Dr. Barry R. Hieb MD

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  www.sdbj.com/article.asp?aID=29204254.76849.1662752.772 - [Cached Version]
  Published on: 8/2/2008    Last Visited: 8/2/2008  

  But managing those new technologies is another task altogether, according to Dr. Barry Hieb, a director at Gartner Research, an information technology advisory firm.
  
  Hospitals often face workflow challenges when introducing new technologies into their workspace, he said.
  
  "The biggest challenge that we face is integrating all this stuff into something that works for the patient, for the nurse, for the doctor and for the technician," Hieb said.

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  www.healthcareitsummit.com/us/agenda/trackSessionsRegis - [Cached Version]
  Published on: 11/11/2007    Last Visited: 11/21/2007  

  Barry Hieb, Research DirectorThe advent of generation 3 CPRs is ushering healthcare into the age of sustainable automation support for evidence-based medicine.

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  security2.gartner.com/DisplayDocument?id=521816&ref=g_s - [Cached Version]
  Published on: 9/13/2007    Last Visited: 7/2/2008  

  By Thomas Handler, M.D. and Barry Hieb, M.D.

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  www.colcap.com/news/0904/091404_pango2.html - [Cached Version]
  Published on: 9/14/2004    Last Visited: 3/2/2007  

  Using a location tracking approach that leverages the existing infrastructure can lead to significant cost savings compared to installing a separate wireless location management system," said Barry Hieb, M.D., Research Director, Gartner Healthcare.

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  www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=& - [Cached Version]
  Published on: 12/10/2007    Last Visited: 12/10/2007  

  Utilizing ultrasound for location services is clearly an emerging technology, says Barry Hieb, senior analyst, Gartner Industries, Stamford, Conn.He maintains that Sonitor Technologies (Oslo, Norway) is the only company that uses sound waves to track medical devices and patients, and that the company has only carried out a "handful" of deployments in U.S.-based hospitals.
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  According to Hieb, in order to circumvent the problem of "wall bleeding" and to gain more accuracy, many RFID vendors will use algorithms that calculate the distance of the tag from the access point, based on factors such as the amount of time elapsed between the issuance of the signal and its receipt, he explains.Three or more access points can be used to locate a tag through triangulation.Of course, "You still run into the problem of increased infrastructure costs and hassle with the implementation of extra access points," Hieb says.
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  Hieb contends that a significant benefit of using ultrasound technology over RFID is that it provides better coverage."If you put a microphone in a room, it should be able to hear any 'chirp' that's in the room because ultrasound travels very well," he explains.However, when antennas receive radio wave signals, if someone is standing next to a metal door frame, the signal may suddenly become weaker, or momentarily lost, says Hieb.Large metal objects such as X-Ray machines don't interfere with ultrasound, he says.
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  Hieb echoes this sentiment."Healthcare facilities need to define which technology is best for which type of function before they run out and deploy an entire system."For example, it's probably not appropriate to put an RFID or ultrasound tag on an aspirin - not only because the tablet is too small, but the cost of the tag is too high - so in this case bar coding might be a good choice for drug administration, he explains."Asset tracking is not an 'all inclusive' proposition; different technologies are suited to tracking different items," he says.Ultrasound is great for tracking items where 100 percent room-level accuracy is needed - patients are a good example of this, Hieb contends.
  
  However, one of the obvious downsides of implementing Sonitor's technologies is that it's so new, claims Hieb.Often with new technology there are no defined standards, so if a second company shows up with an ultrasound tracking application, it will almost certainly use different hardware, he says.
  
  It's unlikely Sonitor's tags could be used on another system, "which means you're kind of tied to that particular company," Hieb explains.There aren't many clients out there that a hospital can talk to about how well the technology works, or how well a particular vendor supports its system, he says.

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  www.fortherecordmag.com/archives/ftr_02182008p12.shtml - [Cached Version]
  Published on: 2/18/2008    Last Visited: 6/29/2008  

  When the question is posed to Barry R. Hieb, MD, a research director with the Gartner group, a member of the American Society for Testing and Materials (ASTM) medical informatics standards group, and an authority on the patient identifier process, the answer is that it will happen by the end of this year.
  
  Hieb, who authored one of the first standards on a national patient identifier nearly 15 years ago, has financed and is working with several business collaborators on the Voluntary Universal Healthcare Identifier (VUHID) Project.VUHID, which arose from ASTM medical standards organization E 31, will make unique identifiers available at no cost to any individual who wants one.The infrastructure is in the final stages of development, and Hieb expects pilot testing to begin by year's end.
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  We believe we now have nothing that will prevent us from implementing this system," says Hieb, who notes that technological advances have enabled them to develop VUHID for a fraction of original cost estimates.
  
