Happy Holidays From The Umbachs

Christmas Card 2012

‘Twas the night before our 15th Christmas and the family is spent,
Nary was a sound uttered, except from our cage of rodents,

The hamsters were nestled and snug in their bed of fluff,
A gift from Santa last year along with lots of other stuff,

The echo of their spinning wheel made its usual hum
But another sound I heard rustle was not the usual one,

Major, our thirteen-year-old “guard dog” didn’t even budge,
These days it takes a lot to stir him, more like a strong nudge,

Down the stairs in my boxers I flew to try and catch a sight,
As soon as I hit the bottom, I could see ‘twas the refrigerator light,

When what to my wondering eyes should appear,
But Santa, rummaging around for a cold beer,

“Help yourself Santa; don’t let me make you stop,”
The fat man had come to expect our annual man-time with hops,

“A lot of people on the naughty list after this election season,
As if my night’s To Do list wasn’t enough of a drinking reason,”

“Umbach, don’t just stand there, fill your glass with some suds,
Let’s get to it; I’m already nearing the bottom of this chilled mug!”

The annual family update weighed heavily on his mind,
As we gathered ‘round the iPad to look at our Facebook timeline,

Our son is now six and in first grade at a new school,
He can’t wait ‘til football, but for now soccer, gymnastics and wrestling will do,

Our daughter is nine and is showing Logan the ropes in fourth grade,
She’s added violin to gymnastics and her expanded soccer play,

Yoga and running continue to keep Debbie on her feet,
This year she even added the sports title of tiathlete,

Reach the Beach, B2B and PMC is where Heath spent his time,
A separated shoulder seemed his only week off from a ride,

This summer was our first to join the swim club in our ‘hood,
Both kids enjoyed success swimming for Team Greenwood,

Once again we managed our annual New England escape,
This year was in Brewster for a week on the Outer Cape,

Work remains exciting with responsibly old and new,
For Deb another year at VCE and Heath at PatientKeeper too,

I soon began to worry that Santa was beginning to tire,
Although it was clear that his tolerance had become much higher,

With backwash in his mug and a twitch of his fat head,
Both my stories and his workload he was starting to dread,

So he gathered up his sack and he headed for the door,
He enjoyed our time together but was tempted to drink one more,

Alas he was the wiser and decided to no longer pause,
He knew better than to risk the wrath of his real boss, Mrs. Claus,

As he leapt from my chair, our dog he could barely avoid,
Such hurry was he in that he nearly forgot his charging Android,

Then he shouted as his sled launched from above our roof tip,
“Be well, stay healthy and beware the Fiscal cliff!”

2012 was my 6th year of riding in the Pan-Mass Challenge.  Thanks to you, I’ve raised over $28,000 for cancer research and treatment!  My team once again raised around $190,000 and the entire field delivered a check for $37M, 100% of which was given to the Dana-Farber Cancer Institute in November!  I am humbled as always by your support.

A Very Late Thank You – PMC 2012 Recap

How appropriate that I’ve waited (procrastinated) long enough to be able to add all of YOU to my list of things for which I am thankful during the holiday season. Thanks to your continued generosity, we were able to contribute $4,630 toward the $37 Million that was delivered to the Jimmy Fund on behalf of the Pan-Mass Challenge on November 4, 2012 (100% of which went directly toward fighting cancer)! The winner of this year’s $200 drawing (randomly picked by the kids from among a slew of construction paper) is Debbie Edson. Your check is in the mail!

This year’s ride was much warmer and dryer than last year’s. About the only new wrinkle was my nickname in the peloton – hunchback – in reference to the bag of ice shoved between my jersey and separated shoulder from 3-weeks prior. Nothing a little Harpoon IPA at the finish couldn’t cure. Debbie and the kids weren’t able to join me at the finish this year as they were successfully representing our swim club in the league championships. I was sad to miss them but knew they would have more fun in the pool than in the car watching 5,000 riders fly by in spandex.

There were many lasting images from the weekend, but I’ll share one in particular from about one month prior to PMC weekend.

