Author Archive
Tribute to the Thunder Show
Those of you who know me personally know that I’m a big fan of Gary Vaynerchuk and his video blog at Wine Library TV. Sure, I like wine and learning more about it, but I’m amazed by Gary’s ability to leverage the web & social media to revolutionize a tradition industry like the one surrounding wine.
As you’ll see, Gary provided the inspiration for interviewing guests here on the Nimbus Health blog. Thanks for that Gary; we’re changing more than just the wine world.
Big thanks to Rand Fishkin, CEO of SEOmoz for being a great sport and reviewing Two Vines Columbia Crest 2006 Merlot/Cab blend with me.
Interview: Rand Fishkin, CEO of SEOmoz
I had the terrific privilege of interviewing Rand Fishkin, an undisputed titan in the Search Engine Optimization (SEO) field. I highly recommend taking a look at this video if you’d like to learn more about getting your site to the top of search engine results. Here’s what we covered:
* What is SEO?
* What’s the difference between SEO & SEM?
* Why should healthcare CIOs care about SEO?
* Why should healthcare consultants care about SEO?
* Examples of good SEO’rs in healthcare
* Ways to increase your site’s SEO
* Free SEO tools you should look into
* What is SEOmoz?
SEOmoz – High quality tools & advice for Search Engine Optimization. I highly recommend checking their site out, especially Rand’s Whiteboard Friday sessions on the SEOmoz blog. Btw, SEOmoz will donate $1 to Ocean Conservancy for each visitor they get from the SEOmoz link by 5/9/09.
Seattle Children’s Hospital – Terrific example of a healthcare organization leveraging SEO.
Senator Proposes Grants for Open Source EMRs
Remember when I mentioned the issue of open source EMRs having trouble scraping up enough money to get certified, as would be required by the HITECH portion of the ARRA for users to get their stimulus money? Senator John D. Rockefeller has unknowingly proposed an interesting solution: federal grants to subsidize open source development.
I’m not sure Rockefeller understands how open source projects are typically funded (blood, sweat, & tears…but usually little in the way of $), and I see no mention of utilizing this money to achieve CCHIT certification, but he could have stumbled upon an interesting solution to a problem he may not know exists.
CCHIT has to charge something for the certification process because it’s supposedly extremely time consuming. And while open source EMR developers may be rich in passion and skillz, the vast majority of them aren’t going to be able to put up the money for certification…so why not make federal grants available to subsidize these non-profit organizations developing software that everyone can benefit from?
I’ll throw out a hybrid solution: CCHIT lowers their certification costs for open source projects by 50%, potential users/developers of the system scrape together some money to cover half the remaining cost, and grants be made available to cover the rest. At that rate, we’d be looking at as little as $10k from users/devs and $10k in grants to get an open source EMR certified every 3 years. Could be a solution that keeps the open source community thriving, requires at least $10k of “buy-in” from prospective users, ensures CCHIT can cover most of its own costs, and provides a excellent alternatives for healthcare providers who find open source systems to be a better value than traditional closed source ones.
Justin
We’ll be demoing at the Seattle 2.0 Awards
If you’re in the Seattle area (+/- 100 miles), grab a ticket to the Seattle 2.0 Awards and get a sneak peak at what we’re working on for our next release. We were lucky enough to get selected to demonstrate our product on May 7th and we’re pushing hard to incorporate one of our most exciting new pieces of functionality before the big day.
In addition to us, you’ll also get to see 12 other up-and-coming companies demonstrate their technology, not to mention you’ll rub elbows with the big players in the Seattle start up scene.
Hope to see you there – should be a great time!
Justin
Lower Costs, Try Online Printing Services
One of the best ways we’ve found for reducing overhead, next to crowdsourcing, has been to leverage online printing companies instead of the standard Kinko’s or local print-shop plays. Two of our favorites are:
uPrinting.com – Great for business cards, flyers, rack cards, etc – anything that you print on paper. You can upload your graphic files to their website and order in less than 10 minutes. The quality is terrific (better than Kinkos & another local shop we tried) and I haven’t seen better prices anywhere else.
