Not missing the “M”

Cryptic headline, eh? Maybe it grabbed your attention. True, it doesn’t reveal much about what’s on my mind lately… Glad you asked….

While I am not about to divulge details or to impugn anyone’s motives or intent, let’s just say that this fall, one of the “hats” I wore previously is perched on the hat rack, duration not yet clear. That would be as an adjunct instructor in health informatics. Note that this refers just to the part-time application of that calling in the academic setting. As a professional informatics and analytics evangelist, I do lots of informal teaching and coaching in my full-time job. I am also engaged in bringing along a team member who’s a novice nurse informaticist, and there are prospects of adding more to the team.

So, while I take some time off from the academic discipline of health informatics, I get to reflect on the nature of that body of knowledge. Specifically, I wonder if the program to which I have lately contributed is as much a health informatics (HI) one, strictly defined, as a health information management (HIM) one. Oddly enough, for such an arcane question, it seems others have asked a similar one. Do an online search for “difference between informatics and HIM” and you’ll see; it will save me posting multiple links here, as they are pretty easy to find.

Bottom line, the HIM discipline tends to focus predominantly on the organization and coding of medical data. It certainly uses the modern technological tools such as EHRs and databases to accomplish its goals, but by necessity its core competencies revolve around making sure the data are collected and classified in a way so as to optimize reimbursement and to demonstrate compliance with the ever-evolving regulatory environment. The “classic” preparation for someone looking to further his or her HIM education/career path, thus, includes heavy emphasis on coding and reimbursement concepts. HIM program faculty should possess commensurate credentials.

Health informatics, by contrast, stretches across multiple professions and stresses the development and mastery of IT-based solutions to improve patient care and clinical processes. Not surprisingly, there are sub-categories here, including medical informatics, nursing informatics, pharmacy informatics, public health informatics, etc. Each provides a niche for clinicians-cum-technologists to practice at “the intersection of computer science, information science and healthcare” (Mohiuddin, 2014).

Examining the distinction between HIM and HI, then, there is absolutely no doubt that my particular talents are squarely in the HI arena. Yes, I have acquired a working knowledge of coding constructs and the like in the course of my daily work, but my passion is to improve patient outcomes and population health using information technology.

As such, I ponder the “truth in advertising” relating to graduate curricula proclaiming themselves health informatics programs, when they are staffed solely by HIM experts. I freely admit my bias, but a health informatics faculty devoid of clinicians lacks a vital area of expertise. Conversely, regardless of how a program is named and marketed, my featured skill set is not exactly simpatico with that needed to facilitate the learning of HIM students.

The healthcare industry today needs more of both HI and HIM professionals. I do ultimately hope to return to the calling of preparing HI professionals on an adjunct basis, while maintaining my “day job.” Who knows, I may even find an opportunity to lead a course in health IT in a more generalist health administration program. I always keep my options open.

References

Mohiuddin, N. (2014, January 29). Health information management vs health informatics: What’s the difference? (Nursing Informatics & Technology web log post). Retrieved from http://community.advanceweb.com/blogs/nurses_18/archive/2014/01/29/health-information-management-vs-health-informatics-what-s-the-difference.aspx

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Quick hits

I am way overdue for some observations on the passing scene. Each topic here is surely worth one or more full posts. I will defer at this time, though if someone wants to comment and request a fuller dialogue, I’m game.

Black and white?
Ferguson. Staten Island. Cleveland. The news cycle has been feeding on events in these locations for months now. Unvarnished racialists are cherry-picking isolated, unrelated incidents to paint a demonstrably false narrative that white police systematically, intentionally, and criminally go out of their way to use deadly force against unarmed young, innocent black victims based solely on skin color. All of the situations are much more nuanced than that, as the grand jury decisions have indicated. And, as some courageous journalists have pointed out, it’s not hard to find shoes on the other foot that have not generated any interest from the dinosaur media, who won’t let balance get in the way of their chosen narrative. Their latest panacea: nationalize the police. What could go wrong?

Presumed guilty
Speaking of our friends (?) in the left-wing media and their narratives, the one about rampant rape culture is getting refuted big-time. Perhaps Lena Dunham would have benefited from some time in the gym rather that stitching together what is likely a libelous smear against a fellow Oberlin collegian. Plus, the story of gang rape at the University of Virginia is exposed as just that, a concocted story. We now hear that, even if these specific items are the fairy tales they have been shown to be, the circumstances demand that, contrary to the concept of due process of law that Western culture has honored for a millennium, the accused rapists are guilty until proven innocent. We must not stand for the destruction of the fabric from which our legal system is woven.

