Lack Of Data Standard, Not Meaningful Use To Blame For Crap EHR Systems

Meaninful Use and EHRs

Let’s not blame the carrot (Meaningful use) for the stick (Electronic Health Record systems) being too short!

If we want to make Electronic Health Record systems (and Practice Management systems) better, cheaper and actually innovate, then we need a standard schema for how core data is stored so that it can be easily exported to a different EHR at the drop of a hat.

Despite the availability of $35 billion of federal funding to incentivize the adoption of this new health information technology, results have been disappointing.  For one thing, physicians, nurses, and other health professionals who rely on such systems on a daily basis reported steadily decreasing levels of satisfaction with them.  The move to electronic records has not only failed to enhance patient care but in many cases actually interfered with it.

Meaningful use isn’t the reason that EHR systems are so fundamentally crappy and exorbitantly expensive, it’s that once you sign a contract vendors know you’re going to be with them for 5 – 10 years because an automatic lock-in is created by the prohibitive costs related to implementation, staff training and patient data transfer.

Sure, there are standards for interoperability, but as far as I can tell there are no standards defining how these companies actually store the patient data within their systems. Or, if we feel this is too much of an imposition, standards defining a schema for importing and exporting of information from the system (what they do with it in their system is their own business).

There are criteria for a data export for a certified EHR but of course they fall short of providing a real solution:

We also note that this functionality is not intended to and may not be sufficient to accomplish a full migration from one product to another without additional intervention because of the scope of this criterion. Specifically, the data and document templates specified in this criterion would not likely support a full migration, which could include administrative data such as billing information. The criterion’s functionality could, however, support the migration of clinical data between health IT systems and can play a role in expediting such an activity if so determined by the user.

This leads to very expensive and time-consuming conversion processes, which usually results in only a partial import of the data your practice needs being imported.

I recently handled a migration from a well established server-based product to one of the largest cloud based providers. Much to my frustration even a basic list of referring providers couldn’t be exported from one and imported to the other without connecting directly to the SQL database, exporting the data, then reformatting to match the new vendors schema, manually creating some data columns that couldn’t be reliably split programmatically and uploading to the new vendor.

The patient demographics were a considerably larger nightmare.

We could have paid the vendor to do it but that would have taken longer than doing it myself and would have cost considerably more.

A defined standard for core data portability would make it incredibly easy to demo solutions from vendors as you could import data into a test environment, evaluate the system with real patient data instead of the often useless test data many vendors load into their demos, and enable practices to make better informed decisions about which solution to invest in.

Needless to say data portability would increase competition between vendors essentially forcing them to focus on what practices actually need, delivering better user interfaces, improved user experiences and lower costs – all of which adds up to products that are easier to use, cost less and create more time for physicians and their staff to actually focus on patients.

The Asterisk – The Enemy Of Honesty

Asterisk - The Enemy of HonestySpare a thought for the humble asterisk (*). It has so many uses, yet none as reviled as its use in marketing. Every time you see one you know that there are special terms and conditions that apply, and that things just aren’t what the seem

Unlimited* is never the same as truly unlimited. Free* is never truly free. If the asterisk is making an appearance on your marketing material then customers will never trust what they read.

Even though it’s universally accepted in marketing, the asterisk is a small little star that casts a huge shadow on our integrity. We use the asterisk to cover our blatant lies and it makes us all feel a little dirty.

Let’s remove the asterisk from marketing and allow our clients and customers to start trusting their eyes and out word.

Let’s make reaching for your spectacles and the magnifying glass to wade through the fine print a thing of the past.

Let’s return the asterisk to the domains of mathematics, linguistics, computer programming and cricket – places where it’s uses are myriad, useful and not deceptive.

And while we’re at it, let’s kill the 30 seconds of high-speed gibberish that explains how the advert was lying at the end of every other radio advert….

Podcasting and Social Proof – A Missed Opportunity

Podcasting and Soaccial Proof - Paul OFlaherty

There’s a missed opportunity for podcast hosting companies such as Libsyn, Blubrry and now SoundCloud, to bring social proof to podcasting simply by opening up an API that allows plugins to poll download numbers and display them next to podcast players.