BuildASign.com – Cheesy name, but these guys knock the ball out of the park. Again, great software, very high quality output, and almost astounding prices on banners, signs, etc. We just got a sign printed up by them to be delivered next week. We called a couple local shops and they quoted us 5-times the BuildASign price. When we told them that was way too high, they dropped their price to 3x the BAS price. Clearly the BAS guys are leveraging the economy of scale advantage they have to keep their prices extremely competitive.
Next time you need something printed, and you’ve got a week of lead time, I highly recommend trying an online printing service.
Justin
HIMSS Publishes “Meaningful Use” Recommendations
HIMSS has published their recommendations on the definition of meaningful use for both hospitals and physicians. I recommend everyone interested in healthcare IT take a look at them.
A couple interesting pieces caught my eye:
- Acknowledgment of open source systems. Today, the cost of receiving CCHIT certification (approx. $35k) prohibits the vast majority of open source EMRs from getting an official stamp of approval. Of course ARRA requires that stimulus money only be provided to users of “certified” technology (which will likely be provided by CCHIT), potentially leaving open source developers and users out in the cold. That the FOSS community and the CCHIT board were able to meet at the HIMSS ’09 conference and discuss ways around this problem clearly manifests itself in these documents. HIMSS clearly recommends that HHS tackle the CCHIT & open source problem, which is the first step towards a win for everyone.
- Progression of interoperability over time. Overall HIMSS appears to place an importance on interop, but only after the first “phase” of widespread EMR adoption. With that timeline, we won’t be looking at mandated interoperable systems until 2013 or so. That’s not the end of the world and it’s certainly better than nothing, but I would have liked to see interop make a more substantive showing in “phase 1.”
Just my thoughts, what are yours?
Justin
CDC Using Twitter to Provide Swine Flu Updates
In a terrific example of a healthcare organization leveraging the power of social media to disseminate valuable and timely information, the CDC is now tweeting updates on the Swine Flu.
You can follow them here: http://twitter.com/CDCEmergency
Justin
Interview: Mark Horoszowski of White Space Healthcare Marketing
Our second interview with members of the healthcare community who think like startup – Mark Horoszowski from White Space Healthcare Marketing. Mark has a lot of expertise in the world of “social media” which he generously shares with us:
More information:
White Space Healthcare Marketing
Mark will donate $1 to the Tacoma Relay for Life for each visitor who clicks the link above over the next two days.
Btw, feedback on our interview format would be very much appreciated. Shorter, longer, more shots of the product/website in use, higher quality video, etc.? How can we make these more interesting and informative.
Justin
Interview with Betsy Nicoletti, Founder of Codapedia.com
To help us march toward our goal of helping healthcare think like a startup, we’re starting a series of interviews with members of the healthcare community who embody a startup mentality. We’re hoping by diving deep into examples of the healthcare industry thinking like a startup, we can help foster a culture of agility & continuous improvement.
With that in mind, I’m thrilled to kick off our interview series with Betsy Nicoletti, Founder of Codapedia.com. Codapedia.com is a community-driven web site built for, and by, physician medical coders. It’s a terrific idea and fills a real void in medical coding information online.
More information:
Codapedia.com*
Medical Practice Consulting*
* In case you miss it in the video, Betsy will donate $1 to her local hospital to help subsidize uninsured patient care for each visitor that clicks on one of the links above by Friday, 4/24/09.
What have we been up to lately? Coding & Talking.
It’s been a while since I’ve gotten a chance to post, but for a couple good reasons. First off, we just finished up a new release of Breeze Medical System; more on that in a bit. We’ve also been busy working on a new feature for our blog – interviews with members of the healthcare and startup communities who will help us achieve our goal of “Helping healthcare think like a startup.”
I’ll be posting our first interview shortly but, like any proud father, I wanted to show off Breeze’s new capabilities a bit:
In short, we’ve added:
- Optical Character Recognition (OCR) processing
- Automated chart section bookmarks – jump between admissions forms, lab results, physician notes, etc.
