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Wednesday, 30 March 2016

Princess Health and March 30th, 2016 Not A Question. Princessiccia

Princess Health and March 30th, 2016 Not A Question. Princessiccia

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March 30th, 2016 Not A Question

This day has been non-stop since 4:30am. I can't keep up this pace, that's for sure. The plan for a refresher nap before a trip to Tulsa and back this evening (duties involving the big broadcasters convention I'll be headed back to tomorrow) didn't happen, thanks to the weather. Part of my job is on-air weather coverage--and the storms moving through this afternoon were just enough to preempt some needed rest.

Let's get right to it--since it's after midnight--I've been home about twenty minutes--All I can say is, thank goodness for good coffee.

Thanks to my phone, I was able to maintain excellent support connections via text messages throughout this rather challenging schedule.

If you read last night's edition, you know I was preparing my brain for a gain simply based on the number of missed workouts of late. Well, after this morning's maintenance weigh-in, I officially give up trying to guess what the scale will say. Obviously, my food plan and maintaining its integrity each day, is working for me in amazing ways.
photo 206.8 weigh day_zpst06zkfuf.jpg
This morning's bi-weekly weigh-in represents a 4.8 pound loss over last time's 211.6. I'm absolutely perplexed. I'm blessed--and VERY grateful, absolutely--but I didn't expect this, at all. I feel great! I'm not worried about this in the slightest. It is sparking some changes, though.

I always communicate with Gerri before and after each weigh-in--just in case I need some perspective. She suggested a monthly weigh-in. And I agree!

I'm keeping my food plan the same for at least the next month. I'll weigh again in four weeks instead of two and we'll see where I am.
photo progress chart 03-30_zpse4k8t5wt.png
Maintenance is working. I'm so glad.

I'm off to bed. My radio show starts at 6am--and I'm schedule to leave for Tulsa, again--at 10:30am in order to be ready for convention activities starting just after 1pm. I'll likely have a late afternoon opportunity for a nap in between afternoon breakout sessions and the evening's schedule of events.

I'll be staying overnight and coming home late Friday after the awards banquet. Plenty of challenges await me over the next two days. From getting this blog posted tomorrow night to food planning--to choices in restaurants and banquet rooms. I will maintain the integrity of my plan--it's not a question--it's non-negotiable. The only questions will be, how challenging will it become and how will I overcome? I plan to succeed.

My Tweets Today:
































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Medstar Health CEO basically admits EHRs are unnecessary after hackers take out its HIT. Princessiccia

Princess Health and Medstar Health CEO basically admits EHRs are unnecessary after hackers take out its HIT. Princessiccia

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It's corporate spin, of course, but that's the plain meaning of what he says:

http://baltimore.cbslocal.com/2016/03/29/medstar-paralyzed-as-hackers-take-aim-at-another-us-hospital/
For a second day, the region�s second-largest health care system deals with a crippling computer virus. MedStar Health says it is making progress, but WJZ is learning some patients are still feeling the effects.

... Despite the challenges affecting MedStar Health�s IT systems, the quality and safety of our patients remains our highest priority, which has not waned throughout this experience. Fortunately, the core ways in which we deliver patient care cannot be altered, manipulated or harmed by malicious attempts to disrupt the services we provide [that is, by taking down the EHRs -ed.],� Stephen R.T. Evans, MD, executive vice president, Medical Affairs and chief medical officer, MedStar Health. �Our ability to serve our patients and their families depends first and foremost on our caregivers, and their expert knowledge and compassion focused on each patient.�

He likely does not realize just how correct his spin actually is.

-- SS

3/30/2016 Addendum:

This is not the first time for EHR outages at MedStar.

As in my May 16, 2015 post "Another day, another EHR outage: MEDSTAR EHR goes dark for days" at http://hcrenewal.blogspot.com/2015/05/another-day-another-ehr-outage-medstar.html, I cited Politico. 

The doctor's observation I highlighted below is of interest.

4/9/15
http://www.politico.com/morningehealth/0415/morningehealth17818.html

MEDSTAR EHR GOES DARK FOR DAYS: MedStar�s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a �severe� malfunction, according to an email from Medstar management that was shared with Morning eHealth.

�All of a sudden the screens lit up with a giant text warning telling us to log off immediately,� a doctor said. �They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.�

This doctor told us that the outage was �disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.

