Monthly Archives: March 2014

Simplicity – Too Often Missing in Health IT

Post by Ed Barthell, MD

Medical Director, Americas, Caradigm

(sim-plis-i-tee), noun  –  simplicity. The quality or condition of being easy to understand, deal with or use.

Simplicity relates to the burden which a thing puts on someone trying to explain or understand it.  We hear again and again from health care workers that the information systems they are asked to use are not simple and present them with a great burden. For example, according to a recent Johns Hopkins study that closely followed first-year residents at Baltimore’s two large academic medical centers, medical interns spend just 12 percent of their time examining and talking with patients, and more than 40 percent of their time behind a computer.1

We hear the phrase KISS (keep it simple stupid) as a worthy goal. One of my favorite books on effective messaging is from the Heath brothers entitled “Made to Stick”.They propose the acronym SUCCESS and the first S stands for “Simple”. In order for messages to stick they must be simple.

So why is simplicity in health IT so hard to achieve? The simple answer is lots of reasons.

The healthcare domain is complex and rapidly changing, and many IT vendors try to solve many healthcare problems for many users at the same time. Committees that make purchase decisions tend to judge IT vendors on laundry lists of functionality and pretty colors rather than focusing on apps that solve common problems for specific groups of end users in a simple and elegant way.   Health care is not unique, I’m writing this blog with the word processor application, Microsoft Word, that dominates the market. It contains tons of functionality that neither I (nor probably 99% of end users) take advantage of in our day to day use.

The concept of simplicity is one of our value statements at Caradigm. It underlies our commitment to an open platform plus applications approach.  Ingest data from multiple source systems once, then allow that data to be used by multiple apps for multiple purposes. So apps can simply and elegantly solve problems for specific end user groups that are not well served by generic monolithic systems.

Simplicity in design allows apps to shield end users from complexity and enables providers to focus on what’s important. Specific examples? A surveillance app that automatically calculates a MEWS risk score in near real time on patients throughout a hospital, so that a simple numeric score triggers activation of the rapid response team. Another application that uses machine learning to generate a simple score to reflect likelihood of readmission, so a specific group of end users, in this case discharge planners, can prioritize the assignment of resources. An app that includes a rules engine to help guide care managers to focus on the most important of many tasks that need attention in a given day. The bottom line is health IT applications that are not a burden but instead make it simple for users to do their jobs well.

As our value statement explains, a simple solution is a beautiful thing. In a world of increasing complexity, we take joy in striving for and achieving simple excellence. This is a value we will continue to pursue with vigor.

  2. Heath, Chip and Heath, Dan: Made to Stick: Why Some Ideas Survive and Others Die. Random House, 2007.

Healthcare in Developing Countries

Post by Wilson To, PHD

Product Manager, Caradigm

A small team from Caradigm, including myself, traveled to a number of small communities around Tena, Ecuador and volunteered our services and expertise to Timmy Global Health.  The organization provides direct medical assistance and healthcare services to low-resource communities in the developing world through short-term medical brigades. The goal is to facilitate long-term capacity development and strengthen local health systems.

Last year, volunteers from Caradigm and Microsoft implemented a lightweight electronic health record system across the villages in the Amazon jungle. With a gasoline generator powering a system of networked laptops and wireless router, the team was able to maintain a clinic-wide solution that was used by every volunteer to capture data in electronic formats. From capturing medical history, vital signs, laboratory reports, scribed physician notes, treatment orders, and dispensing instructions – we’re expecting to continue using this tool to provide a completely integrated system to help view longitudinal patient records and improve care quality in the region.

All of the work we all do in the healthcare industry – whether developing population health management systems or providing quality clinical care to patients – ultimately provides a foundation towards improving global health. Much of the same science and best practices that we have in the United States can be modified and applied to low resource communities – a strategy that has yielded great progress in advancing the global health agenda. We have reduced healthcare inequities, reduced child mortality, and eradicated diseases. However, there are still a number of challenges and opportunities to improve the efficiencies in our systems. This adventure helped me understand a different side of healthcare and a better perspective as to what sort of disparities continue to exist today.

I’ll be providing a recap of the trip in a future post, so stay tuned!


Emerging Themes at HIMSS14

Post by Scott McLeod

Director of Product Marketing, Caradigm

I attended the annual conference of the Health Information Management Systems Society (HIMSS) in Orlando, Florida. Boasting 38,828 attendees, HIMSS is the largest health IT show in the country.

Attending educational sessions and touring the mile-long exhibit floor, one could identify the concerns and priorities of providers and vendors. Key drivers discussed included accountable care, big data and business and clinical intelligence; many vendors made claims of “population health” solutions, if they could address even a small part of a customer’s needs.

I believe the industry will have a bit of a shakeout as the market identifies those vendors that deliver the data control, broad analytics and care solutions needed to succeed in population health.Two emerging themes, in particular, caught my interest—an emphasis on patient engagement and a gap separating population-health pioneers and vendors from the market majority.