- Automated chart keyword books – makes finding keywords within scanned charts easier (e.g. blood transfusions, pneumonia, etc.)
- HL7 integration – we can talk to other HIS systems now (e.g. Epic, Cerner, Meditech, etc.)
Questions/comments always welcome.
Justin
HIMSS ’09 Theme: “Wait and See”
The meaningful use session during HIMSS09 this year was great. Despite the fact no new official information has been released since the HITECH legislation was signed, HIMSS leadership shared their best guesses. No one was looking for final word on the subject, just some insight into a process most of us aren’t privy to; that’s exactly what we got.
There were two other aspects of the stimulus package we didn’t get the same insight on: interoperability and patient access. Both subjects were touched upon during various sessions, but pretty much everything we heard was webinar rehash.
Where were the best guesses on:
- How interoperable is “interoperable?” Generating CCDs? Accepting them? Any other standards being eyed as favorites? Is Interop Avenue a one-way to two-way street?
- How much of a patient’s record will they need to be able to access electronically to meet the legislation’s bar? Just their demographic data? How about lab results? Their entire chart? Will a PDF of their physician’s notes be acceptable or should they be able to get their x-ray’s too?
Of course no one knows the official answers to these questions and that’s not what we’re asking for. What we’re asking for are for the people who have the experience and influence to affect the official answers to share their current thinking with the HIT community at large so we can start narrowing our sights and be more prepared to hit the ground running.
So HIMSS, your mission is simple: find people brave enough to follow your lead and offer us their best guesses on the vagaries of the stimulus package. Let them qualify their answers as much as they like, we’re not looking for perfection – just a nod in the right direction.
What I Loved & Didn’t at HIMSS ’09
Quick list of things I loved about HIMSS ’09, things I was thoroughly disappointed by, and simple suggestions to HIMSS leadership to address the latter for HIMSS ’10.
Things I Loved about HIMSS 09:
- The people. On the bus, on the plane, at a bar, wherever. HIMSS attendees are smart, passionate people looking to make the best of a broken system. Every chance I got to talk with a HIMSS attendee, whether it was about healthcare, or social media, or the local bar scene, it was an opportunity and a pleasure.
- Networking. The special interest group meetings ,”Meet the Bloggers” panel discussion, and the Communities Open House were all terrific places to meet people and make great connections.
- Wi-Fi access during educational sessions. 80% of the educational sessions I attended didn’t require my full attention, which wasn’t a bad thing. In fact, those sessions gave me a chance to multi-task (checking email, Tweeting, etc.) thanks to the almost ubiquitous internet access available onsite.
- HIMSS staff. I can personally attest to the fact that the HIMSS staff works extremely hard for their members and it shows. Whether it was Yvonne helping me get to the convention, Cesar & Ward injecting some much needed passion, or whoever arranged for the Metra passes and the shuttle busses back to the airport, I was consistently surprised by the effort HIMSS staff put into making HIMSS 09 a terrific event for its members.
Things I Didn’t Love about HIMSS 09
- Awful software. I can’t tell you how unacceptable it is that HIMSS doesn’t follow best practices when it comes to security in their own software. Emailing passwords, sending them unencrypted over the wire, leaving them plain text in the database – disgraceful is an understatement. 10-to-1 there are sql-injection and xss vulnerabilities as well. There’s really no excuse for the organization that represents the HIT community to be condoning this kind of software engineering, especially when security must be at the core of everything we do.
- Massive waste. Wanna see what it looks like when you waste $20+ million*? Walk the exhibitor floor at a HIMSS conference. Who do you think ends up paying for the double-decker booths, that 6,000 sq. ft. open bar, and those rotating wastes of PVC & nylon hanging from the ceiling? If HIT vendor shareholders saw how their money was being spent, I think we’d see a lot more intelligent use of marketing $.
