Health Care Technology Chasm

Apple Once Again May Be the "IT" Tool for Health

2011-11-27T17:13:00.001-05:00

Despite focusing primarily on consumer products, Apple has stormed into the health care sector; first with its iPhone and then with the iPad. Through individual users and not enterprise sales, Apple has snuck into clinics, hospitals and other health care facilities with physician apps that help them manage their time and access diagnostic and treatment information. So far, it's estimated that 84 percent of physicians use smart phones (61 percent of all physicians use the iPhone) and more than 22 percent are using the first generation iPad. With the proliferation of Apple products, the biggest impact will come from Siri. Natural language search will fundamentally improve work flows to an extent that fence sitters will make the leap. Apple's new Siri natural language assist will do more to transform clinical health than any other technology tool. Provided that Siri can easily navigate the various clinical apps run by health care physicians, it will significantly help in accessing vital information. Now, the true power will come when a physician's iPhone is connected to the enterprise's back-end data, such as EMRs. Once that happens, one device will prove to be the gateway to data and various solutions.Taken another step, an iPhone 4s that's connected to a provider's EMR back-end running Apixio will prove to be a powerful tool to enable health professionals to obtain the information that they need. Apixio searches all data, in whatever format, based upon a natural word query to ensure that the physician has everything needed to properly care for a patient.Apixio demo (no affiliation) can be found here: http://www.apixio.com/care-coordination-powered-by-searchThe Apple iPhone 4s can be found everywhere, and I look forward to using one to make my life easier.

Treato.com is the Google in Health

2011-10-21T12:01:00.000-04:00

A recently launched online solution for patients looks to be precisely what Google Health could have been in leveraging its core competency: search. Treato.com (a creation of a start-up called First Life Research) allows you to search by condition, prescription or other health term all social media data posted by patients. It's a one-stop (social media) data aggregator - like Google is to everything else. Launched at Health 2.0 in San Francisco this week, treato bridges the search gap in a clever way for people in search of the best data regarding a particular symptom, condition, etc.... for everyone in the health care ecosystem. From the press release:First Life Research CEO, Gideon Mantel says that "[t]he social health web is currently estimated at 10 Billion unique patient records, and is expected to grow at a pace of 40%-50% annually. “Up until now, there was no real way to utilize this untapped pool of collective knowledge, [and] treato™ is taking this vibrant, nearly infinite space filled with potentially life-changing insights - and putting it at your fingertips."By enabling instant access to real-life patient experiences with every listed FDA drug, prescribed or OTC, patients can better understand what it means to cope with their medical condition, as well as the effectiveness and side effects of their drugs. In addition, the platform enables an easy comparison between competing medications, providing valuable information for patients considering switching between brands.The press release is here: http://www.prweb.com/releases/2011/9/prweb8815937.htm

PHR Adoption. Same Old, Same Old.

2011-10-21T11:55:00.000-04:00

A recent study regarding PHR adoption provides less than encouraging adoption by consumers, and its no surprise. Despite the fact that health and access to affordable health care is top of mind for most Americans, few people are changing their behaviors to adopt PHRs. And its little surprise. We're now well into the second decade of Internet related technology, and although health care solutions are quickly growing, they're not on a parallel track with so many other Internet solutions in other verticals. Two early leaders (and I am reluctant to categorize Microsoft as a leader in Internet solutions, let alone health care) were Microsoft HealthVault and Google Health. Each partnered with an impressive health care provider; Google with the Cleveland Clinic and Microsoft with the Mayo Clinic. Neither product integrated on any scalable way with any EMR, but required consumers to upload their own medical records and share with physicians. What we know about human behavior and online solutions tells us that that won't work. Unless you're one of the 15 percent who are chronically ill and cost the system over 70 percent of dollars spent on treatment, you aren't likely to spend much time self-reporting or digitizing health records. In fact, there's no evidence that the chronically ill are doing so. Health records must be integrated, shared and accessible easily, and this isn't the case with any PHR. Until we make that transition to integration and mobile accessibility, it's doubtful that we'll see any benefit with consumer related health care technology. Success can be seen with any social media and data sharing mobile technology, such as Facebook, Quora, LinkedIn, Yelp, etc.... The most successful health care solutions online that see widespread consumer adoption are social media sites such as WebMD and Internet Brands numerous properties, but not because they are best in breed, but because they provide content that is relevant through search and interaction. I liken the current offerings to the car sale web sites of the late '90s; they weren't great or sustainable, but they were better than buying a car through the abhorrent process of a dealership visit.The good news is that it's all upside. As health care solutions follow the trajectory of online solutions for other industry verticals, we'll see greater adoption of them and the behavior that they purport; producing healthier people.

Every Week is Health IT Week

2011-09-12T19:20:00.001-04:00

HHS kicked off Health IT Week with a webcast focused on consumer health. The front end was very well scripted, diminishing in significance towards the end of the last half of the one and a half hour program. Of course, since this is government, no PowerPoints or decks were available, which would have been extremely helpful given the many references to statistics and HHS programs. But first, kudos to HHS for enabling the democratization of access to information and HHS leadership through this webcast. Government doesn't generally work like this. The HHS has been a shining star in the Obama administration pushing hard on its agenda to leverage government health dollars to encourage the use of information technology.Secretary Kathleen Sebelius continued her push to transform our health care to a wellness system by empowering consumers to access health information to improve their health. A few numbers: In 2008, less than 20% of physicians and 10% of hospitals used EMR/HIT that is used in every other industry, and providers were reluctant to invest in unproven and non-standardized IT solutions. So following the Department of Agriculture model, the HHS established 62 regional HIT extension centers to help providers. HHS invested in standards and frameworks and provided reimbursements for the meaningful use of EMR technology through the HITECH Act. To date, more than 80,000 physicians have applied for reimbursement (of approximately 660,000), with a high incidence of rural providers participating. This roughly $18 billion in reimbursements will drive growth (and employment) in the health IT sector, or at least the Obama administration hopes, with a majority of the companies having fewer than 50 employees.But back to consumer centered health care. The average chronic senior sees 14 health providers in any given month, and it is slowly becoming more likely that these many health professionals will have access to current medical information. The "best standard of care" when measured happens only seven percent of the time with paper records, but 53 percent of the time using electronic records. Part of the upside in accessible health records is the importance of patients not having to repeat their stories over and over. Another is the benefit of big data aggregation of all of this integration and access.One particular guest presenter was Don (last name unknown) who adeptly pointed out that the patient is the biggest "expert" and data source, as well as healing source in health care. Self-care is the 80 of the 20 and caregivers are guests in the health care experience. This was a very interesting perspective and a relief to those of us engaged in developing technology to help consumers adopt sustainable, healthy habits - to truly be accountable for their own health. Don pointed out the six requirements of good care and how health IT can help: 1) safety2) effectiveness (alignment of proper care, shared objectives and integration of many)3) equity (honoring diversity, and definition of excellence is dependent upon personal goals)4) efficiency5) timeliness (quickest is self-care, efficiency and shared decision making)6) patient-centered (blue button initiative - open sesame)Of course, the sixth is the most important and if reached, will help bend the cost curve in health care. A new HHS employee discussed patients' civil rights of access to health records, and the Blue Button initiative more clearly set out at bluebuttondata.org. Most of you will recognize the "Blue Button" initiative from the VA patient portal feature of downloading or printing an entire health record. I find it amusing that a common feature of any IT product would be branded this way, but perhaps its a response to consumer surveys that have shown Americans are leery of cloud-based personal data - despite the ubiquity of Facebook, of course.Lastly, a grant/contest was announced regarding a "safe transition from hospital to home" from CMS of $25,000. But I can find little in the way of how to apply. Please feel free to add any information on this in the comments below. The Health IT Week schedule is here: http://www.healthitweek.org/activities.asp

Rock Health Publishes Funding Findings. 'Still Daunting.

2011-08-30T19:28:00.000-04:00

Rock Health, a San Francisco based seed-accelerator for digital health technology, recently published its findings related to health care technology funding (below). We all know that it's been hard - unless you have "mobile" in your pitch - but the most interesting is the focus on consumer by bootstrapped entrepreneurs, despite the biggest funding plays deriving from providers and employers (unless it's primarily a mobile app). With 71 percent targeting traditional B2B (in health care, that's providers, payers, Pharma (biotech, med device, etc...) and employers). Consumer plays are hoping that the upcoming HRA implementation will entice consumers to seek better information to stay healthy as their insurance deductibles increase. Fewer provider resources, increased costs for consumers and decreased revenue for providers and payers to name just a few of the effects of HRA truly create a rich environment for disruptive technology.

Rock Health report here: http://www.slideshare.net/RockHealth/rock-report-state-of-digital-health

Health Care M&A is on the Rise. So Are Health Care Costs.

2011-08-01T20:31:00.001-04:00

It's been a while, but I've been busy adding to the health care information technology deal flow, which is not a surprise given the significance of health care in our economy. And it continues to grow. With the health care reform act, projections put healthcare spend at approximately 19% of GDP. A large part of that is the introduction of regular care access to over 30 million new patients. And how will we pay for this? Increased premiums, certainly, but hopefully the efficiencies of new wellness technology for consumers, as well as operational efficiencies for providers and payers will help bend the cost curve. Naysayers say that it's unlikely that cost savings will be passed along to consumers, especially those who enjoy employer provided health care, but employers are now aggressively adopting new wellness programs and high deductible plans (while eliminating high risk employees through hiring practices) to do their part. Overall this climate has created a fertile field for technology companies that have unique solutions for preventative care and chronic illness management. And McKesson, Cerner, Quality Systems et al have enjoyed significant revenue increases due to the HITECH part of ARRA. It's a good time for established health care technology companies. I suspect that as costs become distributed to employers and consumers, more innovative solutions will prosper as well.

Ford Focus a Med Device

2011-06-01T14:13:00.000-04:00

I read with amusement Ford's push into the health care space by providing in-car features that aid in health care bio display (article below). I spent a fair amount of my career in developing consumer and enterprise IT solutions for the auto industry, so I'm extremely familiar with the space. But Ford's recent initiative leaves me scratching my head. Ford purports to aid diabetics with seat and air sensors that can measure a diabetics blood glucose levels. A noble idea, but I'm hoping Ford can look back into the history of in-car devices to see that better solutions already exist. As with the phone, technology that provides value out of the car is best left as a portable, mobile device. Diabetics aren't only concerned about blood glucose levels in the car, and the myriad of monitoring devices that provide 24/7 coverage should be a signal to Ford that the cost and complexity simply isn't a good value proposition. The better solution is to integrate existing monitoring devices into the Ford OS to allow relevant alerts for rest periods and food. Otherwise, as a friend and colleague in Europe designing cars said, this technology poorly developed will generate anxiety, and less safety.

I heard on NPR a Ford spokesman speak to their health care initiative, given that people are spending more and more time in their cars. But that's a symptom of a greater problem. Perhaps if people spent less time in their cars and more time walking or exploring other transportation alternatives. diabetes would be less of a problem in this country.

Wall Street Cheat Sheet article here: http://wallstcheatsheet.com/stocks/ford-makes-foray-into-healthcare-with-ground-breaking-car-feature.html/

Why Are Health Care Costs So High?

2011-05-12T12:46:00.000-04:00

In a recent HuffPo blog, Richard Kirsch argued that consumers weren't to blame for high health care costs, but that it was the prices we pay. Yes, health care in this country is heavily regulated, is paid for many in large part by Federal and state governments and is rife with inefficiencies. But we can't overlook that as a population, Americans are living less healthy. Kirsch does makes some very good points in the comparison between the systems in the US, Canada and Germany, although Canada is a single payer system, unlike the US and Germany. Fundamentally, what US health reform doesn't do is address prices like other, more successful health care systems. A properly rewarded health care professional will endeavor to improve the health of their patients. But then there's the consumer.

Consumers have a great deal of responsibility for the high cost of health care, but not necessarily on a micro level. If just 15 percent of our population accounts for over 70 percent of our health care spend, then we have a lot to talk about with this small group of health care frequent imbibers. That said, since we have a history of treating instead of caring for consumers, we've abandoned the upside of helping people adopt healthy, sustainable habits to ensure that they enjoy a high quality of life. Will price control help bend that health care cost curve? Absolutely. But that bend will only be temporary relief unless we can get all stakeholders to focus on care instead of treatment. And this means not just at the clinical setting, but a review of our public institutions such as schools to ensure that government dollars aren't robbing Peter - e.g., in the form of unhealthy school lunches - to pay Paul - e.g., escalating MediCare/MedicAid costs. 'Not sure if that old saying worked, but you get my point.

Kirsch's blog here: http://www.huffingtonpost.com/richard-kirsch/health-care-costs-_b_860601.html

Mobile Health Care Apps are Just Getting Started - Slowly

2011-05-03T17:59:00.000-04:00

In a recent survey related to the low adoption of available mobile health care apps
Smartphone apps are increasing in popularity and are being widely used in healthcare as health apps, but more research needs to be conducted on their efficacy as patient adherence tools, according to a survey by Consumer Health Information Corporation (CHIC). No kidding. Most new apps out today have been cobbled together by traditional health care IT companies with no experience in the space - or at least the "consumer" space.

In summary, the survey was given to 395 people in a university or business setting.

26 percent of apps are used only once.
74 percent stop using after the 10th access (including the above number, presumably).
So, 26 percent of smartphone applications retain some level of relevance for users.

34 percent abandon one app for another, more relevant app
33 percent abandon an app for lack of user friendliness.
91 percent expressed a desire to try an app if it helped them gain information.
91 percent most valued ease of navigation/usability.

None of this is surprising to anyone who uses an iPhone, Blackberry or Android, and I've personally loaded many valueless healthcare apps on my 3GS. For example, MedHelp and GE have created the "Moody Me" app that allows the user to track their moods (self reporting) on a daily basis. Seriously. Another collaboration produced "Pic Healthy", an app that requires you to photograph food and estimate its healthiness. It also combines a social media context that enables you to check out what other people are eating. Fundamentally, none of the apps will stick, because they don't leverage existing data and produce credible information to help folks make an informed decision. But I guess it looks good on a press release. Apps that require a lot of self-entry (outside of a photo or other easily uploaded data) are unlikely to be quick and relevant enough for people on the go.

One app that I actually use is the Nike Training app that catalogs quick to longish/easy to intense workouts, with video how-to guides. It's an excellent use of digital media on a mobile device. Quest Diagnostics also has an excellent app that enables folks to track immunizations and lab results through Gazelle. Access to necessary data (instead of self-entry) or quick, easy to navigate informative content is helpful to reaching the tipping point of mobile app adoption.

The HealthCare IT News article is here: http://www.healthcareitnews.com/news/smartphone-health-apps-having-trouble-retaining-consumer-loyalty

The Health of Google Health

2011-04-01T14:25:00.001-04:00

Much speculation has been made based upon a recent Wall Street Journal article regarding Larry Page's priorities as Google's new CEO. Specifically, the article suggested that Page would dedicate fewer resources to Google Health, among many other areas of the business to be scrutinized. In this new age of reactive punditry, I find it amusing the numerous blogs that have followed this article hypothecating the end of Google Health. Health constitutes over 17% of US GDP, and an appropriate share of the world's GDP, so it's likely safe to guess that Google won't abandon the health vertical. Reassess and prioritize existing market opportunities, certainly. But I think that the news of Google Health's death are premature.

http://www.glgroup.com/News/Google-Drops-Health-Project-53170.html

More development: http://www.fiercehealthit.com/story/how-far-has-google-health-really-fallen/2011-05-11

Habits. Another Third Rail of Health Care.

