Tag: hit

Defining informatics for health center teams

I just ran across this great short post on informatics and had to share it. I wish Dr. Gibson had written this post a couple years ago when I first used the word “informatics” with my new health center colleagues. When I said the word, I might as well have been speaking Klingon — no one knew what it was — not the clinicians, the business folks, operations… no one had heard the term. Of course it didn’t help that I recommended we consider hiring an informaticist — a new position that no one knew they needed and couldn’t define. 😉

At the time, and to some degree even today, there was an expectation that mainline IT staff would fill the role of informaticist for the company. And in some small ways, we do. But not in the big ways, not in transformative ways. Our IT staff are saddled with basic systems maintenance, user support, new system installation and integration efforts, and so on. We’re not clinicians by training. While we listen and learn a little every day about our clinical operations, we’re still not doctors or nurses. (Funny how that works.)

So what is informatics? What does an informaticist do? Dr. Gibson explains it like this (boldface mine):

Important informatics skills include change management (not just IT change management, but culture and process change management as well), business analysis, stakeholder engagement, project management, requirements development, strategic thinking to place projects into a larger vision, building for inter-operability, translating between IT & business, system life cycle, communications, [etc.]). A good informatician can speak the language of both IT staff and program staff, and should be a good communicator and group facilitator.

Informatics skills are not necessarily present in IT departments. A programmer may be very skilled in writing a program to do what he wants, but is rarely skilled in getting the thorough understanding of what users need. The database administrator may be very skilled in structuring a database to run very quickly, but usually does not understand the content well enough to create operational definitions that address what program managers want to know.

My recommendation from a couple years ago was that we needed to hire an informaticist, or at least someone who had clinical background and technical chops. With all the reporting and analysis requirements in UDS, Meaningful Use (MU), and Patient Centered Medical Home (PCMH), not to mention workflow changes needed to meet increasing security and privacy requirements (HIPAA, HITECH) and general efficiency needs, having someone who could drive workflow / care / data change projects and communications would help a lot.

In the end we didn’t hire a classic informaticist, but we do have a high-level manager driving Quality Improvement (QI) efforts, PCMH, and MU, and she’s quite technically capable as well as a licensed provider. So we’re covering the need for now.

It’s possible that at our scale (currently around 130 employees), perhaps a full-blown highly-paid informaticist won’t be necessary in the future. It’s possible the EHR vendors and various governmental agencies will settle on a collection of core measurements and workflows that work for everyone and those features will just be built-in to our systems. (Ha! Sometimes I crack myself up…)

But for now, I would argue everyone in the health center space (50-500 employees) needs to be thinking about hiring an informaticist. Someone that has clinical training. Someone that isn’t afraid of computers and likes data and analysis. Someone that can communicate well and can drive change projects. So yeah… a miracle worker!

Meanwhile, everyone on your management team needs to know what informatics is. Your health center needs to get comfortable with data and change. Because “accountable care” demands proof, and the proof is in the data.

BONUS: Informatics Links

Buzz is building around the Fitbit Flex

Fitbit was one of the first to bring a consumer activity tracker + web site + mobile app ecosystem to the edge of the mass market, and they’ve won a lot of converts over the last couple years. But at the same time, there’s been an explosion of other trackers and platforms for capturing physical movement, encouraging more activity, and viewing and sharing the data collected. Can Fitbit stay on top?

Well, they’re certainly going to try.

This week Fitbit introduced yet another revision to their activity tracking lineup, a new design intended to recapture users that defected to the wristband-style Nike+ FuelBand or the Jawbone Up. And the tech press, in their annual CES frenzy, are trumpeting the announcement as the next big thing:

The details are simple, really. The Fitbit Flex will be $100 and launch sometime in the spring. You can pre-order right now.

For me, Fitbit is challenging my devotion to the Nike+ FuelBand by combining what I liked about the FitBit with what I like about the FuelBand. Mostly. So here’s my take on the pros and cons of old Fitbit, current FuelBand, and the announced Fitbit Flex…

Where the Fitbit One Beats the FuelBand

  • Because the design calls for you to wear the Fitbit near the center of your body mass (at or near the waist), it’s much more accurate when counting steps or overall body movement than wrist- or arm-mounted activity trackers.
  • Fitbit has several data integrations included with its cloud-based platform, so you can send your captured data lots of different places, including Microsoft HealthVault. This bodes well for the Fitbit’s future prospects as a provider-integrated EHR-syncing activity tracking platform. You know… someday.
  • The Fitbit web and smartphone app platform is more feature-complete than Nike’s, especially if you’re anal enough to enter all your foods, moods, water, and any exercises not picked up by the activity tracker. Nike has a great iOS app with Facebook integration for social health purposes, but then so does Fitbit.
  • All the Fitbit activity trackers are cheaper than the FuelBand. It’s $70 and $100 vs. $150. That’s a big difference.
  • The Fitbit One (but not the “Zip” edition) can track steps climbed using an altimeter function. The FuelBand can’t do that.
  • Like the new Flex (discussed below), the Fitbit One syncs wirelessly with low-power Bluetooth 4.0 anytime you’ve got the app running on your smartphone.