- Massive waste #2. Junk mail? Seriously? Designing, printing, and mailing your flyers only so they could end up in someone else’s recycle bin (I hope)…poor choice. Marketing by yelling is a waste of all of our time, money & resources.
* SWAG.
HIMSS Action Items for 2010
- Don’t make bad software. Or at least don’t release it. It’s really not hard to fix your software from a security standpoint – 4 hours tops (see the email I sent to you last month). That’s not the biggest problem here though. You clearly don’t understand how important it is for you, the organization that epitomizes the HIT community, to not only provide information on security best practices, but to embody them yourself. Everyone who uses your apps and writes software thought to themselves for a split-second, “Well if HIMSS can send passwords over email…” Don’t perpetuate the software practices that have gotten us where we are today – show your constituents the right way to build software, or don’t write it at all.
- Make an opt-out list for unsolicited snail mail. When we register for HIMSS ’10, please give us a checkbox to opt-out of the shiny pre-conference post cards. Saves us time, saves a little bit of the planet, and save vendors money.
Overall, especially when I consider the massive scale of HIMSS ’09, I consider it a rousing success. While every organization has things it can do to improve, the conference provided terrific opportunities to learn new things and meet new people. I’m definitely looking forward to 2010 in Atlanta, especially if we can rectify some of the ’09 issues.
Your turn. What did you love & hate? 10 points for each relevant item – 20 points for getting me to change my mind on any of the above.
New Info on “Meaningful Use” Definition
While at HIMSS09, I’ve attended quite a few education sessions focused around the HITECH portion of the American Reinvestment and Recovery (ARRA – aka “the stimulus package”). While most of the speakers are rehashing things we’ve heard before, some great information came out of a session on the definition of “meaningful use” that I wanted to share.
Defining Meaningful Use
To get money from the ARRA for an EMR, providers not only have to have a certified* EMR in place, they must be “meaningful users” of it. There have been quite a few questions around what exactly that means and while we still don’t know precisely, we got some very interesting clues from the HIMSS leadership this week.
Apparently the Congressional Budget Office (CBO), while in the process of drafting the ARRA legislation, got HIMSS leadership on the phone and asked, “What would it take for all of the providers in the country to get to Stage 4 EMR adoption?” They also asked about interoperability standards and for some hints starting points there. From these hints, HIMSS is suggesting that “meaningful use” could look something like:
- Must have all ancillary systems online – Lab, radiology, & pharmacy (Stage 1)
- Must be leveraging a clinical data repository (Stage 2)
- Utilizing clinical documentation to record patient status during treatment (Stage 3)
- Computerized Physician Order Entry (CPOE) mechanisms in use (Stage 4)
- Be able to exchange Continuity of Care Documents (CCD) with other entities (a portion of Stage 7)
So in the end, our best clues to date on “meaningful use” hint that it will be: Stage 4 EMR adoption + ability to create & share CCDs. Note, this refers to discussions regarding meaningful use in hospital settings. Definitions in the ambulatory setting appear to be more difficult to nail down – we’re in a holding pattern there.
* They EMR certification body and criteria have yet to be determined. ETA, end of this year.
The Schedule for Finalizing the Definition
We also got some insight on the schedule we can expect for the definition of meaningful use to come down. While the HITECH legislation requires it hit the street by the end of the year, HHS is hopeful to have it available before then. Here’s the outline:
- April 1 – 17th - HIMSS Discussion Drafts open for comment
- May 17th - report from (? – missed the part) on the subject is due to congress
- May/June – July - Congress will solicit comments/feedback from key stakeholders
- Aug/Sept - Final definition will come down
As the industry waits with bated breath, it’ll be interesting to watch the definition crystallize over time.
[Update - 4/13/09] HIMSS has a couple discussion documents they’ve written up on this subject precisely. Take a look at them and provide comments through April 17th here: http://www.himss.org/EconomicStimulus/meaningfuluse.asp
At HIMSS 09
I’m going to be in Chicago for HIMSS 09 from 4/5 to 4/8. My schedule is pretty packed so I probably won’t be posting here at all while I’m away, but I will be on Twitter.
