Wednesday, December 26, 2012

Windows 8 Could be a Winner in Healthcare

At the recent Dell World conference I had the opportunity to try out a slew of new Windows 8 devices. I was struck by how many potential healthcare applications this new platform and the mobile devices it has spawned will be available. Windows 8 could have some significant ramifications for use in healthcare. As Denise Amrich, RN and a healthcare advisor for the U.S. Strategic Perspective Institute in her ZDNet post "Why Windows 8 may be the ideal tablet OS for healthcare" said, "Windows 8, like Windows 7 before it, integrates beautifully with Windows server technologies. Windows 8 adds additional security features and works smoothly with Exchange, SharePoint, Windows 2008 and Windows 2012 Server. Of particular interest to healthcare professionals, Windows 8 also supports Microsoft Lync secured messaging, so IM messages that go between medical professionals can be both instant and rock-solid secure." The ability to seamlessly integrate Windows 8 tablets into the enterprise, and to run legacy Windows based EHRs will allow clinicians to finally have the mobile form factors they have been looking for.

Bill Crounse, MD the Senior Director of Worldwide Health for Microsoft, in a blog post laid out what he sees as the top 3 attributes of Windows 8 that make it a compelling choice for clinicians:
  1. It keeps health information secure
  2. It works the way you do
  3. It facilitates communication, collaboration and productivity without compromise
I agree with Bill's assessment and in particular think that the new tablet devices will be very attractive for use in healthcare. At Dell World I tested quite a few of the new form factors available on the Windows 8 platform including the XPS 10 tablet, the XPS 12 convertible Ultrabook, and my favorite the Latitude 10 Tablet (thanks to Dr. Joseph Kim for letting me have his place in line to purchase one at a steep discount :). I think the form factor and usability of the Latitude 10 approaches that of the iPad, and for all the reasons listed above make it a much more suitable device for the healthcare industry. Using the Dekstop app gives me a full featured Windows desktop that can run all my applications, and other medical apps running native to Windows 8 and RT are sure to be developed. NextGen Healthcare has already released an app called Medicine Cabinet which allows consumers to create, store, track and share personal medication records. I expect the next year to see a great influx of new apps appearing on the scene.

Microsoft has also demonstrated (see below) a prototype of an application for Windows 8 it is calling "Rounds," which is designed to streamline healthcare professionals workflow in hospitals as they communicate within their care teams. Clinicians can click on a grid of patients, view data from EHRs, and hold a video conference with a specialist. Although it is just a prototype at this point, it nicely showcases the touch screen capabilities of Windows 8 tablets. This app is one example of how Windows 8 can combine the functionality of a full PC within the interface of a tablet.

Install Silverlight

Another very interesting feature of Windows 8 is Windows To Go. Windows to Go allows Windows 8 Enterprise to boot and run from mass storage devices such as USB flash drives and external hard disk drives. Basically it enables administrators to configure an image of Windows 8 onto a USB stick. Using a personal tablet or other mobile device to access a hospital network through Windows to Go is a good way to deal with some of the security concerns of BYOD and mobile device management.

Microsoft seems to have bet the farm on Windows 8, and so far the bet appears to be a good one. With greater emphasis on security and mobility the new platform looks to be a winner, and unlike Vista will likely be adopted fairly quickly. Previously devices and applications have been slow to meet the productivity and security requirements of the healthcare industry. As these new devices continue to improve in usability and more apps are developed on the Windows 8 platform, I expect to see some pretty broad deployment of both the platform at the enterprise level as well as many of the new mobile devices in the healthcare industry.

Monday, December 17, 2012

President Bill Clinton at Dell World

I was fortunate to be invited to Dell World last week and I'll be writing more about some of the new products and services unveiled, especially as they relate to healthcare. I was quite happy to see that many of the sessions were livestreamed and made available around the world. The keynote address by Dell Founder Michael Dell and President Bill Clinton is well worth watching. It is very interesting to see the interaction between these two men who come from some different, although not diametrically opposed, political viewpoints. First Mr. Dell gave a rather quick overview of the company's repositioned business in the new economy, then the former President gave a lengthy speech discussing the importance of collaboration and how society needs to think more ab.out the future. One thing that was front and center as an enabler of innovation and collaboration: the Internet. I encourage you to watch the video of the keynote address and check out some of the other sessions at the DellWorldOnline website...

