Subject: News from Dr. Kevin Fickenscher
From: "Dr. Kevin Fickenscher" <[email-masked]>
To: <[email-masked]>
Date: Fri, 25 May 2012 16:08:04 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7X4ptH7LVIvkJ9OxOk6uqCz8UmUM-LnCZLEljiLItHUcOwhNcTbmc652XQeyYqUiTOwBBqTesE0_44oMz2R8B4PiXtpn97Eb7z9c_U0NK5i-jJ1f5bVVQq0]
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The Fickenscher Files, Vol. 2, Issue 11 [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7X4ptH7LVIvkJ9OxOk6uqCz8UmUM-LnCZLEljiLItHUcOwhNcTbmc652XQeyYqUiTOwBBqTesE0_44oMz2R8B4PiXtpn97Eb7z9c_U0NK5i-jJ1f5bVVQq0]
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7UjD8a_Dq4eP3qcw5j38GlBVY2ekLZyd9nSsXjYzwQDSSisBLEzO-np4u7B7L1VFRkqLRXg7DJlWuDA4AHUA_A3yNs2zmfDnmBIs6rJ03T2yDzNmHfq4BcOj6kJbWeXdheYOSBu1DVlYgs5iFxndCX2XnTYNyDX4p2YIfp-cz-_8-7JcKwK8_WBa0rVMsAbOIL7wp_7oYOqEw==],
MD, CPE, FACPE, FAAFP
@MDKev
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Quote of the Week

"Gridlock is not an acceptable option when the debt is  growing faster than the 
economy.  We don't need a consensus.  No, we  need a deal ... and, there's a growing
necessity to cut a deal."

Alice Rivlin, Former Director for the  Office of Management and Budget in comments
at the Brookings Institute  on healthcare and the 2012 Presidential Campaign

"If we want to affect healthcare we should focus on obesity.   One in three of all
Americans are obese and it has been estimated that 21 percent of the nation's healthcare
costs are related to obesity.  And, besides, obesity is a non-partisan issue."

Ross Hammond, Ph.D., Senior Fellow at the Brookings Institute in comments on healthcare
and the 2012 Presidential Campaign

"Parties don't succeed for long if they stop appealing to voters who may disagree
with them on some issues."

Senator Richard Lugar  (R-IN) in an admonition to his challenger and in accepting
defeat in the  Indiana Republican Senatorial primary last week.

The Most Important Thing to Do This Week
You've got to follow-up on this one ...

The Best Video I've Seen In A Long Time -- Nancy Lorenzi, Ph.D. of Vanderbilt University
who sits on my  AMIA Board of Directors introduced me to a YouTube video featuring
Simon Pinek  at a recent TED Conference. The video is titled "WHY? [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7V8eZLnN_UCGQK74Nr0ik1F2O1bq7zqutjcckdRnmEcpyqmcSVn0wv463m7v_A9wWITmDlFogC0U7madTfA2Hc-OklsTGtnPQFHB61PmGS28HrSHApvilvXPt_6t8r2IUy3goikQLifBe9CjESNRRYQ5SHuUpy91NsRcCSh0y1JIg==]"

Pinek challenges our notion of how to engage people in change --  something that
 every leader in healthcare is grappling with over the  last couple of years. What
can we do to engage the people in our  organizations to adopt changes in the way
 work is done?  How do we get  them involved?  Why should they do it?  Pinek's basic
premise is that,  in fact, the order of the questions -- What? Then How? Then Why?
-- is  exactly the reverse of the approach we should be taking. We need to  engage
our followers by discussing Why, then How, and then get to What.   Watch the video.
It's the best. It will change your whole approach  toward driving change in your
 organization.
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Consulo Indicium

Information for your Consideration ...