But of course we didn�t have access to any notes or medication history, and that was problematic.� MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.

-- SS

Tuesday, 29 March 2016

Princess Health and March 29th, 2016 I'm Okay. Princessiccia

Princess Health and March 29th, 2016 I'm Okay. Princessiccia

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March 29th, 2016 I'm Okay

The last couple of days have been two of the most challenging I've experienced in a very long time. I kept up very well last week, and it too was a busy one, but wow--the last two days have had it all; Lots of extra responsibilities at work, busy schedule at home and an unexpected circumstance or two thrown in to keep me on my toes.

I really should have leaned on my support team a little better, last night. I made it through. And all things considered, I have consistently utilized excellent support connections 95% of the time--and it makes a powerful positive impact. So really, I'm proud of this.

I'm not proud to report that this will be my third day in a row without making it to the gym. I've done my very small morning push-up routine--and that's it. I had every intention of the workout last night and tonight. Both night's, the plan had to be modified midstream. Tonight it was work projects I underestimated, that took an hour and a half longer than planned.

Okay--I'm going to declare right here and now, I'm not beating myself up over this. It's something of a thing--and things change. It's certainly not the end of the world. But it is important for the balance in my maintenance plan. All I can do is pick up and move forward. After all, this trek has never been about perfection.

It's about progress--not perfection. It's about consistency instead of intensity. It's about keeping it simple and sustainable not complicated and nearly impossible to maintain.

I'm okay.

Tomorrow is weigh day. The only reassurance I have is the certainty found in maintaining the integrity of my food plan. The last two weigh days, I've spent the night before adding up how many workouts I didn't complete--and then worrying how that lack of activity will affect my weight the next day. My maintenance calorie budget is 2300. That's a bunch to me. And that kind of a budget relies on a consistent workout schedule in order to balance well. At least, that's my perception--and it seems to be confirmed by my maintenance track record thus far. We'll see together, tomorrow.

My Tweets Today:






























Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Bad health IT at Medstar Health: FBI probing virus behind outage (And: ka-ching! ka-ching! EHR costs continue their upward spiral). Princessiccia

Princess Health and Bad health IT at Medstar Health: FBI probing virus behind outage (And: ka-ching! ka-ching! EHR costs continue their upward spiral). Princessiccia

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Once again, a definition of bad health IT:

Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or evidentiary fitness, or otherwise demonstrates suboptimal design and/or implementation. (http://cci.drexel.edu/faculty/ssilverstein/cases/)

I observed bad health IT leading to HIT compromise, hospital chaos and paying of a ransom demand at my Feb. 18, 2016 post "Hollywood Presbyterian Medical Center: Negligent hospital IT leaders allow hacker invasion that cripples EHRs, disrupts clinicians ... but patient safety and confidentiality not compromised" at http://hcrenewal.blogspot.com/2016/02/hollywood-presbyterian-medical-center.html.

It's happened again, at least with regard to publicly-disclosed stories (there is no requirement for hospital disclosure, more on that below).

FBI probing virus behind outage at MedStar Health facilities - AP
By JACK GILLUM, DAVID DISHNEAU and TAMI ABDOLLAH March 28, 2016 10:04 pm
http://wtop.com/consumer-tech/2016/03/fbi-probing-virus-behind-outage-at-medstar-health-facilities/


WASHINGTON (AP) � Hackers crippled computer systems Monday at a major hospital chain, MedStar Health Inc., forcing records systems offline for thousands of patients and doctors. The FBI said it was investigating whether the unknown hackers demanded a ransom to restore systems.

A computer virus paralyzed some operations at Washington-area hospitals and doctors� offices, leaving patients unable to book appointments and staff locked out of their email accounts. Some employees were required to turn off all computers since Monday morning.

A law enforcement official said the FBI was assessing whether the virus was so-called ransomware, in which hackers extort money in exchange for returning a victim�s systems to normal. The official spoke on condition of anonymity because the person was not authorized to discuss publicly details about the ongoing criminal investigation.


Not discussed is corporate accountability for deficient IT security.

�We can�t do anything at all. There�s only one system we use, and now it�s just paper,� said one MedStar employee who, like others, spoke on condition of anonymity because this person was not authorized to speak to reporters.

I note that if the cybernetic pundits were listened to, patients would now be considered at deadly risk due to paper records being used - not due to critical IT infrastructure being hacked and disabled.  Yet it's impossible to disable paper charts en masse.