In presentations and through Twitter (HIMSS reported 63,839 tweets during the show) attendees discussed various aspects of patient engagement. One thread discussed the provision of more information—presenting quality and cost delivered by organizations—to enable and prompt consumers to make better healthcare decisions. Another thread discussed the need to support family caregivers—the least expensive healthcare providers we have. What struck me is the emerging expectation that consumers must shoulder the twin burdens of making appropriate cost/quality decisions and an increased reliance on self-management or family care for their health. For a population that has looked to providers to make healthcare decisions and deliver care, this change may run into resistance—and, according to a HIMSS Leadership Survey, only one percent of organizations identify “Consumer Healthcare Solutions” as a top IT priority over the next two years.

While signage on the exhibit floor promoted solutions for population health and advanced analytics as the solutions de jour, the topics of many educational sessions communicated a different place on the path to value-based care. A few sessions presented the learning of accountable care organization (ACO) pioneers. Many others, however, discussed other priorities—Meaningful Use, quality measures, health information exchange, electronic health records, HIPAA compliance and ICD-10 transition. This is consistent with the HIMSS Leadership Survey which identified “Achieve Meaningful Use” (25%), “Optimize Use of Current Systems” (19%) and “Complete ICD-10 Conversion” (16%) as three of the top four IT priorities over the next two years. “IT Support for Risk-Based Contracting” placed in a distant sixth place with only 3% of organizations naming it a priority.

What this shows is that healthcare delivery organizations have more on their plates than a transition to value-based care. When they have the capacity to make that transition, and make the IT investments necessary to support population health, a role will exist for analysts and vendors and pioneers to help guide that transition. As one presenter stated, “the success or failure of a nationwide transition to value- based care hinges on the ability of hundreds of ACOs to learn very quickly from others.”

HIMSS14 Convention Center

Clinical Surveillance from Three Perspectives: Nurse, Patient, Vendor

Post by Jennifer Crandall, RN, BSN

Clinical Analyst, Caradigm

I have been on the nursing and vendor side of patient surveillance for more years than I would like to admit in print. In providing clinical surveillance, we nurses have the potential to minimize negative outcomes by preventing adverse events or deterioration in the patient’s status. As a vendor, it is our job to enable health systems to take enormous amounts of data from multiple sources to gain insight that drive decisions and actions. These actions can ultimately improve patient outcomes on a much larger scale. This large scale effect is one of the reasons I can be so passionate about a job that isn’t at the bedside helping patients. I am frequently asked “do you miss direct patient care?” At this point, I honestly can say I do not. I can help exponentially more patients by helping facilities understand their own data and use it to improve outcomes across all of their patient populations. And if I can make the job of collecting and using data less “painful” and more beneficial for my fellow nurses, then even better.

When I refer to Clinical Surveillance, I am specifically referring to the collection and analysis of health data about a clinical syndrome/condition that has a significant impact on the health of the population. This data is then used to drive decisions and actions.

It wasn’t until a recent experience from the patient side did I really take a look at what all of this surveillance data meant to me personally. In the days leading up to my surgery, in typical nurse fashion, I began to run through every worst case scenario in my mind. Suddenly hospital acquired conditions and infections (HACs) were no longer just statistics and numbers. Drug resistant wound infections, blood clots, air embolisms or a catheter associated infection, were all conditions that could now happen to me. I thought of the phrase “ignorance is bliss.” Wouldn’t it be better if I didn’t know all of the things that could happen to me?

I was determined that I would dictate a great deal of my care to help ensure I escaped the inpatient experience unscathed by any HAC or other negative outcome. While my intentions were strong willed, once I was post op and medicated, preventing a negative event never again crossed my mind during my stay. Most of my cognitive exercise was spent trying to locate the button for the wonderful machine that delivered the elixir of pain relief or making the long eight foot trek across the floor to the rest room.

It wasn’t until after I was home that I realized that despite my good intentions, we must rely heavily upon the care teams and facilities to keep us as safe from these conditions. It was clear that they were using past surveillance data and studies to keep me safe. Because my surgery (per historic data) did contribute a risk factor for Deep Vein Thrombosis (blood clots), they put the SCD (Sequential Compression Device) on my lower legs from post op to discharge. I was given the proper pre-op and post-op antibiotics to ensure my risk of surgical site infection was minimal. They also kept all devices that came in contact with me – such as blood pressure cuffs and stethoscopes – in my room, thus cutting down on my chance of getting a drug resistant infection from other patients.

I have no doubt that my inpatient experience was influenced by clinical surveillance data collected and studied. While it is always very important to be an informed patient engaged in our own care, I do now realize that clinicians and vendors who collect and study this data are the ones who are able to get insight and drive actions for our positive outcomes.