2011-03-21T15:12:00.001-04:00

Habits. Good and bad, will be a significant determining factor on how successful we will be in improving health, bettering care and lowering costs. Unless people eat better, exercise more and abstain from unhealthy activities, we will never lower costs no matter how efficient and correct we deliver care. Roughly 60 percent of the population is at risk of slipping into a chronic condition, and although about 15 percent of the US suffers from some form of chronic illness (diabetes, heart disease, etc...), these people account for over 70 percent of our costs. So you can understand how critical it is for us to help folks avoid slipping into a chronic health state.
Currently, there are many freemium apps online and in mobile form that allow people to track diet and exercise, mostly in a self-reporting format. But other than allow people to gather information and suggest diet or types of exercise, no leap has been made to create healthy pathways for people that will help them change their behavior. It's a daunting task, yes, but look at the engagement of Facebook. Social media may be our savior in health as well as our undoing in other aspects of our lives. Studies show that people's behavior is most affected by social media - friends. I'm guessing that pre-Internet, studies would have shown that people were most affected by friends. The social media application simply provides access - and scale - to a process that may have taken significantly longer or may have never happened if reliant on traditional communication tools.
Also, social media isn't necessarily reliant on the newest hardware, although the proliferation of smart phones and ensuing apps have gone a long way in making almost every activity relevant to someone. Facebook is used by almost 100 percent of its relevant market, which means that somewhere people are using dial up connections to access it via IE6 on Windows XP. Others are using iPad2s on mobile broadband. It's that kind of relevance that we in health care must create related to adopting sustainable, healthy habits. As integration of life activities proliferates, we'll share more when it's easy and likely prompted. The trick is driving the behavior, not simply reporting it, and that will require a more clever social media pathway than curretnly exists.
In a recent study regarding prediabetes patients cited in a Los Angeles Times article, encouragement from others regarding diet and excercise was significantly more effective than a drug. The landmark Diabetes Prevention Program study "followed more than 3,000 people who were overweight and prediabetic. Researchers randomly separated the subjects into three groups: One-third took the diabetes drug metformin, one-third received a placebo and the other one-third received intense support to help them get more exercise and lose weight." The results reported in 2002: People receiving diet and exercise coaching reduced their risk of developing diabetes by 58%; those on metformin reduced their risk by 31%.

LA Times article here: http://www.latimes.com/health/la-he-prediabetes-20110321,0,4467777.story

Watson will Bridge that Chasm for Physicians

2011-02-17T18:24:00.000-05:00

I've been curiously following the story of Watson, IBM's natural language search solution, through the popular culture media sources. I thought how very odd that this technology triumph would first appear through what amounts to a circus act: an appearance on Jeopardy. Natural language search is the killer app for folks who simply aren't willing to "learn" a software application. Quite frankly, an elegant design should require minimal training, even with clinical applications, because the users have proven to be reluctant to use any product that requires keyed-in data. I'm thinking the majority of physicians. It reminds me of the time that I started practicing law and encountered a boss that insisted that I use dictation for all of my work; no good lawyer would ever use a computer personally. Now I'm not that old, and that person, I'm sure, has achieved a leadership position in that financial services company simply by staying put. But I digress.

VentureBeat reports that IBM has done a deal with Nuance Communications, the maker of Dragon Medical dictation, a great iPhone app medical search engine for health care providers. This is certainly Health 2.5 at its best, allowing health care providers to quickly get answers in a clinical setting, speeding up research and suggested courses of prevention and/or treatment.
Yes, we have miles and miles to go regarding the enterprise adoption of such tools, with lawyers and insurance people raising both valid and unrealistic risks borne by the organization that relies heavily on such innovative technology, but I'm certain that physicians already using mobile apps, whether approved by their employers or not, will quickly find this to be a remarkable tool. Never-the-less, it's nice to see IBM back out front again.

Story here: http://venturebeat.com/2011/02/17/ibm-watson-nuance/

Markle Study Shows Physician's Top Five

2011-01-31T14:44:00.000-05:00

A new study by the Markle Foundation focused on patient and physician requirements for information technology revealed the following top five priorities:

1) Coordinate care
2) Reduce medical errors
3) Cut costs
4) Protect privacy
5) Achieve improvement

Although these are obvious benefits in any enterprise, the overwhelming response related to the issues of privacy and coordinating care to improve health outcomes has been a most obvious, recurring theme.

The entire survey: http://www.markle.org/health/public-opinion-surveys/latest-surveys

Excerpts below:

ose track of potentially important things they are told during doctor visits, and 34 percent of the doctors said they themselves at least sometimes forget or lose track of potentially important things that their patients tell them. Among the patient group, 30 percent perceived that their doctors forget or lose track of potentially important information at least sometimes.

According to the Markle Survey of Health in a Networked Life, we have found that:

Among the doctors, 74 percent would prefer computer-based means of sharing patient information with each other. (Only 17 percent of doctors predominantly use such means today.)

Nearly half (47 percent) of the doctors would prefer computer-based means of sharing records with their patients. (Only 5 percent do so today.)
Yet 74 percent of doctors said patients should be able to share their information electronically with their doctors and other practitioners.
Among the public, 10 percent reported currently having an electronic personal health record (PHR)—up from 3 percent who reported having one in Markle’s 2008 survey.
Roughly 2 in 3 of both groups (70 percent of the public and 65 percent of the doctors) agreed that patients should be able to download their personal health information online.
And 70 percent of the public said patients should get a written or online summary after each doctor visit, but only 36 percent of the doctors agreed. (Only 4 percent of doctors say that they currently provide all their patients a summary after every visit).
"Our past surveys show that most US adults believe personal health records that include copies of their own medical information would help them improve their health and communicate better with health professionals," said Josh Lemieux, Director of Personal Health Technology at Markle. "With this survey, we find an increase in PHR use and learn that roughly two in three doctors agree that patients should have the option of online access to their personal health information. The survey also confirms that having modern information tools comes with expectations for privacy protections."

Other findings from the Markle survey include:

Majorities of 70 percent to 80 percent of both patients and doctors support privacy-protective practices, such as letting people see who has accessed their records, notifying people affected by information breaches, and giving people mechanisms to exercise choice and correct information.

Majorities (65 percent of the public and 75 percent of doctors) agreed that it’s important to have a policy against the government collecting personally identifiable health information for health IT or health care quality-improvement programs.

If there are safeguards to protect identity, however, at least 68 percent of the public and 75 percent of the doctors expressed willingness to allow composite information to be used to detect outbreaks, bioterror attacks, and fraud, and to conduct research and quality and service improvement programs.

Large majorities of the public (75 percent) and the doctors (73 percent) said it will be important to measure progress on improving health care quality and safety to ensure the public health IT investments will be well spent. Both groups (each at 69 percent) agreed on the importance of specific requirements to improve the nation's health in areas like heart disease, obesity, diabetes, and asthma.

Many are unaware of the health IT incentives: 85 percent of the public and 36 percent of doctors describe themselves as not very or not at all familiar with the health IT incentives program, which makes subsidies available for doctors and hospitals to increase use of information technology.

EHR Market Reaching Saturation in Certain Segments

2011-01-16T18:49:00.000-05:00

In an analyst report by Brean Murray Carret & Co,(cited by Mercom Capital), the EHR market for the inpatient market appears to be mature and significantly addressed, which is not surprising given that most hospitals are sophisticated consumers of technology, including the information kind. On the ambulatory front, given that most physicians work in offices of less than five doctors, this appears to be the biggest unserved EHR market, and has been shown by the many surveys citing fairly low technology adoption by small office ambulatory clinical providers. This of course is not news, but presents a challenge by EHR vendors in reaching this fragmented and geographically disperse market.

Brean's report read, in part:

We believe most market participants share the view that the inpatient market is relatively mature. Therefore, the most controversial component of our 2011 outlook is the penetration of the ambulatory market, in our opinion. We believe current valuations imply an expectation of sustained +20% y/y growth in the ambulatory market for several years. Based on a bottoms-up build, we estimate the ambulatory market is nearly 45% penetrated. We focus our estimate on
the 10 leading outpatient EHR vendors to ensure we are counting not only products that will be certified but also ones that are unlikely to be replaced.

Our estimate still leaves roughly 260,000 physicians in the addressable pool, which at face value still appears attractive. However, we believe two years of 20% growth in licenses sold
would place EHR penetration in the physician market at 70% by the end of 2012. Assuming the market achieves 90% penetration by 2014, which is aggressive in our mind, we estimate the ambulatory market can only sustain one year of 20% growth before decelerating. Another potentially more reasonable option is that the EHR market has a slower growth trajectory and never reaches 20%, which we also believe would disappoint the market.

Estimating Market Penetration: The general consensus seems to be that EHR penetration within the ambulatory market is below 20%, due to numerous industry surveys conducted over the years that peg penetration rates ranging from 15 to 20%. Aside from difficulty in estimating the numerator or number of physicians who have adopted an EHR, we also need to identify the total addressable market. We have heard estimates range from 550k to 800k physicians in the addressable ambulatory market.

According to the final meaningful use rule from the Centers for Medicare and Medicaid Services (CMS), there are 478k physicians that will be eligible to receive Medicare or Medicaid incentives under the stimulus. Considering the relatively slow pace of physician adoption prior to introduction of federal incentives, we believe it is highly unlikely physicians that are not eligible to receive incentives will purchase an EHR. Therefore, we use CMS’ estimate as the
denominator for our market penetration estimate.

http://www.breanmurraycarret.com/investment_banking.asp

Recent article regarding primary care physicians here: http://www.modernphysician.com/article/20110114/MODERNPHYSICIAN/301149958/#

Sebelius Speaks to Big Challenges

2011-01-06T22:40:00.000-05:00

Kathleen Sebelius, Secretary of HHS, was interviewed recently by the New England Journal of Medicine on the challenges faced by implementation of the Affordable Care Act. And rightly, she spoke of the upsides in leveraging technology and payment mechanisms to reduce costs through preventative care. Despite her forecast of 19,000 new providers coming into the system in the next five years, this pales in the shadow of the current need and future capacity once ACA shifts into the next phase of care provision. A less than three percent increase in capacity, not including the loss due to retirees, isn't going to cut it, so the only remedy is to leverage technology to support preventative care delivery in the hopes of reducing chronic illness, and the burdens that it brings our health care system and improve efficiency on the administrative side.

Specifically, she believes that "refocusing health interventions at an earlier stage, placing more focus on health and wellness strategies, would help reduce demand and promote population health." She spoke of enabling health professionals other than doctors to increase their scope of care delivery, such as allowing "nurses to practice up to the skill level of their training. . . . We could put some incentives on the table to encourage that discussion."

There is no one answer to improving care capacity, but HIT should be a significant part of HHS' plan.

Full interview here: http://healthpolicyandreform.nejm.org/?p=13542&query=TOC

Ideas Aren't Protectable; a Notion Lost to Certain Harvard Grads

2010-12-31T14:22:00.000-05:00

The New York Times reported again about the Winklevoss twins' ongoing dispute with Facebook founder Mark Zuckerburg today, and it is apparent the traction a meritless claim can make when a party is wealthy, part of the Ivy League and photogenic. I like the Times, and it is part of my daily ritual, but it's starting to look like "People/US/celebrity rag" reporting. To the point, the Winklevoss' aren't news anymore. The technology innovation that happens all around the world is rife with stories similar to this, and even in the rarefied environment of intellectual property protection here in the US, the Winklevoss' have no claim. The significant settlement reached is clearly the product of Facebook's efforts to put it past them, but I wouldn't have done that deal. I'm sure that there are facts and client interests that I'm not privy to, but just because the Winklevoss' had an idea - an idea borne by thousands - doesn't provide a claim. An important tenant of US IP law is that ideas aren't protectable. And the windfall settlement - now estimated to be worth $140 million is scandalous by any measure.

Perhaps this is a ploy by the Twins to land yet another lottery ticket - a reality show based upon privileged people who are simply unaccustomed to being the center of attention. I guess that we'll simply have to wait, unless some other crafty Hollywood reality show producer has stolen the notion and already started casting....

What Will Prove to be the Killer App in Health Care

2010-12-16T16:58:00.000-05:00

As we speed towards the status quo of Health Care cost increases at one percent of GDP every few years, I wonder what will levers can be pulled to slow the trend and give us hope of reversing it. Most traditional enterprise HIT professionals are looking to partner and acquire, but this simply - in the short term anyway - lends to a higher spend. Interesting perspective on consolidation in the enterprise HIT marketplace: http://www.thelundreport.org/resource/is_our_healthcare_system_headed_toward_creative_destruction

Sure, the infrastructure is necessary and someday with the right BI tools will help health care professionals from a policy and practice perspective. But the ability of health care constituents to use such information to reduce the cost of care largely depends upon the revenue streams, and those are defined by payers (private and the government).

Health reform bill? Well, without cost controls as part of the equation, it's unlikely that our free fall of an unsustainable financial burden without - and here's the kicker - actually increasing the quality of health for Americans. But, there are a few bright spots. Previously in this blog you've been subject to an unrelenting call-out regarding information technology that enables patients to adopt sustainable, healthy habits. There's the VA. And there's the concept of ACOs (accountable health organizations) that measure (and focus attention) providers' actual care outcome, as opposed to the traditional treatment. And this measurement would not be possible without certain HIT tools. So we've come full circle as to the importance of HIT to slow down the runaway train of health care spending. Whether it will be used correctly and rid us of this identical debate every decade is anybodies guess.

Primer on ACOs here: http://www.nejm.org/doi/full/10.1056/NEJMp1009040

VA Health Care Ahead of Private Sector. Still

2010-12-12T17:24:00.000-05:00

As I talk with health care IT folks around the country, I'm always astounded by the number of them that have little understanding of the various forms of care delivery - or even a recent visit to a care facility, other than as a patient - and a lack of knowledge regarding the excellent care delivered by the VA. Yes, the Veterans Administration. For those of you who still don't know that the VA delivers the best care anywhere, this one's for you. For those of you who knew, it apparently is still the standard. I won't duplicate the numerous posts below, but here's more recent proof that the VA's model is worth studying.

In a recent study published in "Medical Care", the studies authors found that the VA outperforms the private sector when it comes to following recommended processes for patient care. Report authors cite the use of information technology as a possible reason, but the VA also has initiated the use of checklists as well.

The research team included people from the VA, RAND Corp. and two universities reviewed who looked at a range of studies of diseases common among veterans, such as diabetes, heart disease and depression. The VA's integration of healthcare settings, use of performance measures with an accountability framework, disease-management practices and electronic medical records and health information technology were all thought to significantly contribute to the better ourcomes.

The review found:

Nine studies comparing VA and non-VA care in general showed greater adherence to accepted processes of care – or better health outcomes – in VA.
Five studies of mortality following a heart attack or other coronary event found similar survival rates in VA and non-VA settings.
Three studies of care after a heart attack found greater rates of evidence-based drug therapy in VA; one found lower use of clinically appropriate angiography (blood vessel imaging) in VA.
Three studies of diabetes care found VA to have better adherence to guidelines.
Three studies found higher rates of vaccination against flu and pneumonia for the elderly in VA.
"This report is strong evidence of the advancements VA continues to make in improving healthcare over the past 15 years," said Secretary of Veterans Affairs Eric K. Shinseki. "The systems and quality-improvement measures VA actively uses are second to none, and the results speak for themselves."