Obesity: The Looming Crisis in America -- The Institute of Medicine of  the National
Academe (IOM) recently released a 478-page report, Accelerating Progress in Obesity
Prevention: Solving the Weight of the Nation [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7X6YmVfSWhulC3UV5mkZVWbr44MQUnR5D9t_FN3dCGMfC5nJnyxiWkfOprodJ_J72zIyeRWRi0n09OOpg0NmtzYHofRbmqQyWpfW4dg3xH6ge-TbooHR0vu5NNxjTtmyra5ycYy4sPMBK5A7eF6Q0ypd3DHVPBnAMZM2w8msKG3p6vAL98tBm2R]
that directly challenges the notion that obesity results from a lack of  willpower
on the part of individuals. The study group specifically  embraced policy proposals
and argued for the implementation of multiple,  parallel strategies in the U.S. 
to counterbalance the evolving crisis  the looms from the nation becoming more "obesogenic."
The IOM study was  funded by the Centers for Disease Control and Prevention (CDC)
which  projects that by 2030, 42 percent of American adults will be obese,  compared
to 34 percent today with 11 percent percent in the "severely  obese" category, compared
to 6 percent today.

Exacerbating the problem is the fact that another one-third of  American adults 
are overweight today, and one-third of children aged 2  to 19 are overweight or 
obese when the definition of obesity is having a  body mass index (i.e., a measure
of height to weight) of 30 or greater.  Overweight means a BMI of 25 to 29.9.

Obesity is directly responsible for an additional $190 billion a year  in healthcare
costs, or about one-fifth of all healthcare spending in  the nation. And, these 
numbers do not include the billions more that  are paid in higher health insurance
premiums, lost productivity and  absenteeism from work. Clearly we have a national
crisis. In fact,  obesity is the low hanging fruit of the nation's healthcare problem.
If  we simply focused on this one problem and got the weight of one-half of  our
 obese citizens back to normal weights -- think of the cost savings  that would 
accrue to society. So, instead of concentrating on the  traditional healthcare delivery
system, perhaps our attention should be  directed at exercise and diet. It's simple.
It's possible. It's got  to be a consideration ...

Read more [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7Us9X33cH7bWV5FDWtyx5TszKN-AgT9I42vuC977PCYyWyf_4vowrI1zn7al1cJBq8IFaqaXg1P8mI3OGOaSbw70TElcyjE8rjf_w9xs90quzU_ZtC09q9bff6GlsUu-htgkVJVbPob6xrO_g6hLAknxrYL2yD-wNgOtZ0NQeG2tvJFIaXcSSTJHdP6RAMSSgg=]
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HIEs: Where Do We Go From Here?

The state of the Health Information Exchange initiative and why some states are 
moving forward while others are not.

In March of 2010, the 50 states and 6 eligible territories and  qualified State 
Designated Entities (SDE) received funding totaling  nearly $550 million from the
Office of the National Coordinator (ONC) to  begin the arduous task of building 
health information exchanges (HIE).  These exchanges were conceived as a result 
of growing evidence that  health information technology (IT) can reduce national
 healthcare  spending by decreasing unnecessary expenditures such as duplicative
  testing and unnecessary diagnostic where other efforts have failed. HIE  projects
vary widely from state to state, but the common thread is that  they always involve
bringing diverse groups of stakeholders together to  plan, finance and implement
 IT systems that will facilitate the sharing  of electronic health information.

Within the domain of HIEs, some states, such as Wisconsin, Indiana,  Colorado and
Michigan have made tremendous progress in the HIE arena

