News

On the Need to Improve User-Centered Design (i.e. Design Thinking) for Healthcare IT Usability

The lack of usability of electronic health records (EHRs) and healthcare IT applications, in general, has been in the news a lot again. This time it is a research report published in the Journal of the American Medical Association (JAMA) on March 27. The study analyzed voluntary error reports associated with EHR systems and found that problems with EHR usability may have directly resulted in patient harm. Unfortunately, this situation is all too common in the healthcare industry. Numerous health care systems are designed and created ad hoc, or with a very engineering-centric approach. End users are dissatisfied and often systems or workflows are abandoned and/or dangerous work-a-rounds created. A lot of people are saying Healthcare IT needs a disruption. What HealthIT needs is to begin to learn about and understand the needs, goals, and methods of the actual end-users, like doctors, nurses, medical assistants, etc.

Mainstream Academia Embraces Open Source Hardware

Twenty years ago, even staunch proponents of free and open source software like Richard Stallman questioned the social imperative for free hardware designs. Academics had barely started to consider the concept; the number of papers coming out annually on the topic were less than could be counted on someone's fingers. Not anymore! Not only has the ethical authority of Stallman embraced free hardware and free hardware design, but so has the academic community. Consider the graph below, which shows the number of articles on open source hardware indexed by Google Scholar each year from 2000 to 2017. In the last 17 years, the concept of open source hardware has erupted in ivory towers throughout the world. Now more than 1,000 articles are written on the topic every year.

Medicaid as a Service Part II: The State’s Perspective

This article is the second in a series of four proposing a revolutionary new direction in Medicaid Management Information Systems (MMIS) structure and pricing...Our first article, outlining the general scheme, may be read here. To summarize, we propose that states treat MMIS as a service, as opposed to treating it as a procurement. Put another way - MMIS is a verb (Something you do) vice a noun (something you possess). In the current paradigm, individual States (to include the District of Columbia) create independent, stand-alone MMIS platforms with long contract lead- and execution- times.

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US Core Data for Interoperability Task Force Delivers its Recommendations

On April 18, 2018 the HHS Health Information Technology Advisory Committee (HITAC) US Core Data for Interoperability Task Force delivered its recommendations on the draft US Core Data for Interoperability (USCDI) and Proposed Expansion Process which had been published for public comment back in January 2018. HITAC promptly accepted the Task Force’s recommendations. The Task Force focused almost exclusively on the process for identifying the USCDI rather than the proposed USCDI data itself. I especially appreciated their introduction of some key concepts related to how USCDI should be organized and understood.

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Why the VA Should Stick with VistA and Not Waste $16 Billion on an Attempt to Replace It

This VA leadership lull provides an opportunity for reflection. Specifically, it’s worth asking while we have the time whether Cerner is the right path for the VA to take. While the decision may seem like a no-brainer to some, the VA’s situation is unique and arguably calls for a singular approach to both existing organizational issues and a major healthcare IT decision. Specific to the Cerner decision, what should the new VA secretary consider?

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Signatures are No Longer Required for Credit Card Transactions...How Come Most Medical Records Exchanges Still Require Fax Machines?

If you live in the U.S., you've probably had the experience of paying for a meal using a credit card. The server takes your card, disappears to somewhere in the back, does something with it that you can't see, and returns with your card, along with two paper receipts, one of which you need to sign. Everything that happens to me, I think, what is this, the 1960's?As of last week, the major credit card companies -- American Express, Discover, Mastercard, and Visa -- are no longer requiring that signature. As a Mastercard person told CNET, "It is the right time to eliminate an antiquated practice."

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Healthcare Has Cost Problems, but IT and EHRs Do Not Have to be One of Them

I’m proud to lead a group of intelligent and energetic technology professionals committed to developing a robust healthcare IT system that is (1) easy for clinicians to use, (2) improves patient health and (3) doesn’t bankrupt hospital budgets. We think any sustainable system must have those three key requirements. And how is healthcare doing thus far? The EHRs available today are developing rapidly. Vendors are making frequent and impactful improvements to improve system usability. Clinicians are getting better at maximizing the contribution healthcare IT makes to patient health and safety. It’s not hard to see how healthcare IT can meet the first two requirements and broadly contribute to improved healthcare.

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“Write Code! Save Lives!” OpenMRS Meet in Malawi Shows the Way

More recently, I attended the 12th annual International OpenMRS Implementers’ Conference in the capital city of Malawi, Lilongwe, from Dec. 12 to 16, 2017. At this annual event, volunteers, developers and implementers came together to talk about all things OpenMRS and develop strategies for the evolution and applications of the software....Meeting this determined and committed community has boosted my drive and sense of purpose for writing code. I feel like this is the kind of project that I can contribute code to for many years to come. At the conference, I was reminded of a common Global Health Corps saying: “Once a fellow, always a fellow!”

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New Modalities for Technical Assistance Consulting

Technical assistance (TA) is provided by expert consultants to public health systems projects in order to improve their performance against functional standards or to help solve recurring or one-time problems or issues. Unlike other forms of training or support, TA is usually focused or tailored to a specific circumstance or situation. Common examples of TA include assistance to a jurisdiction in migrating from one product to another, consultation related to a specific programmatic initiative such as school immunization health compliance, EHR interoperability implementation, or data quality review.

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Healthcare's Death Star Thinking vs. Human Centered Design

I missed it when it first came out, but a providential tweet from the always perceptive Steve Downs tipped me to a most interesting article from Jennifer Pahlka with the wonderful title “Death Star Thinking and Government Reform.” The article is not directly related to healthcare, although it does include healthcare examples, but Ms. Pahlka’s central point very much applies to most efforts to reform healthcare: The need to believe that a Death Star-style solution is at hand — that we have analyzed the plans and found the single point of failure — runs deep in our culture.

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