The VA continues to lead with the innovative use of technology designed to improve patient adherence to a healthy habits with the most recent Adobe Blue Button product.

The article here: http://www.healthcareitnews.com/news/use-it-helps-va-outperform-private-sector

To gain greater insight into differences between VA and non-VA care and to also identify ways to improve VA care even further, the authors recommend continuing research with even more recent data. They also say there's a need for studies that compare VA specifically to high-performing private healthcare systems, rather than to a broad cross section of non-VA facilities.

Collaborating with Trivedi on the review were co-authors affiliated with RAND, the University of California-Los Angeles and the Greater Los Angeles VA Medical Center.

Review of "Start-Up Nation: the Story of Israel's Economic Miracle"

2010-11-28T20:51:00.000-05:00

One of my continued obsessions is how we can leverage technology to reach a tipping point in human behavior for better in a scalable way; specifically, how can we help people adopt sustainable habits for health and energy conservation through the use of information technology; what prompts people to make a change - to be inspired to try something new, novel.

So, when I saw this book and the jacket proclaiming that Israel, a country of about seven million people, produces more start-up companies than any other country per capita, I was intrigued. Would I discover the secret to the innovation gap? We take it for granted that most of us aren't in fear of missing a meal or sleeping without a roof over our head. But maybe we've gone soft for lack of such challenges. Well, "Start-Up Nation" explores the innovation stimulus that exists in Isreal. I won't leave you in suspense. Life for this young country was hard. Enemies on every border, a challenging geographic landscape and a small population required a great deal of innovation to prosper. And it wasn't any one thing, but a combination of many things that contributed to Israel's success.

First, Israel benefits from a core purpose, that it would be a secure place on Earth for Jewish people. It's economy, defense and political structure was adapted to ensure that Jews from all over the world could immigrate to Israel and lead a life free from religious persecution. We all understand the benefit of a core mission in a business organization, but how does this translate to a country, made up of immigrants from all over the world with seemingly different economic motivations? Exactly. There were problems to solve relating to the countries very existence, and it was these problems that were obviously most prescient. And many of the solutions innovated for national security, food and energy were adaptable for other verticals and were monetized.

Second, given the omnipresence of national security - Israel endured multiple wars and even more threats during the last four decades - it created a mandatory military service requirement that fed a deep and wide network of professionals that lasted lifetimes. Israel's innovation broadly reaches across so many industries, but surprisingly, extends even into defense industry despite its diminutive size. Again, this was borne out of necessity, as the UAE placed an embargo on nations dealing with Israel for weapons. Like any war front, solutions needed to come quickly, and Israel created an egalitarian environment in order to spur them along. This informality ensures that good ideas aren't suppressed, and champions the best ideas.

Third, Israel had diversity of culture - due to its aggressive immigration policies - but not of character and commitment. Its people were singularly focused on solving its problems and growing the state of Israel into a viable and safe haven for Jews. Out of necessity, they innovated new technologies that enabled the growth of food, sourcing water and the development of new technologies. Failure was not a stigma but a business process that was embraced to quickly vet solutions that weren't viable. As a people, they recognized no hierarchal limitations to good ideas or questions about seemingly bad ones.

There is so much more in the book, of course, but this is my take away. Israel fosters an environment of innovation through a culture built upon the necessity of survival. Like I said, maybe Americans, overextended in expensive cars and large homes, just don't see it that way. Don't get me wrong. I'm not moving anytime soon, but I'm beginning to see some similarities in the US regarding certain seminal issues facing us. Take health care. We have no alternative to address the escalating costs and declining quality. We can't produce more doctors. New medical devices won't improve quality of life. We can only introduce efficiencies and instill sustainable habits. Those of us in health care technology liken it to a war of sorts. With any luck, we'll be as lucky as Israel and enjoy the prodigious creation of solutions to solve our ills.

The book is available at your public library and more information here: http://www.startupnationbook.com/

Still the Best Care Anywhere; and the Best Kept Secret

2010-11-26T14:45:00.000-05:00

Health IT helps the VA outperform the private sector on care methods, a recent report by researchers from from Brown University, the University of California, Los Angeles and RAND Corp.says. Now this isn't anything new for those of you who have read Phillip Longman's "The Best Care Anywhere" and references to his work on this blog, but data continues to grow regarding the benefits of information technology even where civil servants are involved. Longman's seminal research on this subject is available here: http://www.washingtonmonthly.com/features/2005/0501.longman.html

The researchers found that the VA outperforms the private sector when it comes to adhering to recommended care methods, partly due to the VA's use of health information technology. They looked at 39 studies done between 1990 and 2009 on illnesses common among veterans. Many studies identified better adherence to recommended care guidelines among VA facilities compared with non-VA facilities.

Previous study here: http://www.annals.org/content/141/12/938.full

US Chamber of Commerce a Shill for Payers?

2010-11-17T19:25:00.000-05:00

CBS reports that the US Chamber of Commerce, a lobbying group that purports to represent the interests of American business, was largely funded by a donation - $82.6 million - in 2009 by Americas Health Insurance Plans (AHIP), a group made up of large payers such as United Health Group, Wellpoint and CIGNA. AHIP is avidly opposed to the Health Reform bill passed this year. This donation made up about 40 percent of AHIP's budget. What's troubling is the seemingly opposite interests of the Chambers non-health insurance business constituents.

The Chamber's website proclaims that it "... is the world's largest business federation representing the interests of more than 3 million businesses of all sizes, sectors, and regions, as well as state and local chambers and industry associations. More than 96% of U.S. Chamber members are small businesses with 100 employees or fewer." I'm guessing that the "96%" desire to reduce the cost of health care they are required to provide to employees pursuant to the Health Reform law, so one could argue that receiving the bulk of your operating funds from a small constituency within your membership that is attempting to defeat a measure that a majority of members finds advantageous is a clear conflict of interest.

To be fair, the Chamber responded that it sees the Health Reform law as flawed in that it doesn't do anything to bend the cost curve - something that I agree with - and thus, ensure that health care can be extended to everyone.

CBS' coverage here: http://www.cbsnews.com/8301-503544_162-20023120-503544.html

Healthcare for Employers to Rise 8.9% in 2011

2010-11-15T23:48:00.000-05:00

A survey of big employers finds they expect their health-care costs to rise nearly 9% next year and plan to share some of that burden with employees via higher premiums and higher out-of-pocket limits.

The survey included responses from 72 members of the nonprofit National Business Group on Health, which represents large companies such as General Electric, Microsoft and General Motors. It parallels pretty closely another survey on employer health-care costs, by PricewaterhouseCoopers, that we reported on a few months back.

Some tidbits from the report, which you can find on the company’s website:

Next year, 63% of employers who responded said they’ll increase the proportion of insurance premiums paid by their employees. Some 46% plan to raise the limit on annual out-of-pocket payments; 44% plan to raise deductibles for in-network services.
So called consumer-directed health plans, such as high-deductible plans with a health savings account, are one of the tactics employers are using to control costs; 61% plan to offer a consumer-directed plan in 2011.
As far as controlling drug costs goes, employers report using prior authorization (73%), step therapy (63%), a tiered system (63%) and required mail order for maintenance meds (47%).
Most employers plan to change their plans to comply with provisions of the health-care overhaul law, including removing lifetime limits on benefits.
The majority of respondents (56%) counted wellness programs as one of the top three ways to curb costs (cost-sharing and consumer-directed plans also made the list).
On the retiree health benefit front, employers said they were trying to keep a lid on costs via caps on company contributions (46%), boosting employee contributions (37%) and eliminating coverage for future retirees (33%).
Separately, the government said yesterday that Medicare prescription premiums will rise by an average of about $1 a month.

And here's another salient fact shared in a NY Times blog from former Obama budget director Peter Orszag: Payments to social security beneficiaries amount to 5 percent of the economy now; by 2050, they're projected to rise to about 6 percent. Over the same period, federal health care costs will increase six times as much.

Read more: http://swampland.blogs.time.com/2010/11/15/fact-of-the-day/#ixzz15Pw9wSqx

HIT. Consolidation is Coming

2010-11-15T13:28:00.000-05:00

A new report by Marlin predicts that health care information technology companies will see significant consolidation in the next few years, and that the very few will ultimately win in the standards ultimately used. Not surprisingly, HIT vendors will enjoy or endure, depending upon your perspective, very robust M&A activity as major, traditional IT purveyors finally serve health care needs, one of the largest markets at over 17% of GDP. The consolidation will begin with the earlier EMR and practice management side, leaving scores of niche players - and there are a lot of niches in health care's $2 trillion market - for the rich revenue and cost driver value propositions.

On the payer side, Afsaneh Naimollah, an author of the report and a partner at Marlin, stated that "payers have to invent new products and pricing such as pay for performance with providers or behavioral based premiums for the consumers. It is the only way that they can stave off the commoditization train."

The commentary notes several companies that may be looking to build the next generation Healthcare Information Network including incumbents in the healthcare IT industry such as Ingenix (a wholly-owned subsidiary of unitedhealth group (nyse:UNH)), to telecommunication or large technology companies like Verizon (NYSE: VZ), AT&T (NYSE: ATT) or Microsoft (NASDAQ: MSFT) and IBM (NYSE: IBM).

According to Naimollah, "these companies all have pieces of the puzzle. The question is: Which firm will be first to assemble a truly comprehensive information and transactional healthcare platform? You need vision, money and the right leadership to get there, not a small task if you are creating a comprehensive healthcare platform."

The report notes that government standards have been helpful, but ultimately the private sector will set the standards for the industry; just as Microsoft and Intel set technology standards in the 1980s.

The full report is available through this press release: http://www.marketwatch.com/story/the-healthcare-it-market-will-soon-consolidate-into-a-small-handful-of-superstores-marlin-associates-issues-market-commentary-on-top-trends-for-healthcare-it-2010-11-10?reflink=MW_news_stmp

Blumenthal Can't See the Forest For the Trees

2010-11-04T13:48:00.000-04:00

Now, before people get the impression that this blog is criticizing Dr. Blumenthal, it's not. But he made a statement last week regarding the necessity to first establish prolific EMR technology before we see real progress in patient health. And that's simply misinformed and short-sighted. HIT is more than digitized patient data and clinical-based information. Yes, that is important and critical to pursue, but patient facing technology, such as behavior focused and self-reporting tools, will go the farthest in disease prevention. Mark my words. But these tools will require a high patient engagement, through gamification (making the solution compelling enough for the patient to use frequently) and incentives from payers, employers or the government. Much has been written on this blog regarding the transformative effects of information technology for consumers. Currently, over 70 percent of patients use the Internet for health information. But I'm talking about something bigger; where consumers monitor their health through a tool that improves their health literacy and helps them reach the tipping point of sustainable, health behavior.
That's the real upside in health care IT. I wish the powers-at-be would take notice.

Story here: http://www.modernhealthcare.com/article/20101101/NEWS/311019997/1153#

UHC Study Suggests Care Reform for MediCare/MedicAid

2010-10-26T12:17:00.000-04:00

In a study by United Health Group, the largest single provider of MediCare/MedicAid services, the US could save over $3.5 trillion over 25 years by moving away from the traditional fee-for-service model. No kidding. Aligning provider revenue streams with patient health outcomes is the clearest way forward to reduce waste and produce the best outcome for an already strapped budget in an environment of escalating health costs. The proposal suggests that coordinated care - which traditionally wold cost more - is cheaper than cherry-picking specific treatment. The assumption here is that coordinated care will be effective at monitoring patient health and patients will participate in behaving consistently with suggested sustainable life choices. Ultimately, providers and patients will lean more heavily on information technology resources, such as patient health dashboards, to ensure that patient health status can be easily monitored and preventative action taken if there's an indication of a problem. I'm guessing that the report is a bit self-serving, as UHC is proposing a solution consistent with the study, but that's value selling. And if UHC delivers on the cost savings, everyone wins.

A summary of the study is here: http://www.unitedhealthgroup.com/newsroom/news.aspx?id=1254ceff-411d-47dc-8ac0-2c3b4e4790c2

The full report is here: http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper4.pdf

IP Theft Now Surpasses Hard Assets

2010-10-18T16:00:00.000-04:00

The Financial Times reported that Kroll's annual worldwide fraud survey has found that theft of intellectual property-based assets now surpasses that of physical assets. Some sobering statistics:

- 88 percent of those surveyed experienced a loss.
- Theft is now $1.7 mil per $1 bil of revenue - increasing 20 percent over 2009

Threats come from external and internal sources, through stealing paper-based information and information readily accessible through corporate IT environments. This report demonstrates how prevalent the problem is and the inadequacy of our present IT security measures. This is especially troubling as this country seeks greater efficiencies in health care by deploying badly needed solutions.

Kroll's full report is here: http://www.kroll.com/library/fraud/FraudReport_English-US_Oct10.pdf

Full story here: http://www.ft.com/cms/s/2/3c0c9998-da1a-11df-bdd7-00144feabdc0.html?ftcamp=rss&ftcamp=crm/email/20101018/nbe/GlobalBusiness/product

Microsoft No Longer Pays Full Boat

2010-10-10T20:10:00.001-04:00

Microsoft announced that it will end full payment of employee health care. Full story below. Talk amongst yourselves.

http://channel6newsonline.com/2010/10/microsoft-to-end-full-health-care-coverage-for-employees/

REDMOND, WASHINGTON (BNO NEWS) -- Microsoft on Saturday announced that it plans to end full health care coverage for its employees.

Microsoft is currently among a relatively small group of major companies that offers its employees to pay all of their health-care premiums. Reports in recent weeks, however, had indicated that Microsoft was planning to end this.

"We can confirm that Microsoft has begun to evolve its employee health care benefit," a Microsoft spokesperson said in a statement to BNO News. In 2013, the spokesperson said, employees will have to start to contribute to their health care coverage.

"A guiding principle in this evolution is that Microsoft will continue to offer market-leading health and wellness benefits that rank among the best in the country," the spokesperson added, without elaborating how much their employees will have to contribute.

The More Things Change, the More They Stay the Same

2010-10-08T16:25:00.000-04:00

Health care information technology will ultimately save this country's health care system, once fully implemented properly. But what does that mean? Well, other than the enterprise systems that will help payers and providers deliver better care, and the administrative savings that they will reap from more efficient operations, the seminal transformative cost reduction kick will come when we connect all stakeholders and address the behaviors that lead to unhealthy outcomes. Take this recent PWC survey that looks at the adoption of consumer-based health care initiatives. Consumer-based health care initiatives are really code for pushing costs to the people who are truly making the treatment or buying decision - effectively, addressing the moral hazard that exists in our current insurance coverage system.

http://pwchealth.com/cgi-local/hregister.cgi?link=reg/consumerism.pdf

So, how do we encourage people to live healthier? That is, how do we help them reach the tipping point of engaging in sustainable behaviors. Much has been done on paying employees to adopt certain diets or exercise regiments, but perhaps the best immediate solution is to make health care plans truly consumerist - is that a word? Plans that have a high deductible make people think twice about running to the doctor for treatment. Although that may a good thing, if people are simply ignoring symptoms to save money rather than living more healthy, that will ultimately come back to bite us. So, tools that educate and encourage people to live healthy, or adopt sustainable habits will provide long term value to consumers and the health care system - especially for MedicAid/MediCare patients who have no deductible. This will be a WebMD 2.0, where people are able to connect their lifestyle with a dashboard of health monitors and outcomes. Prevention is the new "Black".

