By Mike Farahbakhshian

March 2018: B-Side

In this month’s article, Mike Farahbakhshian refuses to beat the HIMSS horse any further, and instead focuses on over-the-horizon changes to look out for. Time to read: 9 minutes. Suggested drink pairing: see below.

Required Writing: or, a Grudging Introduction in Hot Take Form

God, I don’t want to do this. Yet it would appear that I am required by law to give you a HIMSS wrap-up that hits all the Federal Health IT Buzzword Compliance Regulations. Let me get this over with. I’ll give you the bottom line up front, plus I will provide appropriate wine and hashtag pairings.

Buzzwords Bottom Line Up Front Wine Pairing Hashtag Pairing


Everyone promises to use SMART on FHIR. Vendors handwave over whether they will “embrace and extend” in proprietary ways.
It’s the EDI standardization battles of the 90’s all over again, except Netware didn’t make it.

Merlot, sipped while watching C-SPAN archival footage and wearing Hypercolor.

#90s #rerun #netware #RIP


Chicanery and snake oil. Useless for point of care, so being pitched at supply chain and research applications.
No one has a use case that can’t be done more efficiently and less chattily than a RESTful eCRUD solution.

Thunderbird or Mad Dog 20/20, chugged while trying to keep a straight face.

#tulip #bubble #sham #scam #flimflam #forgetaboutit

AI in Healthcare

It’s Watson.
Or it uses Watson. But mostly it’s Watson.
Nobody got fired for buying IBM.

Grenache, sipped slowly while waiting for Skynet to execute you via drone army.

#ai #watson #machinelearning #machineislearningtoomuch  #ohgodthekilldrones #Skynet #latestagecapitalism

VA EHR Modernization

Everyone’s hyped about Cerner. It’s happening!
Maybe it isn’t happening. No wait, it’s happening.
To reassure critics, Secretary Shulkin tries to throw DHA under the bus. Will it matter once he’s voted off the island?

Amontillado, slightly chilled, sipped while shouting “For the love of God, Montresor!” at whatever news article you’re looking at.

#survivor #battleroyale


DHA: Don’t throw us under the bus! Rollout is going great!
Reality: Rollout is not so great.
Physicians are concerned about data transfer.

Chardonnay, with a black fly in it and Alanis Morissette just standing there like “whatever”.

#completely #unexpected #mnightshyamalan #twist

Lighthouse API

VA: Hold my beer, DHA. Let’s standardize 30 years of siloed IT…
 … using a brand-new API management paradigm …… based on a to-be-fully-decided COTS tool …
… that we extend via crowd-sourcing micro-consulting procurements …
using micro-transactions via GitHub!

Switch to a handle of Sailor Jerry’s at this point and
do this.

#yolo #yoloswag #carpediem #carpeyoloswag #avocadotoast #holdmybeer


Okay, are we done with that now? Did you learn any lessons? Or was it a pro forma buzzword bingo?

GLHC did it better. Source: GLHC

Too bad. If you want a good wrap-up, read some of the excellent pieces on Instead, I’m going to move on to the cool stuff that you may have missed, the stuff that has been overshadowed by the hype. Welcome to the Hype-Free Zone.

Reverse Telemedicine: Bringing the Mountain to Mohammed

As another blogger put it: telemedicine has moved from the HIMSS dungeon to the main floor. The goal of telemedicine, historically, has been honed in on connecting providers with patients who are far away or have mobility issues. As part of this connection, telemedicine has focused on relaying vitals and metrics, images and two-way chatting capability between patient and doctor. Yet, there’s another way of closing the gap between patient and provider.

And that’s by closing the gap between the patient and provider. Physically.