If you’re going to HIMSS, be sure to stop by the TweetUp and/or the Tuesday “Meet the Bloggers” session and introduce yourself: http://blog.nimbushealth.com/2009/03/31/hanging-out-at-himss-09/.
Introducing @EvaTheCoder
After I recently submitted a proposal to give a talk on the value of professional social networking to a healthcare organization, I realized I needed a way to demonstrate Twitter in real-time that would at least hint at the value of the Twit-o-sphere. I needed someone I could count on to interact with in a predictable way during a demo and thus, @EvaTheCoder was born.
@EvaTheCoder isn’t much on personality, but she does have an encyclopedic knowledge of the ICD-9 coding manual. Ask her about any ICD-9 code and she’ll do her best to shoot back a description of it. She’ll also try to have a conversation with you, but as you’ll see, that’s clearly not her strong suit.
I’d love to get some other people pushing her limits before I stand up in front of a group and start conversing with her. If you’ve got a couple minutes to try the following, I’d really appreciate it:
Get her to Follow You
Either of the following should do the trick:
- Follow her
- Send a tweet on a subject she’s interested in (e.g. “I know nothing about medical coding. Maybe I’ll take a class.” or “Medical coding sounds boring to me.” – bold words are required. “Medical coding” AND (“at work” OR “study”) should work as well.)
Let me know if you do either of the above and she doesn’t start following you right away.
Ask her about ICD-9 Codes
- Search for a disease on http://icd9cm.chrisendres.com
- Ask @EvaTheCoder about one of the codes you find via reply or dm (e.g. “@evathecoder what is 295.51?” or “d evathecoder please lookup 300.81 for me.”)
Let me know if what she tells you doesn’t match with what you see.
Have a Conversation with Her
Have anything you want to ask her (e.g. what’s her favorite movie? why is she so perky? who created her? etc.)? Fire away. Let me know if she’s missing any obvious responses.
Thanks again for your help – it’s very much appreciated! Of course, please let me know if you have any questions or other feedback.
Also, big thanks to the TweetSharp guys. If you ever need a .Net Twitter library, I can highly recommend theirs.
Hanging Out at HIMSS 09
I’ll be at the inagural HIMSS National Tweetup (at the same time/place as the Communities Open House). If you will be too, it would be great to see you there.
I’ll also be a panelist at the Tuesday session of the Meet the Bloggers roundtable. Come learn about blogging, why it’s worth it, and how it can help your organization. Also meet the people who generate some of the best healthcare IT information available on the net.
Add these events to your HIMSS Calendar and I’ll see you there.
Medical Coding Blogging
Considering the amount of information that’s required to be a great medical coder and the frequency with which that information changes, blogging is a terrific way for coders & auditors to demonstrate their expertise. If you own a coding consultancy or are an experienced coder looking to expand your opportunities, I would highly recommend starting your own blog.
Why? Blogging sets you apart as an expert in your field. By providing timely and insightful information, HIM directors will see that you have your pulse on the coding world and how you’ll be asset to their organization. Whether they find you through web searches or you refer them directly to your blog, HIM directors will get examples of your expertise in every post you write and can quickly see how you’ll increase the quality of their organization’s results.
The opportunity is ripe by the way – there are very few good medical coding blogs on the web today. Imagine how you would stack up to your competition if you had 30 posts demonstrating your coding knowledge while they just had a static web page with their contact information.
To get the juices flowing, here are three of the best medical coding blogs I’ve come across so far:
- www.medicalcodingjournal.com - Great execution. Good content, updated regularly and not overly “salesy”
- www.medical-coding-resources.com/apps/blog - Although you need to sign-up to see the content, it’s well worth it if you’re a coder. Very detail oriented and regularly updated posts.
- www.askleslie.net - An interesting combination forum & blog where reader’s questions show up as posts. Clicking “Recent Posts” and opening any post by “ljohnson” will get you Leslie’s posts.