McDonald's. Persistent Problem Child

2010-10-08T15:42:00.000-04:00

I have written earlier about the significant health problems caused by fast food restaurants such as McDonald's brand food - if one can call it that. Fast food causes all sorts of health problems, such as obesity, from which results in heart disease, diabetes, etc... But it isn't enough that McDonald's plays a part in what has become 70% of this nation's overall health care spend. Now McDonald's is pressuring the HHS for an exemption for its professed inability to provide actual health care to the tune of 80-85% of employee premiums (administrative costs can't exceed 15-20% of premiums). McDonald's states that its health insurer refuses to comply, therefore, they cannot. And now over 30,000 McDonald's employees are at risk of losing health care coverage. Which of course defeats the purpose of the bill and once an exemption is given to one employer, everyone will line up behind. Ultimately, these exemptions - or as the HHS calls them, an exercise of discretion - will gut what little good the recent health care reform bill provides. I'm guessing that McDonald's employees aren't "lovin' it". I hope that McDonald's will be called to task on how its products and corporate behavior ultimately add to the significant sustainability problems facing this country.

Full story here: http://voices.washingtonpost.com/blog-post/2010/10/mcdonalds_may_get_its_way_with.html

Why I Miss New York City

2010-10-07T11:52:00.000-04:00

Let me count the ways.... After setting up shop back in Southern California to focus on information technology that will support sustainability of quality of life industries (health/energy/socia media), I find myself reminiscing - and envious - about how well New York City is run and forward-thinking it is regarding fiscal policy and sustainability issues. Mayor Bloomberg's impressive business background has equipped him to be a good operator, and he has focused on sustainability initiatives, both in energy (the hybrid taxi initiative) and health (banning trans fats in NYC restaurants). Bloomberg proposes to prohibit recipients of food stamps to use them to purchase surgery soft drinks. Based upon what we know about how diet affects the incidents of chronic illness, it makes perfect sense. As I mentioned in a few posts back about giving our brave soldiers Burger King food on the Afghanistan/Iraq front, why would we perpetuate a habit that we know is unhealthy? Food stamp recipients are also likely to be New York/Federal MedicAid recipients, so it is doubly prudent not to rob Peter to pay Paul; pay for behavior that will significantly lessen the quality of life of food stamp recipients and also increase their incidents of chronic illness, and that of health care and its cost.
It takes courage for a public servant to address a public health issue in such a rarefied, infotainment age. But Bloomberg's focus on the "care" aspect of New Yorkers health will ensure that people will live healthier, and city taxes can be allocated for the benefit of more New Yorkers.

Related articel here: http://www.nytimes.com/2010/10/07/opinion/07farley.html

The Real Cost of that Big Mac

2010-09-16T13:52:00.000-04:00

A nonprofit physicians group has decided to put an ounce of prevention in place of a pound of cure - or should that be a quarter pound of cure. The advocacy group Physicians Committee for Responsible Medicine targets fast food, specifically McDonald's, as a purveyor of food that will eventually kill you. Tell us something that we don't know. But the ad will initially be broadcast in the Washington, D.C. area - an area where obesity and other chronic illness has reached serious levels - where health education has had little positive effect to date. Sadly, it will take more than information to reach a tipping point of sustainable behavior, but the provocative ad will see a much greater audience on the Internet, where it will be shared with millions of people; people who may be more receptive to the message. In McDonald's defense, they have responded as follows: “This commercial is outrageous, misleading and unfair to all consumers. McDonald’s trusts our customers to put such outlandish propaganda in perspective, and to make food and lifestyle choices that are right for them.” But if people were able to make appropriate lifestyle choices, they wouldn't be eating McDonald's.

New York Times report here: http://prescriptions.blogs.nytimes.com/2010/09/16/doctors-group-attacks-mcdonalds-in-tv-ad/?hpw

Consumer Health is a Good Thing

2010-09-02T20:29:00.000-04:00

I was reading a Washington Post article about the trend for employers to shift the cost of health care to their employees. In a survey conducted by the Kaiser Family Foundation, health care costs increased by 13.7 percent for employees while employers where kicking about one percent less for health care premiums. The article explained that given the current state of the economy, employees don't have the power to contest the trend to push more costs on them. Now, I'm just as liberal as the next East/West Coast City Dwelling person, but I actually think the trend to push more cost - and greater decision-making - onto patients themselves. I have written about the perils of the moral hazard intrinsic within our current health care system. Patients don't act like true consumers when their health is at stake, which is perplexing given that health is the number one factor in determining their quality of life.

Greater patient payment responsibility will drive greater personal accountability for how money is spent (their money, and not the insurance companies money) and ultimately how a patient determines that they can reduce their overall health care costs by choosing sustainable habits. And how does this pertain to HIT? There are so many innovative consumer health resources - most of them for free - that can be leveraged by consumers to live healthier, happier lives. They just need an incentive to choose to make them a habit. People behave the way they are paid or pay.

http://www.washingtonpost.com/wp-dyn/content/article/2010/09/02/AR2010090202265.html

More Doctors. Not the Solution to Our Health Care Crisis.

2010-08-22T20:08:00.000-04:00

A recent Time magazine article explored the shortage of doctors in this country, and the impending severe shortage by 2015 of primary care physicians caused by insufficient monetary rewards for newly graduated physicians. Although patient access to care is important, simply loading up the number of primary care physicians under existing revenue streams will only accelerate the cost of care and fail improve the health of Americans. We must focus apply primary care on different terms, such as affecting sustainable diet and exercise habits in people, as well as shifting the burden from the doctors to technology and other health care professionals. As explored in earlier posts, there are cloud solutions that help patients better understand their symptoms as well as the life choices made to bring them about. There are websites that enable people to better understand their family health history and whether or not they are predisposed to be more susceptible to certain illness without a genetic test. And perhaps the quickest and most effective accelerator to reach the patient accountability tipping point, health care insurance products that require patients to serve as consumers - larger deductibles - will remove the moral hazard component and significantly reduce overall health care spend.

Time article here: http://www.time.com/time/business/article/0,8599,2012443,00.html

Guidebook for EHR Meaningful Use Available

2010-08-22T16:10:00.000-04:00

CHIME (College of Healthcare Information Management Executives) released a guidebook to help health care IT professionals to implement EHR solutions in a way to satisfy meaningful use. It's 80 pages and covers topics such as a summary of the HITECH program, cost-benefit analysis of EMR architecture, deployment issues (vendor participation, training and physician buy-in) and measurement to determine success. This isn't a "how-to" manual, but a guidebook that provides an outline of issues to consider and problems to resolve, but looks to be more helpful than not.

The guidebook is here:

http://www.cio-chime.org/advocacy/CIOsGuideBook/CIO_Guide_Final.pdf

On Wednesday, August 25 at 1 p.m. EST, CHIME will conduct a public webinar, highlighting some of the principal building blocks of a successful EHR implementation shared within the guide and how organizations can use it to support their IT efforts to achieve meaningful use. The webinar will feature insights from guidebook author Fred Bazzoli, CHIME Director of Communications, and contributor Edward Marx, CIO of Texas Health Resources, who will be on hand to discuss key premises and answer questions. To register:

https://cio-chime.webex.com/mw0306lb/mywebex/default.do?nomenu=true&siteurl=cio-chime&service=6&main_url=https://cio-chime.webex.com/ec0605lb/eventcenter/event/eventAction.do%3FtheAction%3Ddetail%26confViewID%3D685995469%26siteurl%3Dcio-chime%26%26%26

Focus on Chronic Disease Management. A Start

2010-08-20T12:33:00.000-04:00

Recently, Intel and GE announced a joint venture to focus on chronic illness management technology, specifically telehealth and independent living. Similarly, Philips has announced that it is looking for home health care technology partners. IBM has moved strongly to acquire and develop applications that help providers manage chronic illness, such as its pilot solution with Peking University. The pilot will enable physicians to better manage chronic disease, enabling physicians to use best practices from previous diagnoses, treatment and research to prescribe effective treatments to patients. With an ageing and growing (in size) population, chronic illness related to obesity will provide rich rewards for companies that focus on minimizing their cost to the health care system, and this means keeping them out of a traditional care facility.

This is a start, but the biggest opportunity still remains helping people make sustainable life choices in the first place. An ounce of prevention is worth a pound of cure, and in no other industry is this more apparent, with health care costing the U.S. 17 percent of GDP, and a predicted increase in health care for 2011 to be 8.9 percent, according to the Wall Street Journal.

There are many Health 2.0 cloud solutions in development or in beta that focus on this very goal, but the investment community as well as payers and providers are stuck in the old revenue streams, which is not surprising. People behave the way they are paid, and you can't pay the mortgage on saving lives outside of existing revenue opportunities. But payers and investors can make the bold and selfish decision to introduce technology for their constituents that will encourage and deliver sustainable behavior, and ultimately save their companies the cost of treatment down the road. It's tough in an environment that looks at performance quarter by quarter. But before we begin to focus on modifying behavior, we're simply putting our finger in a burgeoning dike.

Philips announcement here: http://www.bloomberg.com/news/2010-08-19/philips-plans-health-care-deals-seeks-google-microsoft-skills.html

IBM announcement here: http://www.chinadaily.com.cn/business/2010-07/15/content_10113025.htm

IBM Enters the Cloud with ActiveHealth (Aetna)

2010-08-05T20:51:00.000-04:00

Although IBM has positioned itself as an HIT player, it hasn't had much other than the minions of professional services to spread across its health care constituents. That has all changed with collaboration with Aetna's Active Health. Aetna and IBM have announced a joint venture that will provide IBM with a software solution and Aetna with the technology cred to be attractive to provider constituents. Payers are quickly moving into the solution space - many offer free solutions for providers in order to introduce cost-saving technology as well on the claims side.

ActiveHealth will jointly market the cloud suite, dubbed the Collaborative Care Solution. For IBM, the launch is the first cloud computing effort for the healthcare vertical. IBM has integrated services, research and analytics into the solution.

More here: http://www.informationweek.com/news/healthcare/clinical-systems/showArticle.jhtml?articleID=226600080&subSection=All+Stories

Time Flies. Little Changes.

2010-06-01T19:20:00.001-04:00

It's been over two weeks since I've evangelized this or that. Perhaps because I needed a respite from advocating the obvious benefits of HIT and addressing the mundane but real fears folks have for changing behavior that will ultimately provide better results. I'm certainly guilty of resistance to change as well, and as I ponder various leadership opportunities, am amused by my reluctance to take on certain challenges due to founder legacy issues. Then I saw a blog by HBS professor Bob Sutton on the top 12 things good bosses believe: http://blogs.hbr.org/cs/2010/05/12_things_that_good_bosses_bel.html.

Let's take them one by one. These are beliefs that Prof. Sutton found to be held by the best bosses. The the worst bosses rejected or more often simply never even thought about.

1) I have a flawed and incomplete understanding of what it feels like to work for me. As I grow more experienced, I am convinced that I am building my very own Ivory Tower - albeit a sustainable, green-tech one.

2) My success — and that of my people — depends largely on being the master of obvious and mundane things, not on magical, obscure, or breakthrough ideas or methods. Business isn't really rocket science, unless, of course, you sell rockets.

3) Having ambitious and well-defined goals is important, but it is useless to think about them much. My job is to focus on the small wins that enable my people to make a little progress every day. The big, hairy, audacious goal is important. But there are many little steps necessary to accomplish it. As Peter Drucker used to say, "ideas don't move mountains; bulldozers do."

4) One of the most important, and most difficult, parts of my job is to strike the delicate balance between being too assertive and not assertive enough. Despite attempts to ensure that people speak candidly, know that position and years of advocacy can be a scary and off-putting opponent.

5) My job is to serve as a human shield, to protect my people from external intrusions, distractions, and idiocy of every stripe — and to avoid imposing my own idiocy on them as well. I simply can't improve upon this.

6) I strive to be confident enough to convince people that I am in charge, but humble enough to realize that I am often going to be wrong.

7) I aim to fight as if I am right, and listen as if I am wrong — and to teach my people to do the same thing. Integrity. Everyone has to have it to be effective and credible.

8) One of the best tests of my leadership — and my organization — is "what happens after people make a mistake?" Including me.

9) Innovation is crucial to every team and organization. So my job is to encourage my people to generate and test all kinds of new ideas. But it is also my job to help them kill off all the bad ideas we generate, and most of the good ideas, too.

10) Bad is stronger than good. It is more important to eliminate the negative than to accentuate the positive. And this means "bad" in all forms. Bad attitudes and bad behavior that is typically rewarded in most large companies as a show of initiative at the expense of others. Bad is always bad. It is never good. Donald Trump should take note.

11) How I do things is as important as what I do. Process is important to everyone. Employees, like children, will watch and learn.

12) Because I wield power over others, I am at great risk of acting like an insensitive jerk — and not realizing it. Guilty. "I'm sorry" goes a long way.

At the end of the day, if you're in charge, you're in charge. And the results of your team are your responsibility. You are accountable. End of story. Or maybe just the beginning of it.

HITECH: Cash For Clunkers Indeed

2010-05-14T15:54:00.000-04:00

Jonathan Bush and Dr. David Blumenthal have it right. But without HITECH, it's doubtful that transformative technologies like AthenaHealth's solutions would have been any more successful.

At the HEP conference in Dana Point, CA last week - my invitation must have been lost in the mail - Bush said that the HITECH funds encourage the selection of traditional EMR technology sold by GE, Cerner and the like. No disrespect intended, but duh. Doubtful that any of us engaged in next, transformative or disruptive technology had the cash to burn on lobbyists. So, let's applaud those HIT companies that did in order to push $18 billion into the adoption of HIT. Yes, there are issues with its force and effect, but let's put those aside at the moment.

More poignantly, Dr. Blumenthal noted that current health care revenue streams (paraphrasing) don't reward performance, or true patient care performance, and that without an incentive, providers would not have any reason to purchase HIT that will inevitably enable the system to begin to measure health outcomes. It is a very long view, but one that we should begin now. Had we started 20 years ago, well, I might be working in a different industry.

NYTimes blog here: http://bits.blogs.nytimes.com/2010/05/09/the-agenda-behind-electronic-health-records/

Kaiser CEO Speaks of Care Reform, But is Anyone Listening?

2010-04-19T20:01:00.000-04:00

I read David Whelan's Blog in Forbes recently about an interview with Kaiser CEO George Halvorson. Halvorson speaks of his vision of patients comparing apples to apples when it comes to care alternatives - i.e., health insurance - much like a consumer would do in their local farmers market. In fact, this functionality is required of new health care reform legislation and will hopefully be managed to deployment through ONC Director Blumenthal's office before 2012. That said, the difficulty is in the execution, and much like farmers markets across the country, I suspect quality will not be uniform, and consumers will still find it difficult to properly assess care alternatives. But Kaiser has an unfair advantage: its paradigm.