MedStar said in a statement that the virus prevented some employees from logging into systems. It said all of its clinics remain open and functioning and there was no immediate evidence that patient information had been stolen.

These must be honest thieves.

Of course, we hear the "patient care has not been compromised" line once more (http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised).

Company spokeswoman Ann Nickels said she couldn�t say whether it was a ransomware attack. She said patient care was not affected and the hospitals were using a paper backup system.

The absurdity of this claim is that if patient care is not affected by returning to paper, then why did the hospital invest hundreds of millions on EHRs?

(Considering a increasing evidence base of clinician distraction and disaffection e.g., the Jan. 2015 Medical Societies letter to ONC as at http://hcrenewal.blogspot.com/2015/01/meaningful-use-not-so-meaningul.html, EHR-related errors, many of which would likely not occur under a well-staffed paper system e.g., as at http://hcrenewal.blogspot.com/2014/04/fda-on-health-it-risk-reckless-or.html, and plentiful security breaches e.g., the many posts at http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy, I would also ask if patient care is in fact improved by the return to paper [1].)

When asked whether hackers demanded payment, Nickels said: �I don�t have an answer to that,� and referred to the company�s statement.

Dr. Richard Alcorta, medical director for Maryland�s emergency medical services network, said he suspects it was a ransomware attack. He said his suspicion was based on multiple earlier ransomware attempts on individual hospitals in the state. Alcorta said he was unaware of any ransoms paid by Maryland hospitals or health care systems.

The rather calmly-stated "multiple earlier ransomware attempts on individual hospitals in the state" suggests that

  • Hospitals are being targeted in an organized fashion, and
  • Costs to implement proper security will draw even more capital and resources from direct patient care and from real brick and mortar facilities, such as entire new hospital wings that would cost less than an EHR, to cybernetics of increasingly dubious value.  (Past projected cost benefits are certainly being proven even more naive.)

Terrorism or just plain old crime, the medical driector asks...

�People view this, I think, as a form of terrorism and are attempting to extort money by attempting to infect them with this type of virus,� he said.

God help us if true terrorists get in the act of cybernetically paralyzing hospitals.

Alcorta said his agency first learned of MedStar�s problems about 10:30 a.m., when the company�s Good Samaritan Hospital in Baltimore called in a request to divert emergency medical services traffic from that facility. He said that was followed by a similar request from Union Memorial, another MedStar hospital in Baltimore. The diversions were lifted as the hospitals� backup systems started operating, he said.

It used to be that patient diversions were due to doctors and nurses having too many sick patients they are caring for.  Here it seems due to doctors having to many sick computers to deliver proper patient care.

MedStar operates 10 hospitals in Maryland and Washington, including the MedStar Georgetown University Hospital, along with other facilities. It employs 30,000 staff and has 6,000 affiliated physicians.

That's a lot of paralysis.

Monday�s hacking at MedStar came one month after a Los Angeles hospital paid hackers $17,000 to regain control of its computer system, which hackers had seized with ransomware using an infected email attachment.

Hollywood Presbyterian Medical Center, which is owned by CHA Medical Center of South Korea, paid 40 bitcoins � or about $420 per coin of the digital currency � to restore normal operations and disclosed the attack publicly. That hack was first noticed Feb. 5 and operations didn�t fully recover until 10 days later.

Hospitals are considered critical infrastructure, but unless patient data is impacted there is no requirement to disclose such hackings even if operations are disrupted.

I won't even comment on why a US hospital is owned by a Korean medical center.  The statement "unless patient data is impacted there is no requirement to disclose such hackings even if operations are disrupted" implies yet another blind spot in the unregulated health IT industry.  Add that to the blindness towards close-calls and actual harms, and you have a field being pushed on the population under penalty by those somewhat deaf, dumb and blind to the downsides.


Computer security of the hospital industry is generally regarded as poor, and the federal Health and Human Services Department regularly publishes a list of health care providers that have been hacked with patient information stolen. The agency said Monday it was aware of the MedStar incident.

All I can hear is "ka-ching! ka-ching!" as the costs to fix the poor computer security in the hospital industry accrues. 

How much will patient care suffer as a result of the diversion of yet more resources to cybernetics?