Original Jimmy Fund Donation Box – Fenway Park

Many of you may not know that the Red Sox formed a partnership with the Jimmy Fund back in 1953 – the longest standing, most extensive, and significant team-charity relationship in all of professional sports. The Sox and the Braves (who left Boston for Milwaukee the year the Jimmy Fund/Sox relationship formed) used to play an annual Jimmy Fund charity game in Fenway as a way of breaking Spring Training before the start of the regular season. I know this because my father told me upon our first of many trips to Fenway together. He knows this because he played in that game when he was a Braves rookie, in 1966. I’m willing to bet this donation box was hanging on a column just like this one on that day in 1966 – perhaps with a few less layers of green paint on it, but one like it nonetheless.

The Jimmy Fund endures because of the efforts of volunteers and donors like you. Thank you again for your support for this charity and this important cause.

The Case for Inbound Marketing

One of the better presentations I’ve seen on the case for inbound marketing comes from HubSpot.  In sum, it’s better to be found by your target audience than to bother them with email and advertising.  They are not only tuning you out, but they are unsubscribing from your lists. Companies need to “stop interrupting what people are interested in and BE what people are interested in.”  Customers and prospects will find you so long as you are participating in the conversation with the right content and through the right channels.

This presentation itself provides a great example.  Posted to slideshare over 1 1/2 years ago, it’s still being shared and receiving comments as recently as 1 week ago! That’s useful content, and we’ve all heard that content is king.

Meaningful Use ‘Malarkey’

While his timing would’ve been a bit off, Joe Biden might have been forgiven if he had smirked and called the October 4th letter asking HHS Secretary Kathleen Sebelius to suspend meaningful use (MU) incentives “malarkey.”  In the letter, four Republican congressmen cite an apparent weakening of thresholds from Stage 1 Proposed to Stage 2 Final Rules as well as a lack of established interoperability standards as contributing to wasted taxpayer dollars.  On the latter point, the congressmen may be a bit premature as Stage 2 appears to advance data and transfer standards such that we may (finally) expect meaningful exchange in the coming years.  On the former point, however, the congressmen might have a legitimate gripe.

The decrease has primarily come during the public comment periods between Proposed and Final rules each time.  As with most legislation, this is presumably due to pressure from large trade organizations (e.g., AMA, AHA and the like) representing their constituents’ concerns.  Regardless of the drivers for decreased thresholds, one thing is certain – while inroads in interoperability are likely in Stage 2, there still needs to be USE of these interoperable EHRs – there must be data to exchange for interoperability to have maximum effect.  This makes the slow march toward 90%+ for certain thresholds a bit curious.  Why would a physician want to enter 60% of medication orders electronically but only 30% of lab or radiology orders electronically.  That’s a hybrid, inefficient workflow.  If you asked physicians which they’d prefer between lower thresholds and hybrid workflows versus efficient systems that help them treat patients, I believe they’d chose the efficient systems.

Ultimately, widespread adoption success will require innovative, disruptive technologies and not just interoperable systems.  Applications and services that change the way we use existing technologies will play a key role.  It’s not enough to make CPOE “better” – better for whom and how is a key consideration.  Traditional desktop CPOE may improve the way a physician places a medication order or they way a lab result is accessed.  Those are examples of individual improvements rather than disruption.  Unifying all patient data and allowing a physician to re-order a lab directly from a result – all from a mobile device while outside of the hospital – is closer to the disruption that’s required.  Simply designing systems that support the way a physician works – non-linear with constant interruptions – is disruptive by healthcare IT standards.

Ultimately, the technologies that break down the silos to create an integrated, physician experience will lead to success – it may even please both sides of congress.  OK, maybe that’s a bit TOO ambitious.

The Yin and Yang of Lance Armstrong

The daily deluge of articles about the fall of Lance Armstrong in the wake of the 1,000 page report from USADA shows no signs of slowing. It’s barely 9am, and already news has broken about Nike terminating their relationship with Lance and a decision by the now former 7-time TdF winning rider to step down as the chair of his own foundation, Livestrong.  Armstrong’s legacy appears to be descending faster than the pro peloton down Alpe d’Huez (sorry, couldn’t help myself).