If you’d like to try starting your own blog, I promise it’s easier than you think (it takes about 5 minutes). Go to www.Blogger.com, follow the instructions, and you’ll be blogging in no time.
Also feel free to get in touch with me if you’d like some help getting the ball rolling or brainstorming your blog strategy – I’d be happy to lend a hand pro bono.
Justin
Planning your HIMSS Schedule Online
The HIMSS team has put together a very useful feature to help you plan your ’09 conference on their website – MyHIMSS09 Calendar. I remember last year taking several hours to research all of the sessions, pick the ones that were most promising, and meticulously adding each of them Outlook. This year, the processes was much faster…big thanks to you HIMSS.
Now, figuring out how to use the calendar wasn’t entirely obvious to me, so I recorded a quick demo on how to get around in the hopes it might save you some time and shed some light on this very promising tool.
Calendar demo: http://screencast.com/t/2lSXa3pQ3a
Important Note: the MyHIMSS09 Calendar login doesn’t encrypt your password when you log in. That means if someone wants to “sniff” your password while you’re updating your schedule at your hotel room or in a coffee shop, they can. This isn’t a big deal if you stick with the generated password they give you (the worst someone can do is mess with your schedule), but if you change your password to one you use on other websites, be very careful. Your best bet is to login here and use a password that’s unique to the calendar application.
Let me know if you have any questions.
Good luck,
Justin
Are you still not using Instant Messaging?
If you’re not using Instant Messaging (IM), no matter what your role is in the healthcare space, we need to get you on board. Of course you need to be smart about PHI, but if that’s the reason you haven’t taken advantage of this incredible tool, you tossed the baby out with the bathwater long ago and we need to rectify that.
So why is IM useful? Imagine sending emails for the following “conversations:”
- What was the link to that website again?
- Did you get a chance to follow-up with Clayton on that audit report? If not I’ll touch base with him.
- I just had a meeting cancelled. Let’s sync up now.
There’s a chance that each of the people you’re looking to reach are all checking email at the exact moment you hit send, but more likely than not your request will pile up in their inbox with everyone else’s. Two hours later, when the value of a quick response has been lost, you’ll get your reply.
The phone has the opposite problem – it requires full & immediate attention from both you and the person you want information from. No better way to be a high-maintenance co-worker than by constantly interrupting your peer’s train of thought with unnecessary phone calls.
What if there was a way to ask someone a quick question that they could answer when it’s most convenient for them, anytime within the next 5 minutes or so? That would mean they can finish their current thought but you’d still get a quick response – everyone would win. Luckily, IM fills this exact gap!
I’ll address PHI in another post but for now, simply don’t send any patient identifiable data over IM. But please, do not let that stop you from leveraging IM. I have not met a single person who has given IM a shot in the workplace, even if everyone is in the same office, who has not found it useful.
A couple tips to get you started:
- Sign up with the service most people in your office are already using (Google Talk, MSN Messenger, or Yahoo!Messenger) or the service that is associated with your free email account.
- If no one is using IM in your office today, sign up with Google Talk.
- Only add 2 – 4 IM contacts/buddies to start with – the people you share information with most often. Add more buddies as the need for quick conversations arise.
- Use a different account for your work login than your personal one. There’s nothing more distracting that being constantly IM’d by friends while you’re trying to get work done.
- If you have contacts using multiple services (e.g. Google Talk, MSN, AOL, etc.), use Pidgin to talk to them all using a single application.
Good luck and please, let me know how it goes.
Justin
Thank you Yvonne & HIMSS
Just wanted to say a quick thanks to HIMSS and specifically Yvonne in Member Services. Despite being knee-deep in preperations for the upcoming national conference, Yvonne and her VP went to significant effort to ensure we could attend this year’s event.
Many thanks to you Yvonne, and the rest of the HIMSS staff, for making that possible and helping even relatively new players in the healthcare field take part in the exciting changes that are shaping our industry.
Hope to see you there and say thanks in person.
Justin
@Justin_Wilcox