Blubrry already has the excellent PowerPress plugin, which I am sure the vast majority of WordPress based podcasters use regardless of where they host their media, so it should be really easy for them to add it. Libsyn and other providers could get involved simply by releasing a plugin that checks the filename in the enclosure custom field, polls an API every few hours (or once a day even) and allows podcasters to display a chiclet or some text- just like folks do for newsletter subscriber numbers, Facebook subscribers, Twitter followers and YouTube views. SoundCloud could start by making RSS downloads (a podcasters lifeblood) part of the reported public stats instead of hiding the numbers away privately and only showing the “on SoundCloud” plays.

Why would we want this? Because social proof works when building an audience. It’s easier to pick up more followers or downloads the more you already have – then it’s up to you to keep them.

iTunes and it’s frankly poor podcast search, should not be the only social proof that podcasters have.

Fake It ‘Til You Make It – The Thin Veneer Of Social Media?

The Higton Bros may have hit an uncomfortable nail squarely on the head with this video about the reality behind the status updates of our friends and those we follow online.

Facebook can be depressing because everyone else’s lives are better than yours… But are they really?

The video hasn’t lost any of its relevance in the 6 months it has taken to come to my attention (hat-tip to Fast Company) and should serve as a stark reminder that many people who suffer from social anxiety (which I guess we all do in some form or another,  except the most confident of us) are not only dealing with FOMO (fear of missing out syndrome) but with social pressure to be as interesting as everyone else.

It’s a reminder to all of us to take everything we see online from the happiest status update, to the most blistering outrage, with a healthy pinch of salt. It should also bring to the surface the necessity of reaching out to people “in the real world” and finding out what is actually going on before relying on oft ambiguous social updates.

Finally, it’s a stark reminder that if you really want to have awesome stuff to post online – you need to get off your ass and do stuff!

The Beatles Had It Right – Can’t Buy Me Love

Valentines Diamond

So, Valentine’s Day, eh?

My beautiful wife is rather fond of pointing out that “all men pay for it in the end”, and yes Sara’s talking about sex.

She’s not implying that all women are prostitutes, but instead referring to how relationships function and the simple fact that if you want to get something, 99% of the time you have to do something first.

Another way to put it is – lazy, inattentive, unappreciative husbands typically only get two things – nagged at and then divorced. And rightly so. May I add that it also works the other way around.

I have no problem admitting that I dislike Valentines Day. Not because I don’t want to show my appreciation for my wife. Trust me when I say that she will be treated like royalty tomorrow – pampered, have her favorite meal cooked for her, be lavishly spoiled with gifts and I’ll be spending as much time with her as possible.

No, I dislike Valentines Day not only because it is so commercialized but because so many people appear to need Valentines as an excuse to go the extra mile and show their partners how they feel, and so many others are only putting in the effort because, well… It’s Valentine’s Day.

I do not have an ulterior motive when it comes to February 14th. This isn’t a “I’ll treat her like a princess today, and she’ll let me into her castle tonight” kind of thing. Yes, it’s an excuse to buy an extra present or two and maybe go out for a special meal, or to cook her favorite food, but if we are honest with ourselves, we should be doing it all the time.

If you find yourself in a relationship where you are essentially bribing or being bribed in order to get a little “jiggy jiggy” on Valentine’s Day, maybe you need to reevaluate…

I think the reason Sara and I are so happy together is that we don’t wait for Valentine’s Day to roll around in order to make each other feel special. There’s always random “just because” gifts that don’t even have to be expensive, it can often be as little as randomly picking up someone’s favorite ice cream when at the store, or cooking their favorite dinner. They’re just little things that say “I’m thinking of you”.

Don’t get me wrong, we’re not perfect. We have our bad days. We argue, we’re grumpy, we piss each other off, but…

We’ve each been around the block before. We’ve learned from our past relationship mistakes and each know how important it is not just to feel loved in a relationship but to make your partner feel loved too.

We always tell each other how we feel, how much we love each other, and we try to talk through an empathize with issues that we may each be having. We make a point of kissing when we see each other, holding hands when we’re out together, message each other and finding time everyday just to be together and talking about our days.