Where FuelBand Beats the Fitbit One

  • The Fitbit One is easily lost in pockets, off your belt, and can end up in the washing machine (and then the trash). The FuelBand, by comparison, just goes on your wrist — end of story. It’s snug and doesn’t have to come off much, so you’re not going to lose it easily. This advantage cannot be overstated. Lots of users have switched to the FuelBand because the data captured, while less accurate, is more complete and consistent because the FuelBand is just more likely to be worn.
  • The FuelBand’s integrated display is attractive, engaging, and informative. The Fitbit One’s display is okay and functional, but not all that engaging. For the good stuff you have to hop into the smartphone app.

And Now the Fitbit Flex: Where Does it Win?

  • The Fitbit Flex can be used for sleep monitoring, just like its non-wrist predecessors. The FuelBand skips this feature, though the Jawbone Up matches it.
  • If you can be woken up by a vibrating wrist, then the Flex can be your alarm clock. LIke the Jawbone Up, it will theoretically buzz at the right moment in your sleep cycle so you wake up refreshed. Reviewers seem to think it works. The FuelBand has no such feature.
  • The motion-sensing part of the Flex can be popped out and dropped in a pocket if you don’t want to wear the wristband.
  • The Nike FuelBand is sold in 3 wrist sizes and you have to figure out which one is right for you (I screwed up on my first choice). The Flex comes with 2 bands and has a highly-adjustable watch-style wristband.
  • You can swap out different Flex wristband colors (if you must) by buying additional bands.
  • Using Bluetooth 4.0 means the Fitbit Flex can maintain smartphone connectivity all day without killing either the wristband’s or phone’s batteries. The FuelBand runs on older Bluetooth modes, requiring manual syncing and more power. The Jawbone Up isn’t even wireless, instead plugging in to your headphone jack for syncing.

Potential Fitbit Flex Problems

  • The FuelBand has a smooth, rounded shape across its entire body, but the Fitbit Flex has a blocky, squared-off top that’s much more likely to catch on clothing. I’m also wondering whether the watchband styling will be annoying. I haven’t worn a classic watch in years.
  • Aside from the 5 LED dots, there’s no multi-function display, so it’s a step ahead of the Jawbone Up, which has no display at all, but several steps behind the FuelBand, which can also act as a watch. (Of course, with Bluetooth 4.0 live syncing, you can view your Fitbit stats on your smartphone anytime.)
  • The Flex lacks the altimeter of the Fitbit One, so no tracking steps climbed.
  • While wrist placement is convenient, it’s also far less accurate in measuring activity when compared against the Fitbit One or any torso-bound tracker.

Conclusions: Fitbit Flex Wins, But It’s a Fast-Moving Market

  • The Fitbit Flex is a winner overall, if it works as advertised. Remember that the Jawbone Up was a disaster at launch and took a year to be revised. Time will tell, but Fitbit has successfully built and launched all prior models.
  • The Flex effectively neutralizes the threat of the FuelBand and the Jawbone Up by offering equivalent physical functionality at a lower price.
  • The Fitbit platform is a major advantage you can’t see on the box, but it will matter most in the long run. Their platform is purpose-built and widely-integrated with other apps and web systems. The FuelBand is, let’s be honest, a side project for Nike. The Up is similarly a side project for Jawbone, the Bluetooth headset and portable speaker manufacturer. Fitbit is focused where the others aren’t.
  • For all the good stuff about Fitbit and the Flex, the truth is the quantified self sector is just starting to reach the mass market. Who knows who wins in the long run?

For now, I’ve pre-ordered the Fitbit Flex for myself. And I can report back here in the spring.

Desperately seeking a HIPAA-compliant Ford Mustang

After the harrowing account of a hospice in northern Idaho being slapped with a $50,000 fine for 411 breached patient records, it’s good to see that even the big players — the biggest in the industry — screw up from time to time.