But Armstrong presents a unique challenge to those of us, especially cyclists, trying to square our own opinions and feelings about where he stands in the pantheon of public figures. Armstrong was hailed as a “person to be deeply admired” for leading the fight against cancer by The Austin American-Statesman newspaper. “The trickier legacy is the one that goes beyond cycling.  If admirable work turns out to be built on a lie, is the lie then OK, the cheating excusable?” according to an editorial.

Coming to terms with his cycling legacy would seem to be the easier task when considering the impressive array of evidence presented by USADA.  When you look at the top finishers of the TdF during Lance’s 7-year reign, however, does this not represent THE best example  of a “new level playing field” where almost everyone (>70% of podium finishers) doped?  It seems the only real choice, sadly, is to basically ignore that era and declare no holder of the yellow jersey during those years – that’s what the director of the TdF appears heading toward.  Ultimately, of course, the right answer ought to be that no matter where the level is set, cheating cannot be allowed or condoned, and we must accept that not all were doping, therefore his cycling legacy is tainted.  Unfortunately, like Barry Bonds before him (another “prickly” superstar athlete), I strongly suspect Lance would’ve distinguished himself as a champion of cycling’s most treasured race without performance-enhancing drugs and techniques (though perhaps not 7-times).

Much more difficult is how we are to view his impact on cancer – the ultimate opponent.  Livestrong has received donations totaling almost $500 million since 1997.  Like many others, I’ve met, ridden next to Lance (hung onto his wheel more like it), and heard him speak in person.  He has inspired countless people, those with and without cancer, to grab (or buy) a bike (ask Trek about his impact) and ride – for exercise, for fun, for life.  We he have inspired the same in us without the victories?  Probably not.  His drive, example and name are clearly the biggest reason for Livestrong’s fundraising prowess.  Nevertheless, one has to wonder whether the organization was preparing for this day back in 2004 when it began the slow march to change the Lance Armstrong Foundation to the Livestrong namesake it’s held since 2009 – a rare example of a parent brand being usurped by its offshoot.  It’s always risky for an organization to be associated with a single person.  Often it’s about what happens to fundraising when the person retires or is no longer in the public eye.  In this case, it’s what will happen when the person remains in the public eye but for the wrong reasons.  Fortunately, it appears that while Nike is ending it’s relationship with Lance, they have “plans to continue support of the Livestrong initiatives created to unite, inspire and empower people affected by cancer.”

It’s far too early to know the impact of the daily events related to his story.  We can only hope that Livestrong will do what Lance himself tells people in his book “It’s Not About the Bike” – “All I wanted to do was tell people to fight like hell.”

Cycling For A Cure: Part 6

2012 marks my 6th year riding in the Pan-Mass Challenge and raising money for The Jimmy Fund and Dana Farber Cancer Institute.  With your help, we’ve managed to raise over $23,000 so far, but the challenge still remains.  With five years of fundraising data in the books, some trends  from within my annual donor base have started to emerge.  After a steady increase in both total and average amount per donor, overall donations fell in 2011, making last year my lowest total ever.  For the first time I came up just short of reaching the required, minimum fundraising amount ($4,200 in 2011).  Please help me make this a one-year blip rather than a trend!

*2011 Actual = $4,045; $4,200 represents minimum donation charged

The number of donors also fell slightly, though the number of repeat donors continue to grow and remain strong.

In that same time, the number of people affected by cancer whom I have known personally or through association has grown.  This year, I will ride in memory of Bill T, Dave K, Elizabeth W, Gordon C, Irina C, Jennifer L, Johnny A, Coach C, John F, Judy R, Mike W, Noah Y, Nora D, Tyler, and William H.  I am riding on behalf of those who continue to fight, including Alan L, Betty, Carolyn N, Diane R, Don N, Jeff, Joyce K, Judy, Julie O, Kathy R, Kristin H, Lori B, Nancy M, Paul R, TJ H, and Tracy W.  Once again, I ask for your support raising money for The Jimmy Fund.  And once again, 100% of your donations will go to directly to cancer research and treatment.

As in years past, I will draw from a list of all donors for a chance to win $200 (just think, you could actually MAKE money by donating, to say nothing of the tax benefits!). You can choose from one of the following, easy methods to donate:

1) Make an online donation: The following link will take you to my Pan-Mass Challenge Profile: http://www.pmc.org/profile/HU0001. You can also go to http://www.pmc.org, click on eGifts and search for me by my ID (HU0001) or name to make a donation.