OCD on ICD?
On to my professional beat. The oft-delayed ICD-10 transition is yet again a political football. Those not in the business neither know, nor much care, about the controversy. Let’s just say that the current ICD-9 coding system is oh, so 20th century. The underlying problem is that the ICD classification systems, whether they be 9, 10, or 11, don’t correlate well with the goals of nomenclatures like SNOMED CT, which align more closely with electronic health record software. Until the twain shall meet, the tensions will persist, and whichever lobby is strongest in Mordor on the Potomac River will prevail. That is not the most intelligent way to decide such an important issue.

Sour mash Wisky
Now, a lighter topic. My home state Buckeyes barreled their way into the college football playoffs with one of the more dominating performances you’ll ever see, in their defeat of Wisconsin last night. Clearly tOSU made the most compelling closing argument. My main head-scratching question right now is, with the arm Cardale Jones showed us, why has he been riding the bench until now? Anyway, Buckeye Nation had its prayer answered, and if they can knock off Nick Saban’s Alabama crew, this team can be more than just an Urban legend. But the biggest takeaway was, exactly as I opined when the current playoff scheme was first foisted on us, that four teams do not a true championship playoff make. Even eight teams may not be enough. Ten to sixteen is more like it, but the required reduction of regular season gate receipts likely makes the logical solution a non-starter. Meanwhile, the spectacle still succeeds in drawing eyeballs to itself, which is all its purveyors really want.

Boys will be girls
Unfortunately, “what they want” in Minnesota seems to be the extermination of high school sports. The PC push to make sports programs transgender-friendly inevitably led to a ludicrous policy that appears to erase any distinctions between boys’ and girls’ teams. So, when all teams are co-ed, what opportunities will there be for 5-foot-5 girls to play varsity basketball? Does this further the competitive opportunities for 99% of young women? Is it worth it, just because Johnny is in denial of how God made him, and thinks he’s Janie instead?

What say you?

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Stay thirsty, my friends!

I have to admit, I watched some of the wall-to-wall, commercial-free, all-crisis-all-the time coverage on the Toledo TV channel yesterday. Yes, I have some initial thoughts on the situation. (No time to start disappointing folks now….)

First, as to the acute matter itself. Seems like the mayor and his team are doing a decent job of organizing the tasks involved with distribution of emergency water supplies to the community. I’d like to think the same holds in the suburbs and other communities who get their water from the Toledo supply, though at least on 13 news that does not seem to be noteworthy. Of course, the $64 question is when will the Toledo supply be safe, so that is where the focus understandably remains.

Again, this is solely based on what’s served up by the Toledo media, but it’s also heartening that people in the affected areas, and well outside of it, are pitching in to help and get water to those who need it most. There is only so much any level of government can do, and the success of such an operation inevitably depends on the bulk of the populace being altruistic. Kudos to everyone who’s helping!

One can’t help noting that a few politicians found opportunities to grandstand for votes for themselves and for their party, really grating at a time when affiliation shouldn’t matter. (Yes, Teresa Fedor, I mean you.) On the other hand, while it was doubtful that Governor Kasich had much of a shot at carrying Lucas County before this weekend, his delayed appearance (still pending at this writing) makes it certain that he’ll need to rely on other areas of the state to win a second term.

So what about the origin of the problem and how to remediate the region’s water woes over the longer term? There are multiple factors at play in the worsening of the algal blooms in Lake Erie, which are generating the harmful microcystin toxins. I’m sure there are idiots out there blaming it on global warming, despite this past July having been one of the coolest in memory. The unending stream of organic material deposited into Lake Erie, whether it be runoff from farms into the Maumee and other rivers, overflow from the aging Detroit storm sewage system that can’t handle the rains that it needs to, or other sources, simply has to be addressed. Readers of this blog will not be surprised to learn that I don’t believe this is a matter for intervention by the federales. In fact, I am confident that their heavy hand will only make things worse and more expensive all around.

No, this problem was created in Ohio and Michigan, and the two states need to stop sniping at each other, ‘fess up, sit down, and come to grips with a problem that won’t solve itself. Governors Kasich and Snyder, time to address the root cause before the EPA comes in with jackbooted force. Is it going to cost a lot of money? Yes. Is it going to upset agribusiness? Yes. Will the politicians make enemies? Yes, though arguably fewer that they are managing to create with the current circus.