Halvorson speaks of patient care with an organization that is designed to do just that. Kaiser, a prolific user of health information technology, is vertically integrated - i.e., they are the payer and provider for health care. Kaiser health care professionals are paid the same whether they order an MRI or not. This closed system gives them an incentive to leverage IT to improve their care proficiency, not simply to cut costs; whereas health insurers have an incentive to deprive care or significantly restrict it, and providers have an incentive to provide ample care and bill them. It is this paradigm - patient care - that will ultimately prove to be their competitive advantage as the misaligned independent payer/provider model attempts to address chronic illness from a cost instead of care perspective. Another example of vertically integrated care is the Veteran's Administration, which has consistently provided the best care based upon many well-accepted metrics for years, despite being a government-run facility. If the Federal government can do it, private enterprise should be able to surpass it.

Whelan's blog here: http://blogs.forbes.com/sciencebiz/2010/04/kaiser-permanente-pushes-for-a-health-care-farmers-market/

VA's HIT Expenditures Pay Off Big

2010-04-12T13:56:00.000-04:00

The VA saved over $7 billion with HIT expenditures of $4 billion, and enjoyed better health outcomes because of it, a recent study by "Health Affairs" found, as reported by "Government Health IT". On the savings, it is generally accepted that for every one dollar spent on enterprise IT systems in health care, the organization will save two dollars, and this appears to be close enough for government work. In addition, the improvement in quality is a bit harder to measure, but based upon current metrics, the VA enjoyed an upside there as well, albeit that their care delivery system differs from the traditional payer to provider model in the private sector. "Government Health IT" found that "more than 86 percent of VA’s savings were the result of eliminating duplicate tests and decreasing medical errors. The rest of the savings came from lower operating expenses and reduced workload." And we haven't even begun to scratch the surface.

With empirical data such as this, it still leaves the IT community scratching their heads as to why health care decision makers are so slow in embracing the use of HIT. It saves lives. Although the VA was an early adopter in its use of the enterprise EMR, Health 2.0, or connected health, will provide significant improvements in patient communication and participation in their own health outcomes. Baby steps.

More here: http://govhealthit.com/newsitem.aspx?nid=73482

Yes. There Really are Bad Bosses

2010-04-08T19:04:00.000-04:00

OK. This particular blog isn't about health care IT, nor about the need to push HIT adoption more quickly to begin to see the benefits of business intelligence and clinical analytics in patient care. No, this is about an earlier blog that I read which proclaimed that "There are No Bad Bosses - Only Bad Employees". Perhaps the dumbest blog I've read to date, and this is the Internet. Having had my share of really bad bosses - i.e., ineffective, ego-maniacal, indifferent to company values and objectives, and sometimes unethical bordering on criminal - I fully understand the significant damage the wrong person can do to an organization. Leaders - and I'm sure that I'm being charitable to many managers in corporate America by labeling them "leaders" - should be held accountable for their team performance. And team performance will be far better with people who are properly incented, respected and inspired to achieve the company's mission. It's not rocket science. The biggest difficulty that I've encountered when leading a team is helping them deal with company inhibitors. Yes, poorly run teams reporting to bad managers.

I am the first to blame a manager when an underling exhibits a bad attitude or inability to execute on business objectives. It is on us. Assuming that you properly lead, a member of the team with a bad attitude and inability to do the work must flourish elsewhere. And a good team member working with a bad manager who will not entertain a "lead-up" approach by a more capable underling should leave as quickly as they can.

So, in a round-about way, this blog is about the importance of HIT deployment, because without good, dedicated people, we're not going to help health care providers truly transform their operations to focus on patient care. The difficulty, of course, is that bad leaders beget bad employees.

The blog that started it all is here: http://blogs.bnet.com/career-advice/?p=613#comments

Privacy 2.0

2010-04-06T19:07:00.000-04:00

Much has been sensationalized on broadcast news and the mainstream press about the dangers of connected health for the average citizen, but it relies little on the facts related to just how secure patient information is when it's electronic. In reality, the incidence of "security" for paper records is pretty frightening; about 30 percent of paper records are lost - left in the doctor's lounge, another patients room or simply swirling around the parking lot after the trash is emptied. Let's face it. Most providers - about 70 percent - operate in clinics that have fewer than five doctors, with a staff that is poorly trained in the administration of privacy issues. Rather than rely upon training each individual health care worker on the practice of keeping private paper records, isn't it better to provide information technology with built in security that is not reliant on human error?

Having spent almost 20 years in information technology across all industries, I can't help but chuckle - and groan - when I hear citizens rage against the machine that will inevitably provide them greater privacy and superior care. But, this is an issue of education, and we must all evangelize the value of information technology in health care, despite its obvious value. Oddly, most of these same people have been banking and investing online now for over a decade. Go figure.

ONC Delivers popHealth

2010-03-10T14:39:00.000-05:00

The ONC recently made available to providers and EMR vendors - well, anyone - an interesting data aggregation and clinical comparative tool called pophealth. pophealth enables providers to view clinical information, such as cholesterol levels for their practice population. The pophealth solution automatically aggregates patient population data and can be reviewed through a simple dashboard. This is an excellent start to supporting physician care - instead of treatment - of patients, and the comparative features I suspect may likely be used to provide a back-end engine to performance metrics for MediCare/Aid payments. In addition, patient data can be aggregated more easily from a national perspective to help the government to propose clinical solutions to those chronic illnesses that are the most problematic and costly.

Get your download here: http://projectpophealth.org/index.html

Close Enough for Government Work

2010-02-08T20:19:00.000-05:00

The 2011 budget request for HHS is out, and although it has a generous allowance for health care technology, it does not have any specific metrics or performance goals to ensure that civil servants will spend taxpayer dollars effectively. Here are a few of the performance goals:

- Establish the infrastructure necessary to encourage the adoption and meaningful use of health IT.
- Increase the number of low-income children receiving federal support for access to high-quality early care and education settings.
- Increase enrollment in the Children’s Health Insurance Program by 7 percent from 2008 to 2011.
- Decrease by 10 percent from the 2005-2007 baseline, all of the following: the rate of sporadic Salmonella enteritidis illnesses in the population, the number of SE outbreaks and the number of SE cases associated with outbreaks.

One could argue that many of these aren't so much performance goals as aspirations. Taking the first broad aspiration of the creation of the necessary infrastructure to encourage greater use of HIT will likely result from providers benefiting financially from their use of HIT, and it may not necessarily be limited to EMRs and enterprise systems in the near term. Those investments are disruptive to existing practices and don't necessarily support revenue streams of providers. What will success look like for this aspiration?

I'm guessing "close enough for government work" will be the ultimate result. Patients deserve better than a loosely cobbled national health care IT plan, and I'm hopeful that the good work of Dr. Blumenthal will be more robustly supported by the greater HHS organization.

The partial story here: http://www.cmio.net/index.php?option=com_articles&view=article&id=20487&division=cmio

Leveraging Consumer IT to Close Some of the Gap

2010-02-05T15:00:00.000-05:00

Health care reform battles have been waged for decades, and with health care constituting almost 17 percent of GDP ($___ trillion), some stakeholders have far too much to lose to capitulate to true cost and care deliver reform. So where does that leave us? Switzerland. Implementation of structure or devices that do not overtly threaten existing private sector revenue streams have a real chance of succeeding in enabling us to close the cost gap on health care. So, what will this look like? Payers - including the government MediCare/MedicAid programs - and providers can leverage consumer based tools to help patients manage their own care, especially related to chronic illnesses; the largest part of our healthcare expenditure (70 percent of health care spend). There are many Health 2.0 as well as established companies that provide value in this space, but they may be far more successful if they were included in "meaningful use", or simply made part of the party in overall health care reform.

The Obama administration - like all politicians on either partisan isle - has foolishly ignored the huge upside of this health care information technology in addressing our biggest health care challenges immediately. Of course, because most of these solutions aren't promulgated by large corporations, they don't get included in government bills or deployment plans. I guess it's up to the private sector again to continue to solve Americans' biggest health care challenges, and leave the appearance of change to politicians.

EMR Exchange Works in SoCal

2010-01-20T20:02:00.001-05:00

Two early technology adopters have now declared a success their pilot program of sharing patient information. Kaiser and the VA in San Diego, CA - both closed systems - have enjoyed a pilot program for the past several months using the Nationwide Health Information Network, a government set of protocols regarding security and interoperability. The VA of course uses VistA (open source) and Kaiser uses its HealthConnect solution.

This is significant, because Kaiser has a sizable constituency in San Diego, as does the VA. In addition, both will now integrate the DOD's constituents as well, ensuring a significant improvement in information availability for SoCal physicians caring for those patients who elect to allow their EHRs to be included.

The story here: http://www.computerworld.com/s/article/346535/Kaiser_VA_Join_to_Give_E_health_Efforts_a_Boost

Health Care is an American Value

2009-12-27T17:25:00.000-05:00

A recent JAMA article explored whether or not health care was an American value - i.e., whether Americans believed that health care is a right and an entitlement. Depending upon which side of the political aisle you reside, the answer is yes. On the left, with a history of entitlements for folks that neither have the interest or ability to pursue a life that affords them basic services, we as a country have always protected the very poor. Through welfare, aid to dependent children and the state equivalents and Federal MedicAid, we as a nation have provided basic services to those who cannot afford them. It's the middle, working poor that have been neglected.
On the right, providing decent medical coverage ensures that we will in fact save money in the long run; provided that health care is provided in a way that prevents chronic illness.
The problem is, that the current incentives for most health care providers don't necessarily accomplish any of the above, and encourage focus on treatment rather than prevention of chronic illness, which constitutes about 70 percent of our total health care expenditure. To be sure, the author of the JAMA article provides this insight regarding the health care bill currently before Congress:

The bill likely to emerge from Congress will probably do a better job of moving us toward universal participation than of ensuring proper stewardship of our health care resources. The work of reform, then, must continue, along with the dialogue about what values should form the foundation of our health care system, how those values should be understood, and how they can reinforce one another.

This is clearly only the end of the beginning of our health care reform odyssey.

The artcile can be found here: http://healthcarereform.nejm.org/?p=2618&query=TOC

Lies. Damn Lies. Statistics.

2009-11-27T17:34:00.000-05:00

Much has been written about the recent study published in the American Journal of Medicine entitled "Hospital Computing and the Costs and Quality of Care: A National Study". Much of it misleading. The study was quite narrow in its limited data and short time period, as well as the notion that components of an enterprise HIT solution did not produce any "real" savings to health care costs. First, as we all know, it depends upon what we measure. If looked at specifically, certain aspects of a health care operation will enjoy lower costs with a robust IT solution just like any other industry. Second, we must separate objective, empirical savings from those that are behavioral based. Savings in one area may result in providers enjoying the surplus in another.

Overall, this is a useless study other than supporting the well-accepted notion that an organization's administrative costs will not materially decrease during the building phase of an integrated enterprise IT system. Unfortunately, unless the results are studied in great detail by the journalists who report on them, the message is misleading.

The study can be purchased here: http://www.amjmed.com/article/S0002-9343(09)00816-X/fulltext

Health Reform. This Time We Really Mean It.

2009-11-18T12:31:00.000-05:00

Education. It's critical to enable a critical mass to reach the tipping point in any endeavor, and health care reform is no different. David Blumenthal used his monthly email address for just that occasion in order to stress the transformative powers of HIT adoption for all stakeholders (his email in its entirety below). I've been involved in HIT in way or another for almost five years, so take for granted the domain knowledge that I possess, and that, combined with my general impatience, am already at the "enough already, let's execute faster" stage.

Speaking at a California Bar intellectual property conference last weekend in Dana Point, CA (IP in Vogue), I shared the stage with some pretty talented change agents in their own right. But they are focused across all industries in rebuilding the patent and trademark system to serve innovation. I thought it a good opportunity to raise awareness of the opportunities that exist in health care IT given the Obama administration's HITECH Act and the resources allocated to leverage HIT in order to cut costs and improve patient care. My takeaway is that even with a sophisticated audience of IP lawyers, very few people understand the challenges - and opportunities - before us. Continued evangelizing is critical to raising awareness and attaining the support needed to execute on this very long project ahead.

From Dr. David Blumenthal.

The HITECH Foundation for Information Exchange

November 12, 2009

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

As the many activities mandated by the HITECH Act move forward, I want to take a moment to share my vision of the overarching goal and some of its implications. Our goal, above all else, is to make care better for patients, and to make it patient-centered. Information policy and health IT policy should serve that goal.

A key premise: information should follow the patient, and artificial obstacles – technical, business related, bureaucratic – should not get in the way. As a doctor, I have many times wanted access to data that I knew were buried in the computers or paper records of another health system across town. Neither my care nor my patients were well served in those instances. That is what we must get beyond. That is the goal we will pursue, and it will inform all our policy choices now and going forward. This means that information exchange must cross institutional and business boundaries. Because that is what patients need. Exchange within business groups will not be sufficient – the goal is to have information flow seamlessly and effortlessly to every nook and cranny of our health system, when and where it is needed, just like the blood within our arteries and veins meets our bodies’ vital needs.

If we are to reap the benefit of information exchange, Americans must also be assured that the most advanced technology and proven business practices will be employed to secure the privacy and security of their personal health information, both within and across electronic systems, and that persons and organizations who hold personal health data are trustworthy custodians of the information. We must have comprehensive, clear, and sustainable policies that strengthen existing protections, fill gaps as they emerge, fortify new opportunities for patients’ access to and control of their information, and align with evolving technologies. I will devote a separate letter to this critical issue and the many activities mandated by the HITECH Act that we are developing.

On the question of exchange, however, the HITECH Act is pretty specific about eliminating inappropriate barriers.

It squarely tackles the commercial barriers. The HITECH Act calls for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…promotes a more effective marketplace, greater competition...[and] increased consumer choice” among other goals. (Section 3001(b)) This means we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries. Some of these arrangements may improve care for those inside their walls. But ultimately, they have the potential to carve the nation up into disconnected silos of information, and thus, to undermine the vision of a secure, interoperable, nationwide health information infrastructure, which the law requires us to establish. Consumers, patients and their caretakers should never feel locked into a single health system or exchange arrangement because it does not permit or encourage the sharing of information.

It tackles the economic barriers. The HITECH Act incentives for providers and hospitals are powerful tools. While the official definition of “Meaningful Use” won’t be finalized until next year, the HITECH Act specifically highlights “information exchange” as one requirement for the incentives.

It tackles the technical barriers. The HITECH Act focuses on “interoperability” or “interoperable products.” In plain English, this means that our policies, programs, and incentives must aim for electronic health record (EHR) software and systems that can share information with different EHRs and networks so that information can follow patients wherever they go. And to build the pipelines to carry this information, HHS is directed to invest in the infrastructure to “support the nationwide electronic exchange and use of health information …including connecting health information exchanges…” (Section 3011) This means we will work with all our partners in the health and IT industries and with organizations that are committed to information sharing to develop the technologies and policies that can help us deliver information securely, privately, and accurately to whomever needs to see it on behalf of the patient’s health. We must ensure interoperability for the future.

It provides building blocks for information exchange across jurisdictions. The grants for states and state-designated entities in Section 3013 – which will total $564 million – target information exchange across boundaries, not only within each state but explicitly as part of a nationwide framework. We will start announcing the awards this winter. These grantees’ activities must support interoperability that lets patient data follow the patient across political and geographic boundaries. The grantees will be our partners in building the nationwide infrastructure mentioned previously.

In short, the HITECH Act not only authorizes but requires us to mobilize all our policies, programs, and incentives to give the American people the patient-centric care they deserve and expect.

I look forward to engaging all our partners in this unique opportunity.

