Health Innovation and Education Cluster South West
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John Halamka, MD is CIO of Beth Israel Deaconess Medical Center
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Attesting to Meaningful Use Quality Measures
07/02/2012 11:00 AM
I was recently asked how eligible professionals should report the Meaningful Use Clinical Quality Measures if there are zero denominators (i.e. you do not have any hypertensives, adults, or patients with 2 or more visits in the measurement period)
Here's the answer as I understand the regulations and FAQs: 1. Report on the 3 Core measures if you can, which include *Hypertension: Blood Pressure Measurement *Tobacco Use Assessment and Tobacco Cessation Intervention *Adult Weight Screening and Follow-up 2. If any of the 3 Core measures has a zero denominator, replace them one-for-one with one of the 3 alternate core measures. If you can’t get to 3 non-zero denominators between the core and alternate core, report on all 6 (even if it means that you have to report 6 zero denominators) *Weight Assessment and Counseling for Children and Adolescents *Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old *Childhood Immunization Status 3. Regardless of the above, you MUST report on 3 of the remaining 38 Additional Set measures. If you are reporting any zero denominators from these Additional Set measures, you must attest that you have no other non-zero denominator measures. Essentially, you have to confirm that you’re not running away from non-zero denominator measures. In summary, the minimal requirement is for 6 measures (3 core or alternate core, 3 additional set). You may have to report up to 9 measures if there are zero denominators involved. If you can’t find 3 non-zero denominators among the core and alternate core, you have to report on all 6 (even if it means that you’re reporting 6 zero denominators). In addition, you still have to report on 3 from the remaining 38 additional set measures. If any of these 3 additional set measures is a zero denominator, you must confirm that you don’t have a non-zero denominator for any of the remaining 35 that you’re not reporting on. Micky Tripathi posted a blog about this last summer that provides additional detail. You'll find the FAQs that address the Clinical Quality Measures here.  
The Perfect Storm for Innovation
06/02/2012 11:00 AM
In my career, there have been a few perfect storms, defined as "a confluence, resulting in an event of unusual magnitude".
When I was an undergraduate at Stanford University in 1980, two geeky guys named Jobs and Wozniak dropped by the Homebrew Computer Club to demonstrate a kit designed in their garage. IBM introduced the Personal Computer and MSDOS 1.0. I purchased an early copy of Microsoft Basic and began creating software in my dorm room including early versions of tax calculation software, an econometric modeling language, and electronic data interchange tools. Every day brought a new opportunity. The energies of hundreds of entrepreneurs created an industry in a few intensely creative months that laid the foundation for the architecture and tools still in use today. A guy named Gates offered me a job and I decided to stay in school instead. In 2001 when I was first hired at Harvard, a visionary Dean for Medical Education, a supportive Dean of the Medical School, talented new development staff, and a sleepless MD/Phd student came together to create one of the first Learning Management Systems in the country, Mycourses. Robust web technologies, voice recognition, search engines, early mobile devices, and new multi-media streaming standards coincided with resources, strong governance, and a sense of urgency. Magic happened and in a matter of months, an entire platform was created that is still powering the medical school today. At BIDMC in 2010, IS Clinical Systems staff and key operational leaders realized that Meaningful Use Stage 1 was within reach if we temporarily put aside other work and focused our energy, creativity, and enthusiasm on rapid innovation, process change, and education. In a few weeks we became the first hospital in the country to certify our EHR applications - inpatient and ambulatory. We became the first hospital to achieve Meaningful Use. More than 70% of our eligible professionals have surpassed meaningful use performance thresholds. We had no budget, no dedicated resources, and nothing but strength of will to make it happen. It was one of our finest hours. In 2011, the Massachusetts public sector (Secretary of EOHHS, CIO of EOHHS), private sector healthcare leaders, and healthcare IT experts had a bold idea - create a public utility that links together all the existing regional health information exchanges, public health, small clinician offices, payers, and patients using modular components procured and initially operated by state government. We aligned forces and in a few weeks created budgets, project plans, a new State Medicaid Health Plan, and a guiding coalition of stakeholders. Political, organizational, and technical barriers were broken down and unbridled optimism rekindled our health information exchange momentum. 2012 will be a transformative year in the Commonwealth, truly a perfect storm. My advice - look for the perfect storms in your own life. Minimize your distractions, cancel unnecessary meetings, and put aside those tasks that don't add value. Take a risk and dive head first into the possibility of creating greatness. I've seen opportunity come and go in my life. No one remembers the mundane. No one forgets the events of unusual magnitude. Recently, I updated my BIDMC job description to include fostering healthcare information exchange among affiliates, accountable care organizations, and the community. The Massachusetts Health Information Exchange is the next perfect storm in my career and I will devote all of my energies to the confluence being created by EOHHS CIO Manu Tandon, Massachusetts eHealth Collaborative CEO Micky Tripathi, and the dozens of volunteers lending the wisdom to the process. 
Cool Technology of the Week
03/02/2012 11:00 AM
I recently wrote about the explosion of business spam.