Check out President Clinton's cowboy boots ;-)

Sunday, December 16, 2012

2012 ONC Annual Meeting

The ONC held their 3rd Annual Meeting on 12/12/12. Some of my favorite videos from the webcast are below. If, like me, you were unable to make this years meeting, then you will find them very interesting.

The Year of Meaningful Use: Leaders of the ONC State MU Acceleration Challenge


Mat Kendall, Director, Office of Provider Adoption Support, ONC


Farzad Mostashari, MD, ScM, National Coordinator, ONC


Stakeholder Roundtable


Todd Park, U.S. Chief Technology Officer, White House

Panel Members:

David Lansky, CEO, Pacific Business Group on Health

Craig Sammit, MD, CEO, Dean Health Systems

Bill Walsh, Senior Advisor, Health Portfolio, AARP

Scott Whyte, Vice President of IT Connectivity, Dignity Health


Patient Engagement and Health IT


Jodi Daniel, JD, Director, Office of Policy and Planning, ONC

Panel Members:

Lygeia Riccardi, Acting Director, Office of Consumer e-Health, ONC

Dan Kraft, MD, Executive Director, Future Med

Thursday, December 6, 2012

10 Billion Dollars in Electronic Health Record Incentives

EHR incentive payments have reached over $9 billion to 177,100 physicians and hospitals through November and are estimated to reach $10 billion by the end of the year. Robert Anthony, from the CMS Office of eHealth Standards and Services, gave an update at the December 5, 2012 meeting of the Health IT Policy Committee (see below). “We saw a large number of hospitals come in November: 525 hospitals were paid by either Medicare or Medicaid,” he said. This was in addition to the 12,250 new EP's paid during that month. "The incentive payments were almost $1 billion more in November. We are on track for the end of December to hit the $10 billion mark for EHR incentives," he added.

Mr. Anthony reported that the most popular meaningful use menu objectives for physicians are those related to drug formulary, immunization registries; and generating patient lists. For hospitals they were advance directives, drug formulary, and clinical laboratory test results. For e-copy of health information a large majority of physicians and hospitals took exclusions due to patients not requesting a copy of there health information. However performance on this measure was very high where it applied. Hopefully in this next year consumers will begin to demand greater access to their health information.

He also reported data from the Regional Extension Centers which showed some the unresolved practice issues, provider engagement and administrative being the biggest challenges. This data also showed unresolved vendor issue challenges, with delays in implementation and problems with upgrade being substantial problems. This data is also broken out by practice type and it is interesting to see the results stratified by hospital or practice setting and especially the differences in rural and underserved areas.

A recent HHS Office of Inspector General (OIG) report found that the Medicare portion of the meaningful use program is vulnerable to fraud and abuse. After an article in the New York Times highlighting the report, some have been saying that this is a nail in the coffin for the program, and that the report points to the failure of the efforts and the funding so far has been wasted. There is even talk that the EHR Incentive Program should be sacrificed on the fiscal cliff altar. I think it would be wise examine the details of the report, and also look to the future as we continue down this path.

The OIG report states that CMS didn’t verify the information doctors and hospitals self-reported about how their EHR systems function and recommended that CMS "obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information.” But CMS told the OIG that "prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments."

Linda Fishman, from the American Hospital Association, said, "The OIG report contains no evidence of improper payments," Fishman said. "Hospitals take seriously their obligations to provide accurate reports to Medicare, and are working diligently to comply with the highly complex regulatory requirements in the meaningful use program. In addition, CMS is currently conducting audits of hospitals that have received meaningful use payments." Echoing these sentiments American Medical Association Board Chair Steven J. Stack, MD said, "We oppose prepay audits in the meaningful use program, as they would impose additional burdens on physicians who already face separate program requirements for multiple Medicare health IT and quality programs."

While there have certainly been some challenges, I think we need to give the program time to work. As Congress looks for ways to avoid the "fiscal cliff" and find places to reduce federal expenditures, they should think very carefully before breaking the promise to providers and hospitals who have made some serious investments on this meaningful use journey. As Farzad Mostashari recently said, "We have crossed to a new shore and the boats are burned behind us. There is no going back..."