Regards,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

First, We Kill all the Doctors

2009-11-06T12:08:00.000-05:00

Echoing the sentiment from Hamlet - where lawyers were the particular villain - people engaged in the health care debate are pointing fingers of blame and seeking that magic bullet to cure what ails our health care system. As if there was a single solution to remedy what has become 16% of US GDP. As discussed before in this blog, and if it wasn't supremely obvious, health care is complicated. The solutions required to fix it are varied and extensive. My day is generally focused on how best to help our technology ecosystem constituents (big words) reach the tipping point and change behavior to adopt solutions that will ultimately help them lower costs and improve care. But I never thought to blame Doctors for what ails the US' dismal health results. In a recent Reuters article, the author examines why doctors practice in a particular area; both specialty and geographic. And like any other industry, people behave in a manner that reflects how you pay them. Doctors are no exception - and why should they be. Health care professionals will generally provide treatment where there is a reasonable basis to do so, and if you're a specialist, you're likely predisposed to offer the most advance treatment even if there may be an argument against doing so. Very few people would refuse treatment if it's recommended by their doctor. And this is the moral hazard of our health care system.
The issue of over serving a particular population was made widely known by President Obama in his interest in an Atlantic Monthly article comparing the costs in a small Texas community with other, larger metropolitan areas around the country. In addition, a recent study conducted by Thomson/Reuters estimates that unwarranted use of health care constitutes about $250-325 billion. That's a big number, and includes the following:
• Diagnostic lab or imaging tests performed to protect against malpractice exposure
• A surgical procedure with a patient-preferred medical treatment alternative
(Dartmouth’s “preference-sensitive care”)
• A high-cost diagnostic procedure used for patients at low risk for the condition
• A diagnostic test with no expected impact on the course of treatment
• The inappropriate use of an antibiotic for an upper respiratory viral infection
• Intensive non-palliative end-of-life treatment (Dartmouth’s “supply-sensitive care”)
• Brand name drug prescribed when generic or therapeutic alternatives are available
• Failure to follow conservative treatment protocol or follow a recommended course of
successive treatment escalation
Overall, it is estimated that we waste between $500 and $850 billion annually in our health care system, and no stakeholder is blameless. The challenge, of course, is changing that wasteful behavior. A vexing problem indeed.

Journalists may request a copy of the report from David Wilkins at (734) 913-3397 or david.wilkins@thomsonreuters.com.

The Reuters article here: http://www.reuters.com/article/domesticNews/idUSTRE5A44C020091106?pageNumber=4&virtualBrandChannel=11621

Health 2.0. Yes We Can

2009-10-16T20:14:00.001-04:00

As I work on a strategy document, collecting data via Google alerts, various RSS feeds and my regular blogs while listening to Jon Mayer on Pandora, I'm intrigued by the lack of productivity related IT use in health care today. It's not for a lack of game-changing solutions. While our company provides significant value to the entire ecosystem of providers and vendors for care-based product interactions, there are scores more that also focus on health care pain points. And like us, they are free. Of course, in the case of RxVantage, I am biased as one would be as an equity holder. But there are numerous free solutions that require no investment (they are SaaS) in additional equipment and require minimal training.
Listening to Chopra, the US' first CTO, talk about the significant opportunity in health care for start-ups at Health 2.0 in San Francisco last week, his administration has done nothing to support nor even highlight the significant value that they will provide in lowering the cost of health care. I suspect given his experience, he's more familiar with large, enterprise systems, and that's understandable. But most of the heavy lifting will be done by companies like ours, with quick deployment and explosive growth to pull down consistent single/low double digit efficiency.
Politics is politics. Historically, useful technology often finds relevance to users on their own terms. Health care is all together a different animal, and given the skewed reward systems in place today, we can all use a little push from Uncle Sam.

Significant Barriers to Real Reform: Distraction

2009-09-25T20:33:00.000-04:00

Yes, It's "Health Care Reform" 24/7, reminiscent of the CNN coverage of the first Gulf War. But it's mostly just noise; rhetoric to support the underlying constituency of the broadcaster (we're talking TV - or broadcast in technology parlance). Fox is determined to escalate the fear factor related to any change, and that's an easy and effective tool, because the majority of people are fearful, especially after the downturn in the economy has personally affected them greatly. So what are the problems? On a macro scale, the problems are as follows:

1) The existing revenue streams for our traditional payer/provider system reward treatment-based care and not wellness, such as preventative care;
2) The moral hazard imbeded in a subscription, employer paid premiums thwarts the value of consumerism, and people don't demand nor care about cost transparency related to their treatment, as well as fail to make sustainable personal decisions related to their health;
3) The continued Payer escalation of costs to increase public company return on investment due to restricted competition (no public option for most Americans);
4) Insufficient use of HIT (you knew this was coming).

There is little that I can do on reasons one through three, other than contact my representatives and make reasonable personal choices related to my own health, but I continue to support companies with innovative health information technology products that improve care and cut costs. There are many. However, the nation remains fixated to submission on the health care reform news feed. I'm hoping for a reprieve.

Data on Health Care Delivery Still Sobering

2009-08-30T18:20:00.000-04:00

In a recent Oracle white paper, familiar statistics were wielded to push the need to adopt HIT. Now, Oracle can be hardly considered objective, but we've seen these figures before, and a biased party doesn't make them any less real. And why shouldn't Oracle - or any other HIT vendor for that matter - take a bit of what it saves humanity? These numbers are big, and its a wonder why Oracle, Microsoft and other large IT providers were so late coming to the party. They certainly weren't visionary. But maybe they knew something that we didn't, and are now discovering. That health care is in peril because it is incredibly political. And change doesn't come easy to political environments, because transparency and merit rarely fare well in such an environment. Let's review a few sobering facts (straight from Oracle):

• The 15 most expensive health conditions account for 44% of total health care expenses – mostly chronic conditions and patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.
• About 30% of the total annual US expenditure on health care is spent on ineffective or redundant care.
• Health care premiums have risen nearly 84% between 1999 and 2009, from $5,791 to $12,680 for family premiums.
• The US spends more money per capita on health care than any other country; in 2009, per-capita expenditures were $8,300.

The first figure has historically been around 75 percent, and efforts to address chronic illness should be prioritized - including HIT that provides greater transparency into care for patients. The second figure - 30 percent of all health care expenditures is ultimately ineffective or redundant - is the low hanging fruit, and with immediate deployment of HIT, should be significantly curtailed. However, there will likely be a sizable portion of that figure attributable to the moral hazard related to how providers are paid and not rewarded for efficiency.

Health care reform isn't one bill, nor is it one medical device, pharma product or HIT solution. All of these levers should be pulled at once.

US Determined to Be Last. Even with HIT

2009-08-26T20:09:00.000-04:00

A recent Frost and Sullivan study shows that HIT has seen a healthy growth of 12% between 2005 and 2008 despite the economic downturn in China, Japan and Australia. Although these health care systems vary in form from that of the US, arguably, the efficiencies of IT generally bear out first in the most competitive, free market, economies. Which begs the question: why won't US providers adopt tools that will cut costs and improve care? Well, for one, they aren't paid to improve care. They are paid to treat - notwithstanding the closed health care systems such as the VA and Kaiser Permanente (both prolific users of HIT). An excellent analysis of the mechanics of US health care competition can be found here: http://www.harvardir.org/blog/?p=583

In the study, Dr. Pawel Suwinski, a Frost & Sullivan senior consultant who covers the APAC market noted along with other analysts that as more APAC healthcare organizations upgrade their equipment and adopt new computer-based technologies, preventable human errors – those external and internal variables that can affect the quality of care – will drop off.

There is no dispute that HIT will immediately improve care, and with the distraction of HIT infrastructure (EMR/EHR and health information exchanges) that has been created by the Federal and state governments, providers, payers and vendors continue to overlook significant savings to be had with the immediate deployment of HIT focused on improving the administrative side of health care. Apparently this oversight is not lost by our neighbors to the Far East.

More at: http://healthcare.tmcnet.com/topics/healthcare/articles/62845-frost-sullivan-data-shows-118-percent-growth-health.htm

Health Care. It's Complicated.

2009-08-08T20:01:00.000-04:00

During the past few weeks, as the Obama administration has tried unsuccessfully to push health care reform, I have listened intently to the few and seldom heard conversations of the average constituent. By average, I mean a civilian - one who hasn't picked up the cause of improving care by working in the industry, now 16% of the country's GDP and growing more rapidly with our dwindling economy. Why hasn't the tipping point been reached in the minds of the average consumer? For most, they have health care that works through an employer. Yes it's expensive, but most of the cost is insulated in lower wages, hence appearing to still be reasonable. The concept of universal care is also lost on most, as people who work generally don't support the notion that health care should be provided for those who can't afford it, even though we do currently have a system of universal care - i.e., emergency room care, whereby the poor seek treatment in the most expensive venue possible while passing the cost onto the US taxpayer or providers. The notion that it would be far cheaper to the US taxpayer to provide adequate care for those who currently get it in ERs around the country is lost on most. In addition, people don't understand how health care really works, nor do they understand the alternatives to the current system, which is primarily a "sickness system", paying health care providers only to treat illness, and not invest in people's wellness.
Health care is hard to understand to the novice, with complicated revenue streams and multiple payers. In addition, most people don't understand simple business systems like the auto and travel industries, let alone the many moving parts that make up the health care landscape. But once it is grasped, one thing is certain: whether you're a Democrat or Republican, believe that health care is a fundamental right or should be consumed like any other good, health care information technology can improve care while cutting costs. Health care IT is Switzerland. Further delays in implementation will simply delay any improvement in care, and the Federal and state governments should encourage deployment especially when they are payers through MediCare and MedicAid (or the state equivalents). Although EMR and an EMR exchange is an important long term goal, there are tools that we can implement immediately that are ignored given the enormous drain of EMR projects. Governments need to realign priories to enjoy the cost savings of IT that "picks the low hanging fruit". Perhaps becoming familiar with an acronym other than TARP may be in order: PERT (chart).

The Best Care Anywhere: The VA?

2009-07-28T19:28:00.001-04:00

I was engaged in a spirited debate concerning health care reform by two friends; one to my right and another to my left, both literally and figuratively (from a political idealogy perspective). Both were thankfully affluent and possessed good health care options, and doubted that unless doctors were rewarded as most professions are - i.e., the incentive of extremely high pay to excel in one's profession - that patient care would suffer. I failed to bring up the story of the VA, which dollar for dollar provides better care while paying its providers less. It is a true government run care program. How can this be, you ask. Well, the VA is mostly a closed system, providing comprehensive care to veterans during most of their life. Secondly, the VA is a prolific user of health care IT that allows it to work far more efficiently and effectively in the treatment of veterans. But I think an excerpt from Phillip Longman's book, "The Best Care Anywhere" may be more appropriate:

Health for service

It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation's top health-care quality experts, praises the VHA's information technology as "spectacular." The venerable Institute of Medicine notes that the VHA's "integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation."

So what's left? Consider why, ultimately, the veterans health system is such an outlier in its commitment to quality. Partly it's because of timely, charismatic leadership. A quasi-military culture may also facilitate acceptance of new technologies and protocols. But there are also other important, underlying factors.

First, unlike virtually all other health-care systems in the United States, VHA has a near lifetime relationship with its patients. Its customers don't jump from one health plan to the next every few years. They start a relationship with the VHA as early as their teens, and it endures. That means that the VHA actually has an incentive to invest in prevention and more effective disease management. When it does so, it isn't just saving money for somebody else. It's maximizing its own resources.

The system's doctors are salaried, which also makes a difference. Most could make more money doing something else, so their commitment to their profession most often derives from a higher-than-usual dose of idealism. Moreover, because they are not profit maximizers, they have no need to be fearful of new technologies or new protocols that keep people well. Nor do they have an incentive to clamor for high-tech devices that don't improve the system's quality or effectiveness of care.

And, because it is a well-defined system, the VHA can act like one. It can systematically attack patient safety issues. It can systematically manage information using standard platforms and interfaces. It can systematically develop and implement evidence-based standards of care. It can systematically discover where its care needs improvement and take corrective measures. In short, it can do what the rest of the health-care sector can't seem to, which is to pursue quality systematically without threatening its own financial viability.

The system runs circles around Medicare in both cost and quality. Unlike Medicare, it's allowed by law to negotiate for deep drug discounts, and does. Unlike Medicare, it provides long-term nursing home care. And it demonstrably delivers some of the best, if not the best, quality health care in the United States with amazing efficiency. Between 1999 and 2003, the number of patients enrolled in the VHA system increased by 70 percent, yet funding (not adjusted for inflation) increased by only 41 percent. So the VHA has not only become the health care industry's best quality performer, it has done so while spending less and less on each patient. Decreasing cost and improving quality go hand and hand in industries like autos and computers--but in health care, such a relationship virtually unheard of. The more people we can get into the VHA, the more efficient and effective the American health-care system will be.

Does this plan seem too radical? Well, perhaps it does for now. We'll have to let the ranks of the uninsured further swell, let health-care costs consume larger and larger portions of payrolls and household budgets, let more and more Americans die from medical errors and mismanaged care, before any true reform of the health-care system becomes possible. But it is time that our debates over health care took the example of the veterans health-care system into account and tried to learn some lessons from it.

http://www.washingtonmonthly.com/features/2005/0501.longman.html

McDonalds: You Can't Get There From Here

2009-07-07T19:58:00.000-04:00

I was amused to read that McDonald's of "Super Size Me" fame is attempting to green wash its torrid health reputation by building a restaurant out of sustainable materials in Cary, NC. Let's hold the puns for now while we contemplate the irony of selling food that will decrease the health of of its customers from a structure that purports to lend to the health of the planet. Although HIT will enable its users to significantly improve, almost immediately, the provision of care to patients, the fundamental problem remains one of behavior of consumers. As we tip toward the sustainable health care model of preventative care with the help of HIT, consumers must take accountability for their nonsustainable choices, like eating at McDonald's. Organ transplant recipients are carefully screened to ensure that the resources allocated to them are not for naught - i.e., that they will behave in a responsible manner to aid in maintaining their health and preserving the organ donated to them. The same can be said of today's patients, as they receive care that is costing stakeholders more and more.

By the way, despite using "sustainable" materials and providing electric vehicle recharging outlets, no word on whether this McDonald's will modify its menu.

The story here: http://green.venturebeat.com/2009/07/06/mcdonalds-attempts-to-go-green-with-help-from-ev-charging-co-coulomb/

Blumenthal Shares Government Plan and Conviction

2009-06-15T14:22:00.001-04:00

David Blumenthal's interview with the WSJ is here and below (emphasis added): http://online.wsj.com/article/SB124404155221081477.html

National Coordinator for Health Information Technology Dr. David Blumenthal spoke with The Wall Street Journal's Bob Davis about how he plans to convince hospitals and doctors to computerize their records. Below is an edited transcript.
* * *

The Wall Street Journal: What's the potential for health information technology?

Dr. Blumenthal: There's no way to transform the health-care system without information technology. Today we use the same technology for recording health-care information that Hippocrates used. It defies logic that we will be able to get the best out of health information with sheaths of paper flying around by snail mail.

WSJ: What are the potential cost savings?

Dr. Blumenthal: There are disputes about how much we'll save and how we'll show the benefits of health IT. The combination of an improved payment system, an improved education system about health IT and improved governance of the health care system that prioritizes quality and efficiency together with health information technology is where the real payoff is.