* Wisconsin: The  Wisconsin Health Information Exchange (WHIE) [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7VXFEvAPAB-dxnxb8mTUq0LWI_V4Sh-jsLNujYsxXLl7P9NwqE0D6Sv3CP3Qqj2M8tHMcKbwD4SZQ2mGGqnxX1taxvE_RtHNAQ=]
was founded in 2004 and began clinical operations in March 2008. There  has been
 considerable success in demonstrating the value of an HIE  infrastructure through
broad participation of providers.
* Indiana: The  Indiana Health Information Exchange [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7W8-7btWDmEvLXVrc2EJyJUzZAiYBna60kfKm95BqITbiNz0Fr8YekHgUMYhxaVvCI8-j69CPlHVHyvi4jRYORujt1_JDxYtmQ=]
was also launched in 2004 and in 2010, named as a Health IT Beacon  Community by
 the US Department of Health & Human Services. As a  Beacon Community, Indiana serves
as a model for what can be accomplished  at the state level.
* Colorado: The  Colorado Regional Health Information Organization (CORHIO) [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7XdBW3scMPvrrLG6L80nSre-LkOSHv-YWpCi98UjqG1MaXDLPEqbBC2SD3xHnpI5fitps7BVonl48JFIJch96BJHCMlQquM0oEr2YQwvkPSEw==]
has made tremendous progress in not only the development and continuous  improvement
of their health IT infrastructure, but also boasts a long  list of provider participants
covering the majority of the state.
* Michigan: The Southwest Michigan Health Information Exchange [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7WLGY1XONscKO2paZKmaCPEgUUqLZ_Bt-uqj8cj0fk_zjJG0oAGapFszvy9gN7yL_6_f5huBstYgj3vaxC1Qoqn8bwQ5niDwOrMJPxvb4zbJw==]
or mihealthelink [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7X4fklsFDgcdnqR5FPLtLhispG2YcpVQFSCn7Pm1qQSvSwto0FqP8tgU4gUWHmdP5hhXsJnlqJ7maOidUoN8TrmIvuj18BnmAa0uQUgVJSQYQ==],
 has successfully brought all five major providers across the  seven-county area
 of Southwest Michigan together to begin planning for  the development of an HIE
 to serve their patient population.
Read more [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7W9yhvI3LY_0jNEVjCP4VuQhdbmBBINWo9saRXiJi4i_FjTJmV-r_tgfYW_XljQYH9Wi1spk7cuoz3FjKrUa_9BSbGEZDMPhwgoIS4eIGK8BYc8G5CHY5F8hSRlYvm69xsFiDtypAk9qBRRy_X4XC8u8om2Xh1CZZooHvaJvHzu2P6uOTy0JM2dd41ZBWBUQ3nXxRiM42mzGQ==]
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Knowledge Management and Clinical Decision Support

The Agency for Healthcare Research and Quality released its report  last week related
to clinical decision support, a cornerstone for  enabling Electronic Health Record
(EHR) capability.

Last week, the Agency for Healthcare Research and Quality (AHRQ) released its report
entitled: Enabling Health Care Decision-making Through Clinical Decision Support
 and Knowledge Management.

The report effectively singles out the importance of clinical  decision support 
systems and electronic knowledge management systems as a  central component of electronic
health record systems -- if we are going  to realize the benefits. The report defines
a clinical decision support system (CDSS) as  any electronic system designed to 
aid directly in clinical decision  making in which the characteristics of individual
patients are used to  generate patient-specific assessments or recommendations that
can then  be presented to clinicians for consideration. Examples of electronic  
CDSSs include alerts, reminders, order sets, drug-dosage calculations,  and care-summary
dashboards that provide performance feedback on quality  indicators or benchmarks.

The knowledge management system (KMS) is  defined as a tool that selectively provides
information relevant to the  characteristics or circumstances of a clinical situation
but which  requires human interpretation for direct application to a specific  patient.
Examples of electronic KMSs include information retrieval tools  and knowledge resources
that consist of distilled primary literature on  evidence-based practices.

Read more [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7XThq0sM6Bn2wPokKxFncZDAYoOxud76m9QlPqAWU7vbTtw2-ZG3n-6luwxipBnJTKrUcW9uwzJvKXTyfQTyXwy5RKhmSMApqWuwUarrU7xe9HK21Zc6NVijiU1UC_x0swnhsScyVYa-hgZVkXcgwJlybzxigXvqe9oUxCyJ2d7BQ4QUbTRnzLkfVnq4Zc46U8KIf5HuGscgFoGq2aaLGFYuwolqu2q4jLzbmsTNZ8_AQ==]
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The Weekly Whisk

Musings from a foodie ...

If you have the chance to visit downtown Chicago and you favor seafood, you should
definitely consider Catch 35 [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7XengUUInEEvCeO1VCuYHZxsABaGGDXYM0YnL_3ZcYa279RMVRU6ZK97AqI3Lec7pGI3j74qqVG2APNuGPG8vB7zf_xMSGWlRV8ptKLYqMmY5LhNMjvG20m]
[]. I enjoyed it so much that I actually went there two nights in a  row. First,
 the seafood is selected every morning and is absolutely  fresh. You can start with
a variety of both chilled and warmed  appetizers followed by the obligatory salad
of your choice. I started  with mussels (both nights!) and then proceeded to the
 blue cheese and  walnut salad on a bed of fresh greens. The offerings range from
fish and  chips (my mainstay when I lived in London) to Asian infused seafood to
  grilled seafood steaks. They also offer a smattering of beef for those  who insist
on the red stuff. Finally, it's the kind of place that  accommodates a "walk-in"
 without the long wait. We arrived on a Friday  evening around 7:00 p.m. and were
promptly led to a table.