One of my blog commenters introduced me to Unsubscribe.com which provides a free, timesaving, easy to use unsubscribe utility. Numerous times a day, I click on an email scroll to the unsubscribe area, have to figure out the proprietary unsubscribe functionality of the business spammer, retype my email address, and hope it works since unsubscribe sites are generally slow and unreliable. With Unsubscribe.com, I just download a plug in for my email client (apple mail), and simply click on the unsubscribe icon whenever unwanted email appears in my inbox. The unsubscribe servers use natural language processing to figure out the unsubscribe methodology and send the unsubscribe request. It has easily saved me 15 minutes a day. Of course the ultimate answer would be for advertisers to act more ethically. I had a great conversation with Dave Smith, Compliance Officer for Constant Contact about their efforts to enforce email advertising best practices. A few items 1. They ask their clients to certify pre-existing business relationships or opt-in before sending email. Some clients do not follow this policy guidance the Constant Contact compliance team does their best to identify and stop abuses by their customers. 2. They created "Safe Unsubscribe" to make it easier for recipients to remove themselves from mailing lists. It really works - Safe Unsubscribe does actually stop the flow of advertising. 3. They will honor a global "do not call" designation for all email newsletters if such a request is made to the compliance department. My wife uses Constant Contact for her NKG Art Gallery Newsletter, so I'm not opting out of all communications just yet. Only a small portion of my business spam comes from advertisers using Constant Contact - a tribute to their ethical marketing compliance efforts. A utility to automatically unsubscribe and a company using a compliance team to reduce unwanted email. That's cool! 
Our Cancer Journey - Week 7
02/02/2012 11:00 AM
Tomorrow we begin the third cycle of Cytoxan/Adriamycin. In the journey thus far, Kathy has had good days and bad days. High energy and low energy days. Meal days and BRAT (Bananas, Rice, Apples, Toast) days. We frequently discuss the factors that put Kathy at risk for cancer at this point in her life. We talk a lot about the future. Kathy's typical pattern is Friday - Chemotherapy infusion day, good energy, good appetite, some jitters from the steroids Saturday - Good energy, good appetite, some jitters from the steroids Sunday - Waning energy, moderate appetite, bone pain Monday - No energy, moderate appetite, extra sleep needed, bone pain, bland diet Tuesday - Low energy, extra sleep needed, bone pain, bland diet Wednesday - Low energy, bland diet, extra rest needed Thursday - Moderate energy, bland diet Friday - Moderate energy, stomach pain, bland diet Saturday - Moderate energy, stomach pain, bland diet Sunday - Moderate energy, stomach pain, bland diet Monday - Good energy, moderate appetite Tuesday - Good energy, good appetite Wednesday - Good energy, good appetite Thursday - Good energy, good appetite What environmental risks caused the cancer at this point in her life? Exposure to the cadmium and other heavy metal pigments in her traditional oil paints? Pesticides in the environment? Bisphenol in cans? Free radicals? We've talked about psychoneuroimmunology, the impact of mood and outlook on the ability to combat disease. The past two years have been challenging for Kathy - helping our daughter grow from high school to college, transitioning to an empty nest, creating an art gallery business in a challenging economy, sharing the stresses of my Federal/State/local work (especially Meaningful Use for several hospitals and 2000 doctors), and supporting the health needs of our parents. Although they past few years have been stressful, all the events are consistent with our expectation for this stage of life. One event in the past year was a bit out of the ordinary. A 19 year old with a very poor driving record (4 points on his license, 1 high speed collision, 1 hit and run etc.) drove down the wrong side of the road around a line of traffic and hit Kathy's car as she was exiting a parking lot. It was very clear from the position of the impact that it was caused by a driver violating the law. Kathy filed an insurance claim and provided all the details of the accident. The 19 year old driver lied about what happened. Our insurance company decided Kathy was at fault, gave her a point on her driving record, and added a multi-year surcharge to her insurance. When Kathy pursued the issue, noting that the 19 year old with the poor driving record was lying, the insurance company told her that without a photograph of the accident or an independent witness who was willing to verify the events, they would have to believe the 19 year old because Kathy was exiting a parking lot and that makes her at least 51% responsible. Despite Kathy's over 30 year good driving record, the insurance company representative literally ended the conversation with the statement "Life isn't fair". That episode temporarily caused Kathy to lose her faith in humanity and gave her a sense of helplessness in a hostile world. As with any conflict or issue, for everything there is a process. Kathy appealed the ruling to the Massachusetts Board of Insurance and wrote an eloquent letter stating the facts. Today the Board of Insurance ruled she was not at fault, rescinded the point on her license, and demanded that the insurance company refund/rescind the surcharge. She cried when she opened the letter. The nice guy can still finish first. This weekend we'll continue our search for local farmland by touring Harvard, Massachusetts with locals recommended by our next door neighbor. The cancer diagnosis constrains our possibilities but has not dulled our enthusiasm for a long and fulfilling future. 
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