WSJ: How much money does the stimulus bill set aside from health IT?

Dr. Blumenthal: The stimulus bill sets aside $2 billion for the Office of the National Coordinator of Health Information Technology to lay the groundwork for the adoption of health information. It also creates Medicare and Medicaid payment incentives for physicians who are "meaningful users" of health information technology. There will also be penalties for those who aren't "meaningful users'" of health IT.

Estimates of the cost of those incentives and penalties vary. No one can tell you exactly how many physicians will use electronic health care records. The Congressional Budget Office estimates that the federal government would spend $29 billion on incentives, but it would produce savings of $12 billion. Other saving estimates run higher.

WSJ: What will be the effect on doctor's offices?

Dr. Blumenthal: There's a good chance that the current funding will be enough to equip every doctor's office in America with electronic record keeping. I believe that physicians and many hospitals will come to the conclusion that in order to be an adequate professional and to hold their head up with other doctors, they're going to have to be able to manipulate health care records electronically.

WSJ: Critics contend that the system is tilted toward older technologies and won't allow for much innovation.

Dr. Blumenthal: The last thing we want to do is inhibit innovation in this very young industry. There are contending priorities. There is a strong desire to get the technology to the physician and have it used in doctors' offices. There's also the concern that we'll put the industry in a straightjacket (by endorsing only existing equipment).

We'll try to resolve these issues by focusing on performance rather than any specific technology. We'll say to the industry and providers of care: We don't care how you accomplish critical tasks, so long as you do so with electronic technology.

If someone produces the equivalent of an Apple iPhone, where the doctor selects certain applications, that's fine -- so long as it works.

WSJ: How will the government set standards for companies to meet?

Dr. Blumenthal: We will set the specifications with the help of a health information technology committee. There are public representatives, provider representatives and industry representatives on the committee. We expect the first incentive checks to go to doctors in 2011. We'll have the first certifications of technology some time before that.

Wharton & Fox News? Say It Ain't So

2009-06-12T17:43:00.000-04:00

I was surprised to find in Wharton's monthly "Knowledge @ Wharton" an article supported by several Wharton professors questioning the value of health care information technology. Now, I have regarded - without any real personal evidence, mind you - Wharton as a respectable school with smart people. And I get that a robust debate about the merits of any proposed technology is a healthy and important exercise. But this "article" was clearly more of a position editorial than anything I would value from an institution of higher learning. The primary contention of the learned Wharton professors was that there was no data to prove that adopting the IT that has been summarily used by every other industry to lower costs and increase efficiency would actually do that for health care. I'm sorry, but no where is there a stronger testament to "those that can, do; and those that can't, teach." Notwithstanding that multiple data points and empirical studies by governmental agencies, such as the state of Oregon, and the simple, intuitive logic that those in business apply to value and ROI selling, the article is simply superfluous. And then it hit me: did Rupert Murdoch acquire the Wharton School? It's time to move past political positions and focus on actually fixing what is broken. Health IT is truly a nonpartisan issue and will, as it has in every other industry and in your home, bring transparency and efficiency to what is currently a quagmire of poorly measured, captured and used information to manage Americans' health.

Nonsense here: http://knowledge.wharton.upenn.edu/article.cfm?articleid=2260

Blumenthal Speaks of the True Benefits of IT - For Those Who Don't Yet Know

2009-05-28T00:19:00.002-04:00

Blumenthal, speaking at the Brookings Institution conference, as reported by Government Health IT (HIMSS), stated that the true incentive for health IT adoption isn't Stimulus cash, but better patient care. His point is obvious, and should be to the early adopters like Kaiser who understand that IT enables them to operate far more efficiently - like every other industry that has adopted IT improve operations. But perhaps this is his challenge: a health professional frustrated at the slow adoption rate of his industry. But he would be advised to pick up a copy of "Crossing the Chasm" by Geoffrey Moore. "Chasm" methodology is ubiquitous in technology circles, and identifies the lifecycle of technology adoption in virtually any industry. The difficulty faced with attempting to bootstrap adoption via the Stimulus Act - and I am a fan, never-the-less - is that technology laggards will not comprehend, and thus value an IT application, until those that do demonstrate its viability. The Stimulus Act cash will help, for sure, but there's no shortcutting this adoption curve, and technology companies, at least those that want to proliferate their products and services in the long run, will aim at innovators, then early adopters, etc....

http://govhealthit.com/articles/2009/05/21/blumenthal-on-health-it-adoption.aspx

Can the Cause Provide the Solution?

2009-05-17T20:23:00.000-04:00

Noteable this week was a meeting between President Obama and certain leaders of the health care industry establishment: doctors, hospitals, insurance and Pharma companies (payers and providers: the backbone of the health care system). A New York Times article here: http://www.nytimes.com/2009/05/11/health/policy/11drug.html?hp

Clearly meeting to preempt any significant change that may threaten existing revenue streams, these organizations soft pedaled certain "ideas" - not promises, we later discover - to lower the cost of health care, as health care has reached a critical mass of organizations, both political and business leaders (primarily employers), who demand transparency and accountability to improve its value prop to Americans.

The problem, of course, is that had large payers and providers been able to cut costs by becoming more efficient earlier, what were they waiting for? Large payers and providers, like any business, see enormous opportunity in the right kind of universal health care plan. That is, currently there are about 48 million Americans who are uninsured and about that many who are underinsured. Making the overall cost of providing health care within reach, large payers and providers stand to gain an additional 100 million Americans who would have been out of reach to their revenue streams. That's big money.

So, health care and politics remain inseparable, as the only viable solution for Americans remains universal health care, but with a far more efficient health care provision system. Of course the devil is in the details. But, the use of IT - and the initial framework roughly outlined in the Stimulus Act - will improve the efficiency of health care to begin to bring costs down. It will be, however, a very long road.

Blumenthal Speaks Part II: He's Ready

2009-05-03T18:32:00.000-04:00

Speaking at the Markle Foundation's Connecting for Health conference, David Blumenthal, the national health IT coordinator, reported that he's now ready to work with health IT advisory panels specified by the Stimulus Act, Government Health IT reported. Who are these people, and what does he intend to accomplish?

Blumenthal shared the a first priority is to train a health IT workforce. He also professed the importance of interoperability and the need for health IT to improve the quality of care, Government Health IT reported. Although Blumenthal may have been more specific, he has not yet provided any specifics on how he will achieve health IT adoption. His predecessors were equally light on specifics, and the result was the passage of time with no significant movement in the use of health IT. Perhaps the next time we hear from Blumenthal, he'll provide something of value. Technology evangelicals we have. What we need are people to execute on interoperability standards and IT adoption.

The short story here: http://govhealthit.com/articles/2009/04/30/article_0.aspx

Early funding will be particularly important in efforts to open extension centers for technical assistance to healthcare providers, in training a health IT workforce and to spark health information exchange, Blumenthal said.

Interoperability is especially essential to protecting the public health, he said, citing the example of “the incipient potential pandemic that we are facing.”

“We will be, I hope, working quickly but wisely to develop those policies,” Blumenthal said. He said welcomed the contributions of organizations, such as Connecting for Health, to assist the government in setting direction on health IT, and, “telling us how to prevent the problems we could create by regulating too much or by being too precise or specific or by being too intrusive.”

“At the same time it is clear that this field has not advanced enough when left exclusively to the private sector,” he said.

Blumenthal said putting the health IT provisions of the American Recovery and Reinvestment Act into effect would improve healthcare efficiency, quality and population health.

“We understand that health information technology is a vital enabler to be part of a transformed 21st century healthcare system. If we could do it just as well without health IT, we would do it without health IT, but we can’t,” he said.

Under the law and beginning in 2011, increases in Medicare and Medicaid payments to providers would be based on their “meaningful use” of certified health IT.

Connecting for Health also announced its framework for meaningful use, emphasizing that HHS should start with practical goals. Meaningful use focus on medication management and coordination of care, functions that are achievable even for smaller practices via Internet-enabled technologies, it said.

The provision should prescribe standard information types that are electronic, widely adopted and which can support measurement of treatment outcomes.

The group also urged an approach that encourages innovation in the use of applications and services, particularly for small physician practices, according to Carol Diamond, Markle managing director and chair of the Connecting for Health initiative.

“We must invest this money in ways that support information use to improve quality, slow growth in costs and protect privacy, without creating undue burden on clinicians and practices,” she said.

Health IT will Ease Pressure on Doctors

2009-04-27T13:21:00.000-04:00

Health Care IT will significantly allow us to leverage the best use of limited health care providers, freeing up capacity and ensuring that everyone will enjoy the attention of a doctor if needed. The New York Times published an article on Sunday regarding the shortage of primary care physicians and how the move towards universal care is feared to effectively block coverage for those who have just obtained it. Once again, the industry and lawmakers inexperience in other verticals fail to see the transformative effects of IT that enables business to better manage its resources. Yes, health care is not auto manufacturing, or consumer sales, but health care providers now are pretty much flying blind with very little transparency in their operations, whether it be back end business support or patient facing activities.

Given that the U.S. is ranked 26th in the quality of care and health of its population worldwide, but first in cost per capita, it would be instructive to see what the patient to doctor ratio is in those countries that provide universal care, and how they ensure that people who actually need care receive it. There are many issues to address in our system but little information to review and respond to to improve care. But the statistics support that most people seeking treatment don't need it, and very little is spent on preventative care, ensuring that consumers continually seek treatment for issues that can be remedied over time or perhaps even prevented. Tevi Troy's editorial that appears in The Washington Post is consistent with a former Bush administration official, intellectually lazy and rife with unsupported conclusions regarding the implementation and benefit of EMRs. Sadly, many naysayers are sitting on the sidelines - in his case, likely attempting to explain why he was so ineffective - professing the ills of IT like the oil industry did with issues related to climate change.

Editorial here: http://www.washingtonpost.com/wp-dyn/content/article/2009/04/23/AR2009042303943.html

Perhaps we haven't yet hit that perfect storm of extreme cost and limited effectiveness of cost, as consumers will continue to seek answers from health care providers if they aren't dissuaded from doing so or given other avenues to receive answers. Once again the legacy revenue streams of traditional U.S. based health care rears it's ugly head and the cost of care escalates. Those of us on the front lines of pushing the tipping point of health care IT need to be more successful in establishing the significant benefits of it now. Like the issue of climate change, the situation will only continue to get worse until we change our behavior, and figure out how to affect the behavior of others. Ideas welcome.

Obama Names America's CTO

2009-04-18T23:29:00.000-04:00

President Obama has named yet another colleague from inside the Beltway to become the U.S.'s first CTO. A veritable unknown, the 36 year old former VA civil servant will be responsible for a significant challenge of closing the technology gap in this country's use of IT to improve governing efficiency. Sadly, Obama could have leveraged a far more experienced, suitable and capable individual for what is a key role in addressing health care, energy and education policies. To be fair, Obama has not been accountable as a C-level operator and is extremely light on people management. Certainly, Aneesh Chopra is likely a very capable person, and hopefully he'll reach out to thought leaders and the experienced in change management to address the challenges ahead of all of us. The news release below:

http://www.google.com/hostednews/afp/article/ALeqM5g5Ea3RfOeifbeTDS3bVBKY2mUJjg

Obama names first US chief technology officer

16 hours ago

WASHINGTON (AFP) — US President Barack Obama on Saturday named a Harvard-educated Indian-American to the newly created post of Chief Technology Officer in an appointment much-awaited by Silicon Valley.

As the country's first Chief Technology Officer, Aneesh Chopra, 36, will use technology to "improve security, ensure transparency, and lower costs," Obama said in his weekly address to the nation.

"In this role, Aneesh will promote technological innovation to help achieve our most urgent priorities -- from creating jobs and reducing health care costs to keeping our nation secure," the president added.

Chopra, whose background is in health policy, has served as secretary of technology for the state of Virginia and as an executive in a company which advises hospitals.

Obama said Chopra would work closely with Chief Information Officer Vivek Kundra, who is responsible for setting technology policy and federal technology spending, which amounts to more than 70 billion dollars a year.

The appointment of the relatively unknown Chopra came as somewhat of a surprise in technology circles, where speculation over the past three months had focused on more high-profile candidates.

Chopra's name was not even listed among the choices in an online poll of readers by the technology blog TechCrunch which asked who should be appointed to the job.

Microsoft's Bill Gates, Google's Eric Schmidt and Amazon's Jeff Bezos were among the top vote-getters in the poll.

Obama pledged during his presidential campaign to create the position of Chief Technology Officer and there had been some speculation it would be a cabinet-level position but that turned out not to be the case.

Obama ran the most technology savvy US political campaign in history, leveraging social networks, email, text messages and other media to build a vast fundraising and political operation.

But hopes that the president can unleash a technology revolution and create a new e-White House in government have come up against antiquated government technology and privacy and security restrictions.

As Virginia's secretary of technology, Chopra was responsible for applying technology to government reform, innovation and economic development and served as an advisor to Governor Tim Kaine.

Before taking the state government position, Chopra was managing director of the Advisory Board Company, a publicly-traded health care think tank serving nearly 2,500 hospitals and health systems.

Chopra earned his undergraduate degree from John Hopkins University and a masters in public policy from Harvard University.

Why Wait? Change Hurts.

2009-04-18T23:11:00.000-04:00

The Economist has compiled a dizzying summary of the various surveys and studies describing the benefits of a Health IT smart grid. Although I have cited these sources in the past, it is sobering to see the significant resources - money, and more importantly, lives (quality of life) - that would be saved with adoption of a comprehensive IT infrastructure. Not that savings wouldn't start immediately, but reaching a certain threshold has unimaginable benefits in today's health care system.

If 90% of hospitals and doctors in America were to adopt HIT over 15 years, the health system could save some $77 billion a year from efficiency gains (The Rand Corp.).

If health-and-safety benefits are taken into account, the gains could double, saving about 6% of the $2.6 trillion that will be spent on health care in America this year (The Rand Corp.).

Perhaps with the significant decline in the US and world economy, the Obama Presidency and the resulting Stimulus Act we have hit the perfect storm in which we can no longer ignore the need to address the business fundamentals in health care: information technology. Yes, many existing stakeholders' revenue streams are threatened by a more efficient and effective health care system, but change must and will come. The Economist article here:

http://www.economist.com/specialreports/displaystory.cfm?story_id=13438006

Alliances to Come in Health IT. No Kidding.

2009-04-14T19:25:00.000-04:00

Several business schools participated in a public war game in which the consensus among the participants was that health IT companies - and I suspect IT companies without a strong presence in health care as of yet - will begin to form alliances to satisfy the need for IT created by the Stimulus Act. This, of course, happens in all industry verticals when money is to be had, and is most predominant in this poor economy with many other industries shunning any type of IT investment, despite the quick ROI that many IT expenditures deliver. The more difficult predictive challenge is "who will team up?"

Some of the predictions - and some are insightful if not repeatedly shared over the past few months in blogs and periodicals on the topic:

* Entrenched interests will continue to resist EMRs for some time to come. Healthcare system change, engendered by EMR, means some interests will win dollars while other traditional players will lose - and no one wants to lose. Physician, hospital and patient/consumer markets--are going to be major challenges for all companies in the field, the teams acknowledged. Hospitals and doctors actually can make money through these current inefficiencies and will likely resist change. Smaller medical practices may continue to resist installing such EMR systems, not wanting to invest in long-term promises while sinking lots of money into new and complicated electronic medical records systems. Emerging pay-for-performance requirements, and reimbursement incentives may sway the thinking though.