  Another key was the ASTM's creation of a second set of patient identifier standards, which serves as an implementation guide."That was where things came together in a way that made us realize something remarkable was happening," says Hieb.
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  While the NHIN has illuminated many problems that the current healthcare system faces in accurately matching patient records, Hieb says that it has also opened the door for the development of a voluntary system such as the VUHID by laying the framework for secure creation of a unique identifier that can be controlled by the patient.
  
  To obtain an identifier through the VUHID, a patient will submit the request to his or her physician, who will gather the appropriate information to validate the individual's identity.
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  It doesn't know who that person is, what kind of clinical information is attached, and so forth," says Hieb.
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  "All of that is now coming from the record location capabilities of the HIE," says Hieb.
  
  For providers not linked to the HIE, patients can request paper copies of the records to enter into their personal health record or provide them to the hospital or clinic to be entered as part of their official record and then linked to their identifier.
  
  "The patient will have a significant amount of control, but the ideal situation is that the doctor's office will electronically link up to the RHIO or HIE," Hieb says.
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  In this method, Hieb says that the VUHID never sees the patient information because it never crosses the server.
  
  "We are doing it this way because we can go to the privacy advocates, who are on track when they say we shouldn't have a national database, and prove to them that there is nothing at the VUHID facilities.It knows about the identifiers and that's all.That's the key," he says.
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  Hieb says that the VUHID does three things to resolve the problems within the current system.
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  Because it is a voluntary system, Hieb says it will take time and education to achieve the critical mass necessary to show the significant benefits a unique patient identifier is expected to have on the accuracy of health data.
  
  "We are one step forward.We haven't solved the problem, but now we have a mechanism" to do so, he says.
  
  Challenges Remain

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  www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=& - [Cached Version]
  Published on: 10/2/2007    Last Visited: 10/2/2007  

  Barry Hieb
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  Barry HiebData security issues were brought to the fore last August when the Department of Veterans Affairs "lost" a hard drive containing 26.5 million patient records.This security breach was of potentially disastrous proportions, says Barry Hieb, analyst and research director at Gartner, Stamford, Conn. "The malice that could have been orchestrated with that many names, social security numbers, and insurance IDs is unfathomable," he says.
  
  However, just as the dust of this latest security blunder had begun to settle, the Government Accountability Office (Washington) released a report citing that 17 security breaches had occurred in the 46 hospitals it has surveyed since 2003 â€" that's a 36 percent breach rate.
  
  Threats from the inside
  
  "Hospitals spend millions of dollars on firewalls, intrusion detection, anti-virus, and vulnerability applications, all trying to keep people out of their system.But often, the biggest threats come from within an organization," explains Hieb.
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  According to Hieb, credentialing software is essentially a recording and storage application.However, newer credentialing applications are also being used to track the performance of an individual, such as how many operations a surgeon has performed in a particular area, or what continuing education modules have they completed, he explains.
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  "If users know that they are being watched, it provides a greater incentive to do the right thing," suggests Hieb.
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  The process of authentication can be easy or complex, says Hieb.Authentication is comprised of three factors â€" who you are, what you know, and what you have, he explains.The typical approach to accessing a hospital system is providing a username and password, which is called one factor authentication.Two factor authentication consists of providing a username and password (one factor) and another item such as a smartcard or fingerprint, says Hieb.He claims that most authentication systems used in hospitals are "not as strong as they should be."
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  Hieb contends that although biometric technology is well-built, changing procedure in large institutions is difficult to initiate.
  
  "We're also not hearing the right messages from Washington, D.C.If you're a hospital that goes out and implements an RFID security system, and the next week Congress says they advocate the use of fingerprints, then you're stuck," he says.When a hospital selects a new solution, it's at financial risk â€" the system it chooses could later be decreed as redundant, says Hieb.

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  www.fortherecordmag.com/archives/ftr_10292007p14.shtml - [Cached Version]
  Published on: 10/29/2007    Last Visited: 6/29/2008  

  According to Barry Hieb, MD, a healthcare research director at Gartner, Inc., the lack of efficiency and the money that leaks through transcription cracks have always been issues in the healthcare industry.In June, Hieb authored "The Evolving Model of Clinical Dictation and Transcription," an industry research paper in which he discusses how the "role of dictation and transcription in clinical documentation is evolving in response to new technologies and new functional requirements ... "
  
  The report finds that "traditional dictation and transcription are giving way to 'editor-based' approaches and that once-and-done dictation will eventually be adopted in the majority of situations."
  
  "Transcription and dictation is a big industry, and millions and millions of dollars are spent on transcription," Hieb explains.
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  Hieb believes medical dictation and its associated transcription activities have moved into the second phase of a three-phase evolution because of the emergence of mature speech recognition capabilities.He writes in his report that "because speech recognition makes increased productivity and associated cost savings possible, it is now an integral part of most new dictation and transcription contracts."
  