As I've written before, stories like this support a serious rethinking of the entire healthcare IT hyper-enthusiast movement to whom the considerable downsides (even patient death) are just an unfortunate "bump in the road" (http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html), or perhaps more accurately, the healthcare IT hyper-enthusiast religion.

-- SS

[1] I've written that paper for many clinical settings, including highly specialized forms as I implemented highly successfully in invasive cardiology (http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story), needs reconsideration, relieving clinicians of clerical work and employing data entry clerks to enter the data.  This would be supplemented by far less expensive document imaging systems for 24/7 availability, and computerized lab results retrieval - the latter with appropriate humans on the receiving end to prevent the "silent silo" syndrome of lab results returned to a computer silo but missed by clinicians due to being very busy and due to unreliable/fatiguing cybernetic alerting.  A lot of workers can be paid for by saving $50 or $100 million on software.

3/30/2016 Addendum:

This is not the first time for EHR outages at MedStar.

As in my May 16, 2015 post "Another day, another EHR outage: MEDSTAR EHR goes dark for days" at http://hcrenewal.blogspot.com/2015/05/another-day-another-ehr-outage-medstar.html, I cited Politico. 

The doctor's observation I highlighted below is of interest.

4/9/15
http://www.politico.com/morningehealth/0415/morningehealth17818.html

MEDSTAR EHR GOES DARK FOR DAYS: MedStar�s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a �severe� malfunction, according to an email from Medstar management that was shared with Morning eHealth.

�All of a sudden the screens lit up with a giant text warning telling us to log off immediately,� a doctor said. �They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.�

This doctor told us that the outage was �disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.

But of course we didn�t have access to any notes or medication history, and that was problematic.� MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.

-- SS


Monday, 28 March 2016

Princess Health and March 28th, 2016 Tweets Only. Princessiccia

Princess Health and March 28th, 2016 Tweets Only. Princessiccia

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March 28th, 2016 Tweets Only

Tweets Only, tonight.

My Tweets Today:
































Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

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Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Sunday, 27 March 2016

Princess Health and March 27th, 2016 A Precious Gift. Princessiccia

Princess Health and March 27th, 2016 A Precious Gift. Princessiccia

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March 27th, 2016 A Precious Gift

This was a wonderful Easter. Except for getting home over an hour later than expected, it was just perfect. I maintained the integrity of my calorie budget, continued my abstinence from refined sugar, exceeded my water goal by four cups, engaged in spot support communications via text and phone and spent the majority of the day in company of loved ones--and really, that's such a precious gift.

There was a topic I wanted to elaborate on--but this is clearly not the time. I must drop in bed. I'll save it for another night. Instead--I'll tell the rest of today's story with pictures and captions--and the Live-Tweets of the day as it unfolded.

photo Noah In My Arms_zpsq1b7tqsi.jpg
This was Noah's first official Easter egg hunt. Courtney, unfortunately, had to work today and couldn't be there, so Irene, Allen, Amber, KL and I accompanied Noah to his age group and waited for the huge firetruck to start the egg hunting frenzy with a blow of its extremely loud horn. When the time came, it slightly startled our little man!

photo FullSizeRender 2_zpsdtrj9a6x.jpg
He has grown beyond the 'frightened of people in costumes' phase--and straight into the, 'this is cool,' phase.

photo IMG_9953_zpssllpvvw0.jpg
We all gathered at the restaurant prior to the big hunt.

photo IMG_0063_zpsusv3dxs8.jpg
Noah and I made the trip to see mom this evening. We enjoyed a late dinner out and a great Easter evening visit before heading back home--and taking little man to his Nana's (Irene's) house for a sleepover.

I rarely have a day that includes two restaurant meals. Today was the exception. I feel like I navigated well. It helped that both places were really easy for me to navigate. Instead of tacos at lunch--I made it a salad, knowing I'd have tacos later. Beef for lunch--chicken for dinner. I enjoyed some variety--including an unusual breakfast. Mainly, I enjoyed the time spent with everyone--and Noah, oh my, that little guy owns my heart.

It feels so good to be at a healthy weight, enabling me to keep up with him--and not just the physical part of that equation--it's also about not being in a constant food fog. It's hard to express gratitude and appreciate important things and others, when under the influence of the food fog. Before I elaborate any further--turning this into a big exploration of thoughts and experiences, I better go to bed! Another time...

My Tweets Today:




































Thank you for reading and your continued support,
Strength,
Sean
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