Sara is not just my wife, the mother to my children and the person whom I share a house with. She is my best friend, my confidant, my partner, my lover and everything I could ever want, and more.

If you feel about your spouse, partner or significant other, the way I feel about Sara, I can’t imagine how you could wait or allow yourself to be limited to one over-commercialized day a year to show them just how much you love them.

Dear Podcasters, You’re Ruining My Run (Podcast Loudness)

Audio stereo WAV in Audition CCI’ve been making a concerted effort to get back into shape and while I’d love to say that my beer-gut is diminishing, sadly the most noticeable result has been a growing irritability caused by podcasts that are all published at different audio levels.

Let’s talk about LUFS:

Loudness, K-weighted, relative to Full Scale (or LKFS) is a loudness standard designed to enable normalization of audio levels for delivery of broadcast TV and other video.

LKFS is an abbreviation of:  Loudness K-weighted Full Scale, and one unit of LKFS is equal to one dB. The LKFS term is used in the ITU BS.1770 standard and the ATSC A/85 standard also operates with this term. Other organizations, such as The European Broadcast Union (EBU), uses the term LUFS, which is an abbreviation ofLoudness Units Full Scale. Despite the different names, LFKS and LUFS are  identical.

The LKFS standard (ITU standard) is what allows you to listen to the radio at a consistent level without having to turn the radio up or down every time a new tune is played (unless they’re cranking out some AC/DC then you have to turn up the stereo – it’s the law). That’s awesome right?

What’s not awesome is when I’m on the treadmill and every other podcast is barely audible over my headphones, while others are way too loud, forcing me to have to repeatedly fiddle with the audio levels on my phone.

Let’s face it – I’m not the most graceful of people at times. One of these days, pulling my phone out of my pocket while running is going to result in my breaking a leg as I go flying backwards off the treadmill and into the min-fridge.

The solution is to make sure that every podcast has consistent audio levels, and the magic number that has been settled on is -16 LUFS. I’ve embedded a tutorial by Mike Russel from Music Radio Creative so you can see just how ridiculously easy it is to do Adobe Audition CC.

I don’t know if Audacity can adjust LUFS out of the box (it’s been years since I’ve used it) but I’m sure there are plugins for it (a quick search found this LUFS meter), and even mobile podcasting apps like Auphonic can automatically adjust the levels as they process the audio.

So fellow podcasters, there’s really no excuse to now have your audio at the correct levels and give podcast listeners the best experience, is there?

LinkedIn’s Group Spam Problem Is Almost Unbearable

LinkedIn Spam

Not the first to complain about the spam problem that plagues LinkedIn groups, but I shall definitely jump on the bandwagon because it feels like it’s escalating lately.

I’ve been rather careful about the groups I’ve joined (a mere 20) and changed all my settings to receive only digest emails only for the groups I’m most interested in, weekly for others and turned them off altogether for others, yet it feels like the spam levels have increased. I may have to excuse myself from most of my groups just for the sake of email sanity.

I know that the vast membership of LinkedIn tend to be typically unengaged unless actively seeking new opportunities, but the successful groups are more engaged and with their high numbers are a tempting target for the less scrupulous of our profession.

Marketers. I guess they’re why we can’t have nice things.

The Truth About New Year’s Resolutions… They Suck!

The Truth About New Years Resolutions

Most of us make New Year’s resolutions and most of us fail to keep them. It’s not because we didn’t have the intention to keep or achieve them, it’s simply because they were unrealistic to begin with.

Last year I had resolved to write a book in 2014. It didn’t happen because I over-estimated the amount of time I’d have available between family and work commitments. Actually I did worse than over-estimate, I knew I wouldn’t have time between work and family commitments, but deluded myself that I could write it anyway.

Don’t spend half next year feeling guilty for not achieving the resolutions you make while feeling nostalgic over the next few weeks.

Write an honest set of resolutions down and then aggressively trim them using honesty and reason. Rinse and repeat tomorrow, and the day after that…

It’s better to feel happy about achieving some well-thought-out resolutions than it is to feel guilty about not achieving ill-conceived ones.