  The OAD dictation model, Hieb explains, will take longer to unfold but will be driven by the need to provide value back to physicians at the time they are dictating reports.
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  Enter speech recognition, Hieb says."While speech recognition isn't perfect, it is evolving," he notes.With back-end speech recognition, the physician's completed dictation gets fed into a "recognizer."While Hieb agrees that the first pass isn't perfect, the dictation then goes to an MT.
  
  "We will be calling MTs editors rather than transcriptionists because their job won't be to work from the raw data but to go back and correct the places where it looks like the speech recognizer got confused," Hieb says.
  
  Using speech recognition technology cuts significant costs from the entire transcription cycle, he says."The editors can crank out 50% to 100% more copy a day and, as a result, the hospital gets charged less money.But the downside is there is still a two-day turnaround time, and the hospital is still paying for both transcription and dictation costs," Hieb says.
  
  The advantage to the editor mode of transcription is that the doctor is not being asked to change the way he or she operates, and the report is turned around faster."Presumably, the editor is happier, is doing more work, and is being more productive.And from a documentation standpoint, you are telling the physician that the report will be back more quickly, but you still have to look at it, revise it, and sign off on it," Hieb explains.
  
  The OAD model, he says, carries with it a good news/bad news scenario: The hospital can save money and enhance performance, but the doctor has to change his or her dictation routine.
  
  "Doctors are hesitant now because we will be telling them, 'You will be dictating at a computer, but you can see what you are dictating'," Hieb says.He acknowledges that some doctors are poor dictators, but with OAD, they can receive direct feedback and make edits as they go, while the patient information is fresh in their minds.
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  Hieb believes that one of OAD's benefits is that when the clinician dictates, edits, and signs off on the record, it's ready to go into the electronic chart."The turnaround time has dropped from four days to two days [with back-end speech recognition] to two minutes, and now any doctor can see that report as soon as the physician signs off on it," Hieb explains."That turnaround time brings nothing but benefits and better care to the patients."
  
  Although a hospital would have to invest in the software and hardware technologies necessary to implement an OAD system, Hieb says those expenses would pay off in the long run."There will be set-up and maintenance fees, but they will be nowhere near the costs of the money spent on dictation and transcription," he explains.He agrees, though, that getting doctors to change their behavior will be the largest hurdle to overcome.
  
  Hieb says analyses of the time and effort required when a doctor performs raw transcription and dictation rarely take into account the extra steps of having to go back and look at the first draft, examine the corrected draft, and eventually sign off.
  
  "With OAD, there is no subsequent time added to that chart, little hassle, and minimal risk of error," he says.
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  "If a doctor is a good speaker, that accuracy will go even higher," Hieb says.
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  Nevertheless, Hieb says OAD is being accepted more readily in private practices."That is where the technology is really making inroads because the doctors see they can save time and money, and if they have an electronic copy of the record, the staff isn't busy chasing down records.In fact, they may be able to reduce the amount of staff they are paying," he says."The OAD knows to file the record in Susie Smith's chart, and the general trend in medicine is toward more clinical automation."
  
  Initially, Hieb says some doctors felt they were taking on secretarial responsibilities; education and peer endorsement helped OAD gain physician acceptance."If we tell them it's in their own best interest and that if you spend a little extra time editing, you will save time and money in the long run, they quickly see the benefits of OAD."
  
  As with many speech recognition technologies, OAD integrates more easily into radiology and pathology, but Hieb says it can also be effective in the emergency department (ED), where time is of the essence.
  
  "In the ED, the real benefit is getting that data out there and into the chart instantly.The more quickly and effectively the information is captured in the chart, the more quickly the physicians have access to that data," Hieb says.
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  For Hieb, the reason to embrace OAD is because the goal of the healthcare system is to help sick people get well and healthy people stay healthy."We are entering an age when information is a critical component of achieving these two goals, and once and done is a better, more efficient way to capture that information," he says.

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  ww.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&t - [Cached Version]
  Published on: 4/12/2007    Last Visited: 4/12/2007  

  Barry Hieb, M.D., research director for Gartner Inc., Stamford, Conn., says the EMPI market is maturing."There's no question that anybody who is serious about exchanging data needs to get one," he says, adding that one of the technology's most likely customer bases, the RHIO market, is hampered by unclear business models.
  
  "I think every IDN, every RHIO, would buy one if they didn't have to spend real money to get one," Hieb says.

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  www.idgvb.com/newsitem.cfm?id=133 - [Cached Version]
  Published on: 9/13/2004    Last Visited: 9/7/2008  

  Using a location tracking approach that leverages the existing infrastructure can lead to significant cost savings compared to installing a separate wireless location management system," said Barry Hieb, M.D., Research Director, Gartner Healthcare.

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