2) Text to Give to My Ride: Just text “PMC HU0001” to 20222 to donate $10. You will receive a message asking you to confirm by replying “Yes.” It’s that easy!

3) Mail in a payment: Checks can be made payable to the PMC, Jimmy Fund, DFCI, or any combination of the three (please don’t make it out to me). Please send your checks directly to me so that I can process them with the standard forms, etc. If you would prefer to send your check directly to the PMC, however, please include a note indicating you are sponsoring me and send the check to: PMC, 77 4th Avenue, Needham, MA 02494.

Thank you for your continued generosity, and see you on the road!

Heath Umbach

Harpoon B2B Finish Line

Five HIT Predictions for 2012

One thing you are sure to find this time of year are predictions. I’ve decided to do my own not so much to join the crowd but rather because I look forward to comparing my predictions to what actually happens in a little less than a year from now. So with that, here are my predictions for the year in HIT – which ones do you think will come to pass, and which ones have I missed?

1. mHealth experiences a re-birth

mHealth is all the rage and for good reason – it holds great promise to make a significant impact for both providers and consumers alike. But while mHealth for consumers is still on the upswing of innovation and expectations, mHealth for providers is starting to pass the Peak of Inflated Expectations. Walk the floors of any HIT trade show over the last year+ and you were bound to run into iPads at every turn – not necessarily because these vendors were mobile app developers, but because they either 1) wanted you to think they were or 2) managed to make their products “accessible” via a mobile device. But accessible is not the same as usable or efficient. Perhaps the most public example of this was chronicled in a CIO magazine article that described physicians handing in their iPads after a poor experience accessing their EMR. This doesn’t signify a failure of mHealth for providers, rather it was a failure to recognize that app design is arguably more important on a mobile device than in a portal/web or desktop application. Design flaws and workflow gaps are even more exposed on a mobile device. Now that the market has begun to recognize and experience this reality, intelligently-designed mobile apps (whether native or web apps) will continue to rise to the top and carry providers through to the Slope of Enlightenment.

2. Providers begin to expect full workflow support on mobile devices

This prediction is admittedly a bit late as providers have already moved beyond mobile access to clinical results to expect full workflow support. And why not? We should not expect a physician to access lab results on his/her iPhone only to set that device down on the nursing station next to the computer terminal (that is already in use) to enter orders, document care, enter a charge, etc. Perhaps what has fueled this expectation the most is the iPad and other tablets (though not many others). Not many would expect to enter a clinical note or use order sets on a smartphone, however, the tablet form factor presents a new opportunity to do just that – support a physician’s entire workflow. Full, integrated workflow support is a (perhaps the?) critical component of sustained physician adoption of HIT. Where reasonably-sized form factors are concerned, this will also hold for mobile workflows.

3. What worked for Stage 1 will not for Stage 2

My summary of the first year of Stage 1 Meaningful Use (MU): fewer than expected (or budgeted by OMB) meaningful users in year 1, lots of confusion and less movement due to the Stage 2 delay that wasn’t a delay, and early movers characterized by the use of existing systems to meet the bare minimum Stage 1 objectives (e.g., using ED systems to achieve the 30% CPOE threshold). But many hospital IT and physician leaders have already or will soon realize that a Stage 1 strategy isn’t likely to succeed for Stage 2 and beyond. The latter stages are going to require much deeper adoption, use and exchange of health information. IT leaders will need to lay a strategic path that considers all stages of MU, ICD-10 migration, efficient revenue capture, ACO/Value-Based Purchasing and a litany of federal, state and local priorities if they are to be successful. Each of these and other priorities hinge on efficient, meaningful use (pun intended) of integrated systems that respect and protect physician efficiency (and revenue) if they are to succeed.

4. ICD-10 is not Y2K

As the fireworks exploded in Times Square last night, someone said to me “remember how freaked out everyone was at this very minute back in January 2000?” Yes, I do, and the fallout (or lack thereof) threatens to put providers and hospitals significantly behind the ICD-10 eight-ball if they consider that migration to be another non-event like Y2K. Most reports, surveys and commentary place providers and hospitals significantly behind in their preparations for migration to ICD-10. This will have to change in the coming year. But I believe the challenge and emphasis will ultimately be on documentation and not on systems simply supporting the 4-fold increase in the number and format of ICD-10 codes. IT solutions that focus on improving documentation (thoroughness and efficiency) will best prepare providers for ICD-10 and shield them from the potential loss of revenue.