Read more [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7V-PWzCp2R0D8xfgVA1gorZtTec_nwVuYObgpnFyrO2HjDb1qWPssxG-VKjf8LjCCzKFNoC7vcIvR7-dXqTc_kl74cCAMNn0fJQC5OFPAGZRlafvcjJx4euLEWg5gXAce1iTL8DREOfrEZwNynB4Z_kbeVB9E-2AYjRDfPD6cCpUpJfm6JLIbpQ90nviN4yEkk=]
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The Good, The Bad, and The Ugly

The ongoing saga ...

The Good -- The work of basic scientists like Christopher Walsh, M.D., Ph.D. at 
Children's Hospital Boston [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7UdMXn2A_axfDlH-80slWOy36B4je4Oj1bgH71z-jmxKl-0UT9efHITnaBrpst2KKDHhiKqCtcTa-BFqdjImBNICfdZUZ00BVBm7uhcc82BNYhB2AcG9MclDQRcm8wHCtWD5NbnlhQHVLM0-YE4gyo3N4FPobEp45HERQxuvNnlC6O2Y9C-8432fwX4Vt94VFI=]
is a daily occurrence in American medicine where dedicated healthcare  professionals
work on solving problems that face families around the  world. Dr. Walsh is focused
on  rare genetic brain disorders [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7Ui429Rt9kzis_GxjfioynSNQtx4tV-fpGc6UH3qWDQivO7D-M0t9SRFS8W7oqoznncdP5rl6qxkb5T7xIqNIfeZ_XzGjWjSCVsloLw2kZzMwwUJYeYfVCS18nCoZAq2hQ=]
of children. We need the Dr. Walsh's and the Dr. Whoevers of the world to keep their
focus AND, we need to support them ...

The Bad -- Another moderate Republican goes down in defeat, Senator Richard Lugar.
 It seems that we are losing "the middle" which is where most decisions  are made
in the USA. Without a moderate middle -- on both sides -- we  should anticipate 
that the legislative stalemate will continue.

The Ugly -- Richard Cohen had an editorial [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7VYshgkWwWhXRRUlvnqPJLLEPkMjqRk7CVgO3LxIgOUCFIhoTXQn3cNs8sr8e0Jo-M7X8kb8HYcZsYlHNybvY9n4CoFMRXH2TtuDO8LsvmcqMDJWhCBKaF1_8tr75YM4cKcx85Rk46puBNceHytsEFSDwVMvovSQDbqbeEWkD9rc9cbKUyKnFNmlAQm_6cap3u85cnwUbBQb7PL_zFxK5H8CwrGzYd87nR_OgbSmfNPs-_GplNbvu7nRgQD6Ct7K0o=]
in The Washington Post several weeks ago that speaks to the continuing sad saga 
of the people in Syria. It's a tragedy ...
Read more [http://r20.rs6.net/tn.jsp?e=001tEnfN2pyb7WvZyBg-7jNPL1gE7oVSnSAoP-vMQKb8F2kXy_P1jiSfsJFikm5CllCDGVjaj4Znnxmc7wzts4C7mU606Qfct-d8sybIxQR7JA5YfV4KdFpoObLEH1O4i2pprIE9oZPUq5xY2SqZLDQ3dcDYz18VNipHmcTtRpg0G26ktU1do7JKabqTnmXFaIeperJ6YX9h9RnPlW9iOcKDQ==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Send to a Colleague [http://ui.constantcontact.com/sa/fwtf.jsp?m=1105336033970&a=1110087001784&ea=hbiden%40rosemontseneca.com]

In This Edition

Quote of the Week
Consulo Indicium
HIEs: Where Do We Go From Here?
Knowledge Management and Clinical Decision Support
The Weekly Whisk
The Good, The Bad,  and The Ugly

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Sponsors
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