Soarian product is the fact that John Glaser, formerly CIO of the Partners Health System in Boston, was recently appointed the CEO of the Siemens' healthcare IT unit (see: John Glaser joins Siemens as CEO of health IT unit). Below is an excerpt from the HIStalk interview in a Q and A format: Q: Carilion was a high-profile Siemens client and an early Soarian adopter. What led to the change from Soarian?A: Soarian had a great reputation and was doing ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3747000 Mon, 12 Jul 2010 11:27:16 +0100 3747000 http://www.medworm.com/index.php?rid=3733305&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fwdatadriven-conideration-of-joint-replacement-options.html Various types of medical registries (e.g., cancer, drug, prosthesis) are becoming critical elements for assessing the quality of healthcare. This applies to physicians and patients alike (see: Saving Lives with Web-Based Patient Registries for Patients with Chronic Diseases). Part of the conversation with one's orthopedic surgeon should involve the type of prosthetic device that he or she recommends. Of great interest is that an artificial joint registry will soon be available on the web that gathers data directly from U.S. hospitals about these devices. Similar data is already available from other countries. Presumably, healthcare consumers will have access to this new U.S. registry after it is created. You can refer to a recent article for many more details about how to "get it ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3733305 Wed, 07 Jul 2010 11:46:25 +0100 3733305 http://www.medworm.com/index.php?rid=3730115&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fmeditechs-competitors.html It can be a challenge to analyze the sales and customer base of the various EMR/HIS software vendors because these data are considered proprietary. However, a recent interview of Howard Messing, President and CEO of Meditech by Mr. HIStalk, was very interesting (see: HIStalk Interviews Howard Messing). Below is an excerpt from that blog note:Q: [What is your] total count  [of hospital clients] ....It used to be around 2,100.A: 2,100 or 2,200....Q: What competitors do you face across the table most often?A: I think McKesson is certainly in the medium-sized hospitals as the competitor, and I think we face them most often. In the small hospitals, probably CPSI. In the large hospitals, it’s mostly Cerner. Occasionally in the largest hospitals, Epic....Q: Have the demographics of your c... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3730115 Tue, 06 Jul 2010 13:08:34 +0100 3730115 http://www.medworm.com/index.php?rid=3721978&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fpathologists-as-clinicians-what-exactly-does-this-mean.html Discussion: Insourcing of Pathology Specimens by Specialty Groups; Consideration of the Underlying Forces that Promote Pathology Insourcing; The Importance of Integration of Insourced Pathology Services). Subsequent to posting these notes, I have learned from one colleague, an astute observer of our field, that these pathologists are actually becoming clinician-like. For example, those working in a GU practice and specializing in the interpretation of GU biopsies work so closely with their urologist colleagues that they are starting to identify more closely with this specialty than with pathology. Put another way, they are more becoming more closely integrated with a clinical specialty than with pathology. It is quite possible that these "insourcing" pathologists working in speci... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3721978 Fri, 02 Jul 2010 12:50:57 +0100 3721978 http://www.medworm.com/index.php?rid=3718713&cid=t_99762_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F07%2Fincreased-demand-for-outpatient-surgery-as-driver-for-outbound-medical-tourism.html I recently came across a report by Deloitte focusing on medical tourism (see: Medical Tourism: Updates and Implications). This is a topic that has been of great interest to me in the past. One section of it lists the most important growth drivers for outbound medical tourism, defined in the report as U.S. citizens traveling to other countries for medical care. It describes the increased demand for outpatient surgery as one such driver. Below are more details copied from the report:The number of outpatient surgical procedures performed in the United States has tripled from 1996 to 2006. In 2006 alone, almost 35 million patients had outpatient surgery. This growth has been due, in part, to enhanced technology that allows many patients to go home just several hours after a procedure, rather t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3718713 Thu, 01 Jul 2010 13:24:22 +0100 3718713