Both Uber and Lyft have started Healthcare transportation services. Before anyone rolls their eyes and draws comparisons to ambulances, this is meant to avoid significant costs to hospital networks in missed (scheduled, non-emergency) appointments. Currently, more than 3.6 million Americans per year miss doctor appointments due to an inability to access reliable, timely transportation. These missed appointment can cost an individual practice around $150,000 and the overall Healthcare industry up to $150M a year. This affects Federal Healthcare as well, with one military hospital losing $260,000 in a month from no-shows. Hospitals are paying out of pocket for these rides so far, because it is still cheaper than money lost in missed appointments. Presumably, the next step is to hook these ridesharing services into Federal Health infrastructure: VA community care, DHA purchased care, Medicare and Medicaid.

Plus Uber Lux if you need to see your doctor about your affluenza.

That’s not to say there aren’t kinks to be worked out – namely ensuring patient information is kept secure – but the bottom line is this “reverse telemedicine” brings the mountain to Mohammed – but it is a simple and straightforward use of technology to squeeze efficiencies, save costs and improve patient outcomes. The technology itself isn’t futuristic or revolutionary – it’s no Watson or SpaceX – but it’s a novel implementation of simple technology that solves real problems. That’s the kind of tech evangelism I can get behind.

AI for Revenue Lifecycle Management: Unsexy, but Critical

Look, it doesn’t matter whether the Healthcare system is single or multi-payer. The bottom line is that money will change hands. “Revenue Lifecycle Management” was the buzz word du jour a few years ago, and it’s still a key driver in the outsourcing of billing and collection overseas to the Philippines, India etc.

However, with the move from fee-for-service to value-based care, advanced cost accounting needs to be introduced to the revenue lifecycle. So… what does advanced cost accounting mean? What makes it advanced?

Two words: Artificial Intelligence.

Daisy, Daisy, give me your answer do / I’m half crazy, recouping this revenue.

AI for cost accounting may not be as sexy as Watson telling you your hangnail isn’t malignant, but it’s critical for enabling inter-network referral and billing. While governance standards like TEFCA make possible a number of Qualified Health Information Networks (QHINs), we must remember that these QHINs will eventually form a nationwide network of networks.

Like this, except actually the crappy Voltron with a million little cars and such; each represents a QHIN.

TEFCA is just a governance framework. In terms of operationalizing these larger, more interoperable hospital networks, we will need AI-assisted cost accounting. The AI will allow these QHINs to work as a network of interoperable value-based organizations. They will analyze revenue lifecycle goals and key performance indicators. Furthermore, they will – with good UI/UX design of course! — ensure that patients will have a way to view statements and invoices, and challenge them as necessary.

The latter part is critical. Good communication means swift satisfaction of debts. Bad communication means that debts linger, accrue unneeded interests or go to collections when they don’t have to. Sometimes, there’s a data entry mix-up, a misallocated order or perhaps a misspelled name in a legally binding document which takes weeks to resolve. It’s more common than you think.

I. Have. Opinions. On. This.

By ensuring a smart AI, along with common-sense options that put the patient first – like payment plans or language-accessible documentation, hospitals can get a huge ROI boost. In some cases, this boost can lead to a more than 7,000 percent increase in monthly collections. In an era of rising Healthcare costs and tighter margins, squeezing any blood from this stone will help keep hospitals solvent and focusing on their prime directive: helping patients.

Again: is it sexy? No. Does it bring to mind images of a Star Trek future? No. But it’s a simple and straightforward, utilitarian way to use advanced technology to make the Healthcare machine work easier and better.


If I may mansplain for just one moment…

I think the biggest ripple we will see in Healthcare delivery will radiate from the increased presence of women in Health IT. HIMSS finally making this a priority is dropping that stone in the water.

Too often, “women’s health” issues are handwaved as being primarily related to OB/GYN issues, and treated with the same flippancy and mendacity as a sitcom:

Does this sound like an accurate assessment of women’s health issues by the Health IT community? Source: Achewood.