Finally, while the local TV stations may be reaping a ratings bonanza given the way they have latched on to the crisis, I don’t believe they have served their audience particularly well. Viewers can only take recycling of the same handful of remote reporters at distribution sites, no news to report except that people are still lugging water bladders about, so often before getting tired of it. Same for the consumer reporter breathlessly informing us of price gouging (the fact that jerks will be jerks, even in a civic crisis, should be no news flash) and the meteorologists showing us every ten minutes where the algae are (and where they will probably be next week). Surely many interested viewers gave up on hearing anything new and switched to other fare. Better, I suggest, would be to announce that aside from breaking events like the next mayoral press conference (based on this morning’s performance, perhaps even that doesn’t qualify), the news folks will come on at the top of every, say, four hours with a 30-minute wrap containing only what’s, well, news. They can keep running their crawls across the bottom of the screen screaming, DON’T DRINK THE WATER! as a public service, but as for the blanket coverage, I think every local now knows what the bottom line is—and does not need it intoned every five minutes. Just sayin’….

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Random summer thoughts

No single topic today, just keeping the blog semi-warm while the mercury creeps back up as we expect in late July.

My health lately has been a mixed bag. I never have been able to shake the constant paresthesia in my right posterior thigh and lateral aspect of my right foot, which first appeared after my back injury in February. Neither gabapentin nor pregabalin seem to have had any effect. At this point, I must operate under presumption this will be permanent. Especially disappointing since it has affected my leg strength and gait. Whether spine surgery for the underlying pathology would help this, so many months out, is questionable.

Fortunately, the symptoms do not prevent me from getting in lots of walking time on the treadmill. And that brings me to the upbeat side of things.

Without having done a lot of research into it beforehand, I applied through the company’s wellness portal to participate in a weight loss program called Naturally Slim. Actually, though my weight loss goals were not prodigious, I have found it to be a very welcome aid to what I had already started with monitoring food intake. The primary emphasis in the regimen is on portion control, which I have always known to be my biggest problem. Where it helps the most is in putting some structure around the exercise: eating slowly to “taste every bite,” waiting until one is actually hungry to eat (which can zap snacking), and eating one food at a time. While I don’t profess to follow all the prescriptive habits, I have been able to add some of that structure into reducing the amount of food I eat each day. I know the NS gurus abhor calorie counting, but this quant can’t help it, especially when the Fitbit app makes it so easy. What I have been able to tell that since joining the NS program, my daily intake has dropped from the 1800-2000 kcal/day range to around 1400. The key will be, do the new habits I’m learning now result in the behavioral equivalent of “muscle memory” that will keep me in that same ballpark over the long haul?

Between that and the increase in calorie burn from exercise, the weight loss is coming right along. 24 pounds in a shade over two months. Other metrics are positive as well. Blood pressure is now in ideal range, and lipid profile done in June was better than I could have imagined. Perhaps at next PCP visit we try getting me off the lisinopril and atorvastatin and seeing how I do. Better living without chemistry?

Elsewhere in life. I have also been picking up the pace in the reading department. This is largely due to my next second-job endeavor, starting this fall as an adjunct faculty member in an online master of health informatics program. I just had to submit my syllabus for the fall course in healthcare IT networking and security, which required that I get through the required texts, as well as suggest some other readings for students that actually connect back to healthcare. I also cooked up some interesting writing assignments. The term begins in five weeks.

All of this, plus the regular work schedule, has cut significantly into social media presence. My Facebook time is way down, and I hope my much reduced volume of status updates isn’t disappointing to those who, I’m sure (LOL) hang on my every syllable of wisdom….

Last but not least, we have put some weekends aside in pursuit of Zora’s RAE (Rally Excellent Advanced) title. Having achieved all three of the basic titling levels in rally obedience, the objective here is to earn qualifying scores in both the advanced and excellent classes—at ten separate trials. Each one of these blessed events is referred to in the jargon as a leg, also sometimes termed a double Q or QQ. Well, after two QQs in Maumee at the beginning of June, and two each the past two weekends in Monroe and Moraine, Zora and Rita are up to six legs—though not to be confused with an insect. We return to Moraine for two more trials next month.

OK, enough computer time for now. I have a stack of print magazines to get through (hopefully with some useful nuggets of information I can leverage in one or more of my jobs) before the weekend is over. Stay cool!