This widely-cited case, first reported by the L.A. Times, tells the story of how healthcare giant Kaiser Permanente got a little sloppy and ended up working with a contractor who stored electronic patient records all over the place, including sometimes storing records — and I love this — in the trunk of his Ford Mustang.

Which raises the obvious question: Are Ford Mustangs HIPAA compliant? What about a Honda Accord? Maybe a PT Cruiser?

And while that’s the wildest part of the story for me, what’s even more fun is the fact that Kaiser and their mom-and-pop patient records handler (yes, literally — mom-and-pop) have been trading accusations in and out of court for the past 2 years, each accusing the other of not caring about patient privacy and data security.

L.A. Times writer Chad Terhune did a masterful job painting a picture of the comical data security with these gems:

  • “On a recent day [the patient records] sat next to a red recliner where Ziggy, the family’s black-and-white cat, curled up for a nap.”
  • “…kept those patient records at a warehouse in Indio that they shared with another man’s party rental business and his Ford Mustang until 2010.”
  • “…Kaiser said the Deans put patient data at risk by leaving two computer hard drives in their garage with the door open. In response, Stephan Dean moved them to a spare room.”
  • “‘We could have sold these emails [with patient records] to somebody in Nigeria, but Kaiser doesn’t care about its patients’ information.'”
  • “‘[Kaiser] should have signed a contract prior to the commencement of this project,” the manager wrote.”

Be sure to read the article all the way to the end. That last sentence is a killer.

Kaiser got into this mess because they gobbled up yet another smaller hospital and needed to absorb all the patient records quickly. So they outsourced the job. No problem there, really. It’s who they outsourced to that ended up being a disaster.

So far, there’s no known patient data breach, which is great for patients. But authorities are investigating and Kaiser’s got a lot of egg on face with such a high-profile piece hitting the Times.

The lessons for your patient data security efforts? Wait… you really need me to spell this out?

It’s simple. You need your own Ziggy — a certified Patient Privacy Attack Cat — and a Mustang. IT’S RIGHT THERE IN THE FEDERAL CODE, PEOPLE.

Updated ‘quantified self’ gear coming this year

The quantified self movement keeps chugging along, with updated tech announcements coming from both Withings and BodyMedia this week.

BodyMedia will introduce an updated version of their arm-mounted health data collector, theoretically shipping in August. The new version is quite a bit more attractive than the current one. It measures activity / movement, sleep patterns, and calories burned. It competes with the Nike+ FuelBand, the FitBit One, and others.

Withings, who first arrived on the scene with a Wi-Fi weight scale, is introducing an updated scale — the Smart Body Analyzer — but also an activity monitor — the Smart Activity Tracker — to compete with FitBit and all the rest. It’s not clear when these products will ship, though Withings is claiming a Q1 release.

The Smart Body Analyzer is the most interesting addition to the field, as it’s bringing more sensors to the party. This thing will get your weight and body fat percentages, like the current model, but it will also capture heart rate and — this is the amazing bit — air quality, in terms of CO2 levels in the ambient air. Captured data syncs via Wi-Fi or Bluetooth, and naturally goes into their cloud-hosted data monitoring system and smartphone apps. You can sync over to Microsoft HealthVault if you like.

Personally, I’m wearing a Nike+ FuelBand right now and I love it. It actually think the FitBit is more accurate, but the FuelBand goes on your wrist and stays there — you don’t lose it off your belt or send it through the wash in your pants. The only one I really want to try out is the Jawbone Up, which has more features than the FuelBand, but lacks the FuelBand’s integrated data display.

Meanwhile, check out this article from AllThingsD on the trends in the space:

Fitbug pitches employers and launches new activity, weight, and blood pressure gear [UPDATE]

[Update at bottom of post]

This is a new one on me. I follow the “quantified self” market fairly regularly, but it’s the first time I’ve seen activity tracking devices and services being pitched directly to employers.

The idea: As an employer, you want to encourage healthier behaviors, in order to drop your insurance costs. With Fitbug, now your company can hook up with them to provide units to staff and track progress individually and as a group.

The site offers relatively little information and no real studies of effectiveness. But it’s an intriguing idea — one that’s likely to gain traction in the next few years as devices get cheaper and employers (and health insurance carriers) get employees and customers more engaged in health management and promoting healthy behaviors.

New Fitbug Gear

Meanwhile, Fitbug is introducing a bunch of new gear, including the Fitbug Orb, a low-cost ($50) Bluetooth-connected activity tracker (that’s not currently shown on their own web site). They also have a new wireless weight scale (the Fitbug Wow) for $80 and a blood pressure tracker (the Fitbug Luv). None of the new gear is shipping yet, but should all be on the market before summer.