However, there are a great number of pressing health issues that affect women significantly differently than men. For example, the opioid epidemic has resulted in more than double the deaths from prescription overdose in women than men. But why? Several reasons:

  • Women have, for reasons medical science doesn’t know yet, a higher rate of autoimmune disease and chronic pain conditions like fibromyalgia;
  • Women who choose to give birth are often given opioids;
  • Women have a higher rate of PTSD and sexual trauma, which are risk factors for opioid abuse;
  • The majority of caregivers (66%) are women, and thus under peculiar pressure to provide care while also shrugging off any pain (physical, emotional or otherwise);
  • And let’s not forget women’s fashion, especially high heels, aren’t that great for the back, and opioids are often prescribed for back pain. (Which makes it ironic that Vogue would post a think piece about the opioid epidemic as a women’s issue.)

The Office of Women’s Health has provided the report in full for your perusal and I strongly suggest you read it, lest I mansplain more than I have to.

I happen to agree that more women in prominent roles in Health IT will help drive the use cases, user stories and business needs to help tackle epidemic health issues that affect half of the world’s population in a different way. And that’s a good thing.

The Best Mousetrap Is Public Hygiene

We always hear about building a better mousetrap, but the bottom line is that the best mousetrap is infrastructure that doesn’t welcome vermin. Yet no one trumpets sewer systems, better insulation and agricultural storage systems as “the better mousetrap.” Rube Goldberg made a better mousetrap, sure.

You’ve probably never heard of Eilsworth Kimmel, or Norman T. Harding, Jr., who invented the rodent resistant plastic liners for grain silos and rodent resistant paint, respectively. Yet these two people have, in their own way, done more to remove the threat of vermin damaging crops and spreading disease than any wild-eyed Elon Musk wannabe ever has.

We’re gonna need Space Eilsworth Kimmel and Space Norman T. Harding Jr. to make tribble resistant liners and paints now. Thanks, Elon.

The running theme of these advances you may have missed at HIMSS are this: none of them are disruptors. Instead, they are grinders: slowly and methodically building successful technology and governance models atop one another. They grind to solve new problems while revisiting old problems periodically.

We must never forget that the only goal is solving the problem at hand, and not getting too attached to how we do it. It’s easy to be seduced with concepts like blockchain or machine learning or synchronous video, but sometimes solving the problem means taking a tried and true technology and being persistent and patient. The best mousetrap is, after all, still a group of pissed-off terriers. (content warning: rat terriers ratting)

These aren’t killer apps, disruptors or sexy technology. For example: Using existing technology to make telemedicine happen via a patient transport app instead of fiddling with synchronous video and wonky chat systems isn’t “out of the box thinking;” sorry. It’s creative, it’s novel, but it’s anything but out of the box. Rather, it is focused and determined, with the single-minded pursuit of the core patient need: to make distance irrelevant in providing care. Uber and Lyft didn’t get obsessed with perfecting glitches in video and metrics from home health devices. Rather, they focused on their core capability: moving people on time and leveraged that capability to solve the problem at hand: to make distance irrelevant in providing care.

Likewise, ensuring revenue lifecycle management can squeeze efficiencies from an already taxed system as we transition from islands of fee-for-service to a continent of accountable care organizations isn’t like discovering agriculture. Instead, it’s like discovering crop rotation: an initially unremarkable advancement that turns an unsustainable system into something that can grow and expand to meet needs.

Putting more spotlight on women in Health IT may not solve a problem today, or even tomorrow, but it ensures the use cases – those boring, staid situations we all build software around – more accurately reflects half of the human population. Moreover, perspectives from minorities in Health IT will help link the holistic view of health, wellness, socioeconomic status and prejudice together into a complete picture of what it means to be a patient, and how to better provide care.

The next HIMSS is going to be in Orlando, and I’m sure there will be a new buzzword set to play bingo with. Maybe some of these buzzwords will be great, and I’m sure you will hear about them in this column as I try my hardest to write outlandish clickbait to ensnare your eyeballs. Yet, let’s not forget the massive improvements in Healthcare that you may not have heard about, that will silently and thanklessly change the way we all receive care.



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