5. ACOs will (continue) to get more attention than they deserve

This is not a repudiation of ACOs or what they attempt to accomplish. But ACOs have dominated much of the conversation during the latter half of 2011, and I expect that to continue. While the tenets and concepts of ACOs are likely here to stay, I still think it’s too early in that process to warrant the airtime to-date. Instead, providers will continue to focus on many of the critical building blocks required to support successful ACOs in the coming year – they just won’t necessarily be doing so in the name of a formal ACO. Do you sense a common theme? Use of integrated, efficient systems in the name of care coordination and higher-value care. While ACO will undoubtedly continue as the preferred acronym of the day, the foundational work required to support an eventual ACO model will be where the real action happens.

Happy New Year!

Santa’s Gonna #OccupyMyHouse

‘Twas the night before our 14thChristmas and the kids are all snug and dreaming
While I sit reviewing tasks with Pandora in the background streaming,

With SecureGirl reading her iPad and Major tucked in by our side
I better get to sleep soon if I’ve hope of waking up to ride,

Major, age 12

Their homework done and jackets hanging upon each door hook
The kids had just finished reading yet another Harry Potter book,

Then suddenly I jumped remembering what I’d neglected to do
I’d forgotten to leave Santa his cookies and cold brew,

If there’s one thing over the Christmas Eve years I’ve learned
The Jolly Old Elf’s pint on this night is indeed hard-earned,

So I slipped out of bed and descended to the kitchen fridge
Only to see his silhouette perched high upon the frosted ridge,

“Whoa team!” he shouted, “Take a break you overzealous reindeer!
Finally I’m back at the Umbach’s; I can’t wait to grab that annual beer!”

Eschewing the usual chimney entry and opting for the door first
He was clearly ready to sit by the fire and quench his oversized thirst,

“Umbach, where are you, I don’t have all night to take!”
I quickly handed him his glass, hoping the kids would not soon awake,

“What have you been up to Santa, how’s the delivery been?”
Distracted by his Facebook app, Santa was making sure he had checked in,

“Damn this device, I can’t even get a decent 3G network!
Umbach, quickly, what’s your SSID and Wi-Fi password?”

His connectivity now established and social media situation under control
We settled in to discuss the year as his drink began to take hold,

L is now five and for kindergarten getting very tall
He’s started soccer and wrestling to go with gymnastics and karate this fall

T’s in 3rd grade at Haynes where for two more years she’ll stay
She enjoys swimming, gymnastics, soccer, and performing in ballet,

Flowering lotus, one-handed tiger, plank, and half-forward fold
A sampling of yoga poses SecureGirl strikes and somehow manages to hold,

At the crack of dawn healthITjunkie still throws his leg over the bike seat
This marked the 5th year he rode in and raised money for the PMC,

healthITjunkie at the finish of PMC 2011

We are always busy at work with more than enough to do
Deb has joined VCE and I’m back at PatientKeeper for round two,

2011 was a great year for skiing, perhaps even our best
With both kids getting stronger, it’ll soon be time for a trip out west,

With the flowers of spring on Mother’s Day came a small family reunion
Both grandmothers and an uncle were present for Taylor’s 1st Communion,

Throughout the summer the kids enjoyed camp at Drumlin and Thoreau
For L it was his first camp experience while T is an old pro,

Before summer ended we managed to spend another week on the Cape
In advance of Hurricane Irene we were able to make our escape,

His mug now empty, my stories long and mercifully complete
Santa decided ‘twas time to saddle up and again hit the street,

We exchanged but a glance knowing the time was right
For Santa knew better than to cross Mrs. Claus on this night,

Then he shouted from his sleigh rising above the line of trees
“Enough Occupy Wall Street, it’s time we Occupy Our Families!”