 

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Socially transmitted disease

A Cincinnati woman is using UC Medical Center after three of its employees allegedly posted a screen shot of her medical records for syphilis on a Facebook page called 'Team No Hoes' last fall.

This troubling story, authored and disseminated by the Associated Press, appeared in my local newspaper this morning. Those of us who work in healthcare and deal in protected health information (PHI) on a daily basis can only shake our heads in disgust at the woman who is alleged to have obtained PHI in order to defame another person. If indeed that is shown to have occurred, she should be liable for the damages that are awarded. But what about the hospital???

Disclaimers:

  • I am not a lawyer and cannot pretend that my coursework on legal issues in healthcare, or my years of handling similarly sensitive PHI, constitute bulletproof legal thinking.
  • I know only what is in the AP story, which does not appear to have picked up much embellishment in other news sources, with the single exception of the New York Daily News. There’s no assurance that the published pieces present all the facts of the case.
  • I’m a former colleague of the hospital administrator quoted in the story.

On to my take.

The plaintiff’s gambit is clearly to invoke a wide blanket of the respondeat superior doctrine, which holds an employer liable for torts committed by its employee in the course of his or her employment. Those who have studied health law are well familiar with the concept and its impact on healthcare organizations whose employees may act negligently while providing patient care or other medical services. Note that plaintiff’s attorney indicated the plan of attack by boasting, “They can’t hide behind a shield of, ‘This employee was acting outside of the scope of their responsibilities.’ If that’s going to be their defense at trial, I’m looking forward to the trial.”

His argument rests on the judicial consensus that when an employee is clocked in to work, at the workplace, and using the tools provided by the employer (in this case, computer and patient billing system), the employer is responsible for the bad actions of the employee. Broadly speaking, that’s correct.

But, as Lee Corso says, not so fast, my friend.

A little closer read of the bounds on scope of employment, with relation to an employee’s action, is that it must be performed “at least in part, by a purpose to serve the master” (Dobbs D, Keeton RE, Owen DG: Prosser and Keaton on Torts. Keeton WP (ed). St. Paul, West Publishing Co, 5th Ed, 1984, pp 501-502). When the defendant employee allegedly looked up the patient’s billing record at the instigation of the rather unsavory male sexual contact of both (I was going to say love interest, but I doubt there was much real love involved), the action cited cannot possibly be construed as one which even in part served the interests of the hospital. Not in any way.

If the UC Medical Center is held liable in this case—despite presenting (one assumes) the proper documentation that the employee was trained in responsible use of PHI, her agreement to follow the policies she willfully breached, and the appropriate audit trails, not to mention the fact that it fired her upon learning of her act—think of the chilling effect it could have on all manner of organizations in the medical services industry. People in billing departments, by definition, need to be able to access, well, billing records. How else does a hospital reasonably deter the scoundrel within its walls who is determined to steal information he or she is not entitled to see, much less cause to be plastered on a social media site?

I could, and perhaps may in the future, additionally weigh in on other themes in this story. For instance, it does not appear that the plaintiff denies that she indeed contracted an STD, just that the distribution of that fact on a Facebook group led to harassment and emotional distress. (Guessing the Walmart in Cincinnati was sold out of big-girl panties.) And what about Facebook itself? Maybe they should try to name Mark Zuckerberg in the lawsuit as well, since he was obviously complicit in allowing a group named “Team No Hoes” to exist on his company’s platform.

Bottom line: bad actors will behave badly, regardless of the avenues available to them. If you run me over with a Chevy, am I free to sue GM?

 

(picture retrieved from http://assets.nydailynews.com/polopoly_fs/1.1817389.1401923982!/img/httpImage/image.jpg_gen/derivatives/article_970/university-cincinnati-medical-center.jpg?enlarged)

 

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Computer scare

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I don’t know whether to laugh, cry, or scream. Today in my news feed I found a short article from the online site of Health Data Management magazine, Nurses Union Rails Against ‘Unproven’ Medical Technology. About the only thing I can commend it for is that the headline puts ‘unproven’ in quotation marks.

It serves as a PR prop for an advertising campaign of, sad to say, a nurses’ union. Now, mind you, I am not intrinsically opposed to the concept of nurses organized to better their working conditions and to bargain for competitive wages. I am on the board of directors for a district of my state nurses’ association, and the state-wide unit is heavily engaged in representation of working nurses as a collective bargaining unit.