UPDATE: 2012-01-08

While Fitbug has one of the most in-your-face pitches to corporate health device buyers, they’re not the only ones talking to this market. Waaaaaayyy at the bottom of the Fitbit site is a link called Corporate Wellness that takes you to a page pitching the same concept: buy tons of our devices for employees and use them to promote wellness / drive down insurance costs. Sorry I failed to notice that one! If you have other examples from device makers, please let me know.

Health IT Links: 2012-01-03

Here are my selected links, with commentary, from the Health IT, community health center (CHC), nonprofit, and general IT sectors today. Please pass me any recommendations you’ve got in the comments or hit me up on Twitter: @jmproffitt.

Products

  • PhoneFactor (Mini-Review at SC Magazine)
    Add 2-factor authentication based on phone calls, SMS messages, and OATH to your web apps, Terminal Services, Citrix sessions, and RADIUS-backed VPN sessions on the cheap. Pretty cool. SC Magazine certainly liked it. (Another option would be to deploy an SSL VPN with 2-factor features built-in, but that’s a story for another day.)
  • Technologies to watch 2013: Windows Server 2012 cannot be ignored
    The Windows Server platform continues to march on, with some great additions in the 2012 edition. This article points to more than 9 advances that just might solve some problems for you, including the vastly-improved Hyper-V, and some fascinating storage pooling techniques blended with a faster SMB file transmission implementation. Of course, watch out for application hosting issues — your app vendors may not yet support Server 2012. I don’t know about you, but we’re still eliminating Windows Server 2003 servers.

Security

Business of Healthcare

  • WellPoint to cover virtual doctor visits
    More payers are starting to cover telemedicine / telehealth costs. Do you do any telehealth in your clinic today? We don’t do it yet, but there’s a real future here, so I know I’m paying close attention.

Health IT Links and Notes: 2012-12-31

Here are my favorite links from the Health IT and general IT sector today. Follow me on Twitter to get most of these links real-time, albeit with less commentary.

OCHIN awarded federal grant to help community health centers with HIT
OCHIN has scored a 3-year $775,000 annual grant to provide services to client clinics dealing with PCMH, MU, EHR implementations and so forth. Good for them. But I wonder whether the client clinics might be better off struggling with some or all of these issues directly. After all, they’ll have to change their cultures to really develop a viable PCMH program, and you can’t buy culture. Furthermore, if you think Health IT changes are going to stop after PCMH and MU, you’re dreaming. Plan to hire IT capacity in-house if you can, because you have got to have internal change and technical capacity.

Vampire data and 3 other cyber security threats for 2013
I’m always a little suspicious of a security services vendor trumpeting all the threats that will destroy your business if you don’t hire someone like them. But in truth the threats are real — it’s just a question of how much risk you’re really facing in your situation. Still, the threats and issues to consider here include:

  • Watch out for risks posed by data you aren’t aware of or can’t easily monitor or control (what they’re calling “vampire data”), including cloud-hosted stuff or old data stores you’ve forgotten about
  • If you don’t already have lawyers and others on retainer to help you in a breach situation, you really should because you don’t want to be scrambling to hire them after a breach
  • You really need to be logging stuff and reviewing the logs, folks (easier said than done)
  • Hackers are as much about disrupting your business as stealing your data these days
  • Just start publishing your breaches, even if it doesn’t involve ePHI

Analysis: Microsoft Is Squandering Its Hyper-V Opportunity
Critics love the Hyper-V included with Windows Server 2012. But it’s not taking off because of several strategic mistakes Microsoft has made and continues making. Meanwhile, VMware remains king of virtualization for most businesses.

How to Say ‘Yes’ to BYOD
Saying “no way in hell” to smartphones, tablets and other employee-owned gear in the enterprise strikes me as a bigger risk than saying “yes, but with controls” and this audio panel discusses how you can say yes and feel good about it. About 15 minutes long.

How MiGym plans to quantify the health club workout
Finally. Pretty soon you’ll be able to take your smartphone to the gym and capture workout data from the machines already there, then sling that data into an online PHR (like Microsoft’s almost-forgotten HealthVault). My own thinking is that there’s a future for CHCs in the health club space. I mean what are we doing, disease management or health promotion? Keep an eye on gyms, health data devices (the “quantified self” movement), PHRs, and developments in payer preferences for preventive care with results.