Occupy My Fridge

@securegirl
@healthITjunkie

PMC Delivers $35M to the Jimmy Fund

Dear Family, Friends and Donors,

On Veteran’s Day, the PMC delivered a check for $35 million dollars to the Jimmy Fund, $2M more than in 2010!  As always, this year’s ride was very rewarding and filled with inspiring stories of those who have and/or continue to fight against cancer and fond remembrances of those whom we’ve lost.  A sincere thank you to everyone who donated again or for the first time.  Unfortunately I came up $155 short of the $4,200 minimum this year, but don’t worry as the PMC has my credit card.  I’ll be back next year hoping to catch up!  This year’s winner of the random $200 drawing is Joyce Kelly. Joyce, your check is in the mail!  A short recap of this year’s ride follows.  Please also enjoy some photo highlights from this year’s PMC weekend.

Logan & Taylor with me at the (wet) P'town finish

From PMC 2011

In 1999, upon winning his first Tour de France, Lance Armstrong pledged to ride in the PMC.  12-years and 7 TdF titles later he made good on that promise.  His presence certainly amped up the crowd at the opening ceremony as well as the start line early Saturday morning.  Lance took off from in front of the crowd as soon as the start gun was fired as he no doubt wanted to avoid the mass of 3,000+ amateurs hoping to suck his wheel for as long as they could stand it. Fortunately, I “caught up” to him at around mile 25 and was able to ride with Armstrong and Senators Kerry and Brown (with Kerry on my left as always).

Day 2 started at 4:30AM in steady rain.  By the time we all made it through a cup of coffee and to the start line, the rains had essentially cleared and we were left only to deal with puddles, wet pavement, and constant “tire spit” flying in our faces.  Due to our 21+ mph avg., we managed to finish, shower, eat, and get on the road home before the real rains came.

Taking my turn pulling the pack on a wet Day 2

From PMC 2011

This year’s ride was dedicated to the memory of Bill, Dave, Elizabeth, Gordon, Irina, Jennifer, Johnny, “Coach” Johnny, John, Mike, Noah, Nora, Tyler, and William and ridden on behalf of Betty, Carolyn, Don, Jeff, Judy, Julie, Kristin, Lori, Nancy, Paul, TJ and Tracy.  Sadly, five people were added to the list in the months surrounding this year’s ride. I look forward to the day when that list no longer grows.

Finally, I’ll leave you with a link to a short video entitled What a bike was meant to do. This video best encapsulates what the PMC is about.

Thank you for your continued generosity, and see you on the road!

What if the question is “What SHOULD I do” rather than “What COULD I do?”

Since it’s signing in February of 2009, the HITECH Act has made providers and hospitals deal with the question of “What Could I Do” with respect to demonstrating Meaningful Use (MU). That is, what systems do we have in place, what systems do we need to acquire/upgrade in preparation, etc. to demonstrate MU? The clock started ticking when Stage 1 objectives were published in the Federal Register, and the clock has been ticking ever since.

But what if you are a provider or hospital living in the rarefied air of asking the question of “What Should I Do?” That is, if you have the infrastructure, systems AND adoption in place and have already collected the necessary 90-days worth of data to successfully attest – SHOULD you go ahead and do so by November 30th (the deadline to attest in Federal Fiscal Year 2011)?

Today’s post by Joseph Conn of Modern Healthcare entitled EHR Early Birds May or May Not Get the Worm essentially points out this question facing certain hospitals as we near the end of FFY 2011. Conn references The Advisory Board Company’s Protima Advani who recommended delaying Stage 1 attestation until FFY 2012.  Advani and Conn nicely described the potential disadvantages of early adoption created by the ONC’s Stage 2 Final Rule timeline – currently anticipated in the summer of 2012 – so I won’t repeat them here.

I agree with Advani, who holds to her original recommendation to sit and wait. Although the HIT Policy Committee has recommended that ONC delay Stage 2 for early attesters (those submitting in FFY 2011), ONC has yet to officially accept this recommendation and change the timeline.

Bottom line, if you are still planning, selecting or implementing HIT, then by all means don’t slow down as you likely still have lots to do. If, however, you have collected the 90-days of MU data and are just waiting to submit, you might as well wait until ONC officially delays Stage 2 or until Nov 30th to make your decision, whichever comes first.

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