The union’s press release, which is generously parroted by a supposedly respected health IT site, uses a theme that I have no quarrel with, Insist on a Registered Nurse. But the release itself consists of unsubstantiated attacks on all manner of technological advances that touch the patient care workplace. Prominently featured is a three-and-a-half minute “fun new video” titled “Computer Care.” Those in the field will immediately discount it as being 100% parody, from the bean-counting administrator to the computer geek trying to enter data into the system while the patient has a heart attack. But, of course, those in the field are not the target audience. It is the general public, who are being encouraged to rebel against electronic health records (EHRs) and the like, and to equate more technology with fewer nurses.

The press release repeatedly claims that EHR technology is “frighteningly” unsafe and experimental, and that countless lives are endangered on a daily basis by its use. Not one shred of evidence is adduced to support this assertion. It falsely states that EHRs “dictate treatment for patients.” In fact, while they do a decent job of using sophisticated clinical decision support algorithms to suggest best practice guidelines that a clinician might consider, they do not dictate the care provided. Supposedly the systems “too often fail.” No context is provided; how many times is “too often”? In reality, unplanned downtime is rare, and when nurses participate in well-executed planning for such events, patient care can proceed with a minimum of detrimental effect.

It makes a fallacious connection between improved electronic tools in hospitals and the shift from inpatient to ambulatory and population based care. It even tries to tie EHR adoption to the perceived disparity in U.S. health statistics like infant mortality and life expectancy.

I expected better from this outfit, but perhaps I was being overly optimistic. Perhaps they would really like to have nurses robbed of useful, life-saving technology. Think of an inpatient care environment without heart monitors, defibrillators, IV pumps to safely deliver drugs made possible by recombinant DNA techniques, lab tests that are resulted in seconds rather than hours—I could go on and on. Not to mention, we would relegate nurses to go back to writing out all their notes, vital signs, etc. in longhand, as well as deciphering the illegible scribbles of others on the care team. Now, that’s dangerous.

Totally unmentioned in this hit piece is the fact that in the most successful EHR implementations, nurse informaticists and staff nurses are integrally involved in the planning, design, implementation, and training. This is precisely because we know that nurses are the patient’s best advocates and will insist on workflows that improve, not worsen, patient safety.

To sum it up, health IT helps make care safer and more efficient. Are nurses really against that?

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Putting the Flex through its paces

Nothing profound or political today. As I root for the elusive sun to come back out and warm us up—it appeared oh, so briefly a bit ago but retreated again—I guess I’ll just stay on the treadmill a bit longer instead.

I now have a few days with the Fitbit Flex under my belt. Literally, as it happens. Yes, I know it is supposed to be worn on the wrist. But I have been of the tribe that usually holds onto the treadmill rails while doing my brisk (about 14 minutes to the mile) walks. (Go ahead and abuse me, Jillian Michaels!) As I had discerned from my research, that habit definitely does not pick up most of my steps. But attaching the bracelet around my belt does. That way I can continue getting virtual credit for the calories I am burning.

It really is like a game, and one I do not mind playing. I have been relatively good with staying within my calorie limits. But so far I find that even while the Fitbit app “permits” more food calories when more exercise is tracked, after days like yesterday when I burned a lot and ate accordingly, the number on the scale (the most important one!) went the wrong direction. So, given that Rita has declared tonight to be pizza night, I am pretty much starving myself until dinner time, and racking up a goodly quantity of steps, distance, and active minutes.

Indeed, and this is no news flash, my main problem has always been portion control. And keeping a food diary is one powerful way to help keep that aspect in check. It has been a few years since I last went that route, and the tools are better today. Last time around, I used a clunky BlackBerry app whose name I do not even recall (was there EVER a BlackBerry app that wasn’t clunky?); tracking food on it was so onerous I only kept up with it for a couple of weeks. While the Fitbit app and website aren’t perfect by any means, they are a big improvement. Hopefully I can stay on the “program” long enough to make a big difference on the scale.

The other developing story for me at present is continuing progress toward coming on board as an adjunct faculty member for a local college’s health informatics program. More on that when the deal is sealed. But we’re projecting first eight-week course this fall on networking and security in health IT. There’s certainly no shortage of news stories these days in the HIT security world, and I am keeping a virtual clipping file to supplement whatever readings are in the syllabus. Watch out, students! 🙂

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