As with all Chasm adoption, this is very correct in that technology innovators and early adopters will see value long before the rest of the providers.

* A shortage of technical manpower will slow down the implementation of electronic medical records, no matter how much money is thrown against the challenge.

* Allscripts (and other similar pure plays, such as Epic) will seek to exploit cheaper web-based solutions to bring EMRs to smaller medical practices. In order to penetrate the small medical practice market, where most of the EMR potential user base exists, it will have to look to stripped-down, cheaper cloud computing solutions rather than the client/server solutions sold to larger medical practices and hospitals. It may also have to look to form an alliance or merge with a larger player that has a far more extensive sales force, such as a pharmaceutical firm, to effectively access the small medical practice market across the nation.

* The market that is driving efficiencies, such as EMRs and other scalable solutions, will act as a catalyst to force small medical practices to band together or merge in the next few years, allowing doctors to spread the cost - and the risk - of EMR implementation.

* Kaiser-Permanente seeks to lower healthcare costs by "undocking" healthcare information within its system, vastly increasing the access and portability of patient data. As a major healthcare provider, Kaiser is well positioned to set industry best-practices and influence adoption of EMR systems, rather than provide the 'killer app' platform itself. Kaiser will become the nexus of important alliances between government and industry to craft standards in healthcare IT--e.g., to afford interoperability of data-related tools and technologies--that have been nonexistent.

Again, Kaiser is the leading innovator in this industry, and completely gets the operational efficiencies as well as the business/patient care intelligence upside of scalable health data across its members and patients. Kaiser is most willing and most likely to benefit as a payer and provider of care.

* McKesson will be working to vastly expand its healthcare IT niche through its dominance in logistics and understanding of the health value chain, data creation and data utility--with an emphasis on physician, payor and healthcare delivery applications. The company will be looking to generate synergies among all these different points of the healthcare delivery chain through information technology.

The full release here: http://sev.prnewswire.com/computer-electronics/20090413/NY9770313042009-1.html

Private Sector Remedies Stimulus Flaw

2009-04-09T13:54:00.000-04:00

Nextgen Healthcare, a division of Quality Systems, Inc., announced a money-back guarantee for providers who acquire its health care IT solutions - including EMR solutions - if its solution does not qualify for Stimulus Act reimbursement. As you may know, the Stimulus Act requires that any reimbursement follow a solution's interoperability with yet to be named standards. The government expects that these standards will be released in 2011, freezing any existing sales of badly needed health care IT. It is likely that all other health care IT providers will follow suit in order to address this obvious provider objection. The full press release is below:

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20090405005011&newsLang=en

Nextgen Healthcare Unveils Money-Back Guarantee Program

Leading EHR and Practice Management Vendor Aims to Help Physicians Meet All Standards and Certifications for Federal Stimulus Reimbursement Programs While Reducing Investment Risk

HORSHAM, Pa.--(BUSINESS WIRE)--NextGen Healthcare Information Systems, Inc., a wholly owned subsidiary of Quality Systems, Inc. (NASDAQ: QSII) and a leading provider of ambulatory healthcare and connectivity solutions, today announced its new Money-Back Guarantee Program. The Program will reduce the investment risk for physicians by guaranteeing* the following: a solution that will always evolve to meet the standards and certifications for federal stimulus reimbursement programs of interest to physicians using NextGen Healthcare products; a solution that uses open standards and enables generally seamless communication across the healthcare community; a fully-functional solution, and swift and professional implementation; and top quality training and support.

“Now that the Health Information Technology for Economic and Clinical Health (HITECH) Act has been passed into law, it is even more critical for physicians to make smart investments when it comes to healthcare technology and to know they’re making the right decision,” said Patrick Cline, president of NextGen Healthcare. “Through this new money-back guarantee program, our clients can feel confident that their new NextGen systems will work properly and will help them meet federal guidelines outlined in the new legislation. They can also feel comfortable that NextGen Healthcare will stand behind them and their investment.”

The Program is applicable to NextGen Healthcare’s full suite of products, which includes NextGen® EHR (Electronic Health Record), NextGen EPM (Enterprise Practice Management), NextGen CHS (Community Health Solution) and the NextMD® patient portal. These products can be customized to fit the unique workflow and content needs of various care settings and specialties.

* For more details on terms and conditions for NextGen Healthcare’s Money-Back Guarantee Program, please visit www.nextgen.com/offers.

About NextGen Healthcare

NextGen Healthcare Information Systems, Inc. a wholly owned subsidiary of Quality Systems, Inc. (NASDAQ: QSII), provides integrated electronic health record and practice management systems, connectivity solutions, and billing services for hospitals and ambulatory practices of all sizes and specialties. For more information about NextGen, please visit www.nextgen.com and www.qsii.com.

This news release may contain forward-looking statements within the meaning of the federal securities laws. Statements regarding future events, developments, the Company's future performance, as well as management's expectations, beliefs, intentions, plans, estimates or projections relating to the future (including, without limitation, statements concerning revenue and net income), are forward-looking statements within the meaning of these laws and involve a number of risks and uncertainties. Management believes that these forward-looking statements are reasonable and are based on reasonable assumptions and forecasts, however, undue reliance should not be placed on such statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and uncertainties, some of which are outlined below. As a result, actual results may vary materially from those anticipated by the forward-looking statements. Among the important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are: volume and timing of systems sales and installations; length of sales cycles and installation process; the possibility that the products will not achieve market acceptance; seasonal patterns of sales and customer buying behavior; the development by competitors of new or superior technologies; the timing, cost and success or failure of new product and service introductions, development and product upgrade releases; undetected errors or bugs in software; product liability; changing economic, political or regulatory influences in the health-care industry; changes in product-pricing policies; availability of third-party products and components; competitive pressures including product offerings, pricing and promotional activities; the Company's ability or inability to attract and retain qualified personnel; possible regulation of the Company's software by the U.S. Food and Drug Administration; uncertainties concerning threatened, pending and new litigation against the Company including related professional services fees; uncertainties concerning the amount and timing of professional fees incurred by the Company generally; changes of accounting estimates and assumptions used to prepare the prior periods' financial statements; general economic conditions; and the risk factors detailed from time to time in Quality Systems' periodic reports and registration statements filed with the Securities and Exchange Commission. A significant portion of the Company's quarterly sales of software product licenses and computer hardware is concluded in the last month of the fiscal quarter, generally with a concentration of such revenues earned in the final ten business days of that month. Due to these and other factors, the Company's revenues and operating results are very difficult to forecast. A major portion of the Company's costs and expenses, such as personnel and facilities, are of a fixed nature and, accordingly, a shortfall or decline in quarterly and/or annual revenues typically results in lower profitability or losses. As a result, comparison of the Company's period-to-period financial performance is not necessarily meaningful and should not be relied upon as an indicator of future performance. The Company undertakes no obligation to publicly update any forward-looking statements, whether as a result of new information, future events or otherwise.

Blumenthal Speaks, But Specifies Little

2009-03-30T23:53:00.000-04:00

The newly appointed National Coordinator for Health Information Technology, Dr. David Blumenthal, has written an article for the New England Journal of Medicine regarding the need for health IT and the health IT provisions of the Stimulus Act. What he has not done is provide an outline of how he intends to spur the adoption of health IT. Well, he's newly appointed, so perhaps we'll see more in the coming weeks. In the interim, here's the article.

http://content.nejm.org/cgi/content/full/NEJMp0901592?query=TOC

Stimulating the Adoption of Health Information Technology
David Blumenthal, M.D., M.P.P.

The recently enacted stimulus bill — the American Recovery and Reinvestment Act of 2009 (ARRA) — touches almost every aspect of the U.S. economy. Health care is no exception. In fact, the ARRA is historic health care legislation of the type rarely produced by our famously incremental federal government. The law prevents dramatic state cuts in Medicaid, expands funding for preventive health care services and health care research, and helps the unemployed buy health insurance. But perhaps its most profound effect on doctors and patients will result from its unprecedented $19 billion program to promote the adoption and use of health information technology (HIT) and especially electronic health records (EHRs).

The HIT components of the stimulus package — collectively labeled HITECH in the law — reflect a shared conviction among the fledgling Obama administration, the Congress, and many health care experts that electronic information systems are essential to improving the health and health care of Americans. However, proponents of HIT expansion face substantial problems. Few U.S. doctors or hospitals — perhaps 17% and 10%, respectively — have even basic EHRs, and there are significant barriers to their adoption and use: their substantial cost, the perceived lack of financial return from investing in them, the technical and logistic challenges involved in installing, maintaining, and updating them, and consumers' and physicians' concerns about the privacy and security of electronic health information. HITECH addresses these obstacles head on, but huge challenges await efforts to implement the law and fulfill President Barack Obama's promise that every American will have the benefit of an EHR by 2014.

One of HITECH's most important features is its clarity of purpose. Congress apparently sees HIT — computers, software, Internet connection, telemedicine — not as an end in itself but as a means of improving the quality of health care, the health of populations, and the efficiency of health care systems. Under the pressure to show results, it will be tempting to measure HITECH's payoff from the $787 billion stimulus package in narrow terms — for example, the numbers of computers newly deployed in doctors' offices and hospital nursing stations. But that does not seem to be Congress's intent. It wants improvements in health and health care through the use of HIT.

To achieve this goal, the law takes several approaches. It starts by creating a leadership structure to guide federal HIT policy: the Office of the National Coordinator of Health Information Technology (ONCHIT) within the Department of Health and Human Services (DHHS). ONCHIT currently exists under executive authority, but HITECH enshrines it in statute and greatly expands its resources. One of the national coordinator's first responsibilities will be to create a strategic plan for a nationwide interoperable health information system, a plan that must be updated annually. Two statutory committees will advise the coordinator: a Health Information Policy Committee and a Health Information Standards Committee.

From the standpoint of physicians, the legislation's most important provision may be $17 billion in financial incentives intended to get doctors and hospitals to adopt and use EHRs. Starting in 2011, physicians can receive extra Medicare payments for the "meaningful use" of a "certified" EHR that can exchange data with other parts of the health care system. These payments can total as much as $18,000 in the first year in the case of physicians who adopt in 2011 or 2012, with at least $15,000 for physicians who adopt in 2013 and a slightly lower amount for those who do so in 2014; incentives are gradually reduced and then ended in 2016. Thus, physicians demonstrating meaningful use starting in 2011 could collect $44,000 over 5 years. Waiting until 2013 would result in a maximum bonus of $27,000 over 3 years. Experts estimate the cost of purchasing, installing, and implementing an electronic-records system in a medical office at about $40,000.

For physicians with high volumes of Medicaid patients (30% or higher), the law provides subsidies through the Medicaid program as well. Doctors must choose whether to participate in the Medicaid or Medicare bonus program — they cannot receive awards from both. Hospitals participating in Medicare also stand to benefit. Meaningful use of EHRs in 2011 will earn hospitals a one-time bonus payment of $2 million plus an add-on to the Medicare fee based on the diagnosis-related group (DRG). The add-on, which would phase out over a 4-year period, would apply to every admission up to a (yet-to-be-designated) maximum amount. Children's hospitals and other hospitals with a high volume of Medicaid patients can participate in a Medicaid incentive program instead.

HITECH also threatens financial penalties to spur adoption. Physicians who are not using EHRs meaningfully by 2015 will lose 1% of their Medicare fees, then 2% in 2016, and 3% in 2017. Hospitals, too, face penalties for nonadoption as of 2015 — in their case, taking the form of cuts in their annual updates under the DRG system.

Spurring the adoption of EHRs and other HIT will probably require more than financial carrots and sticks. Many physicians and hospitals will need technical help to keep their systems working and to update them as technology improves. HITECH provides $2 billion for ONCHIT to begin putting such support systems in place and authorizes a variety of tools for building the requisite infrastructure. It sets aside $300 million to support the development of health information exchange capabilities at the regional and state levels. The law also authorizes grants to create regional technology extension centers to help providers install EHRs, funds to train a workforce to assist with HIT implementation, educational programs for medical students, and grants and loans to states to assist with adoption and interoperability.

Mindful of concerns about privacy and the security of electronic-records systems, HITECH strengthens protections of health care information as well. It extends the privacy and security regulations of the Health Insurance Portability and Accountability Act to health information vendors not previously covered by the law, including businesses such as Google and Microsoft, when they partner with health care providers to create personal health records for patients. It requires health care organizations to promptly notify patients when personal health data have been compromised, and it limits the commercial use of such information.

All this constitutes a substantial down payment on the financial and human resources needed to wire the U.S. health care system. Still, major hurdles remain. First, the DHHS and ONCHIT are operating on a very tight schedule. The infrastructure to support HIT adoption should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses. Meeting this deadline will be challenging. It takes time to develop and implement innovative federal programs, and it will take even more time to create the local institutions needed to support HIT implementation.

Second, much will depend on the federal government's skill in defining two critical terms: "certified EHR" and "meaningful use." ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT. Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients. By tying Medicare and Medicaid financial incentives to "meaningful use," Congress has given the administration an important tool for motivating providers to take full advantage of EHRs, but if the requirements are set too high, many physicians and hospitals may rebel — petitioning Congress to change the law or just resigning themselves to forgoing incentives and accepting penalties. Finally, realizing the full potential of HIT depends in no small measure on changing the health care system's overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of EHRs.

The nation's economic woes have given birth to an unprecedented federal effort to modernize the information systems of a troubled health care system. It is now up to the government and the nation's health care professionals and facilities to turn this opportunity into real improvements in the health and health care of Americans.

Dr. Blumenthal reports receiving grant support from GE Corporate Healthcare, the Macy Foundation, and the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services and speaking fees from the FOJP Service Corporation and serving as an adviser to the presidential campaign of Barack Obama. No other potential conflict of interest relevant to this article was reported.

Source Information

Dr. Blumenthal is director of the Institute for Health Policy, Massachusetts General Hospital–Partners Healthcare System and Harvard Medical School — both in Boston. He has been named National Coordinator for Health Information Technology.

This article (10.1056/NEJMp0901592) was published at NEJM.org on March 25, 2009. It will appear in the April 9 issue of the Journal.

Kaiser Shows How IT Can Reduce Effects of Chronic Illness

2009-03-28T17:31:00.000-04:00

In a partial geographic roll-out of EMR and care registry, Kaiser focused on coronary heart disease patients in Colorado to improve their survival rate after suffering a heart attack. Provided that patients joined the program within 90 days of a heart attack, their death rate was cut by 88 percent. Notable in Kaiser's pilot program was its holistic approach to IT integration - i.e., ensuring that all stakeholders were incented to use the network to address preventative care and treatment decisions, as well as training for care touch points on the use of IT. It isn't IT itself that solves the problem, but the manner in which it's used.

George C. Halvorson, chairman and CEO of Kaiser Permanente, stressed the importance of caregivers' training, coordination, and ability to use that technology in achieving better health outcomes:

"Technology itself cannot solve the health care crisis," Halvorson said. "Our Colorado region achieved quality care results by aligning people and technology in the most efficient care delivery system. It was not newer or more expensive treatments, but an integrated approach to deliver the right care at the right time. Maximizing information for the clinician means optimizing care for the patient. As Congress and the president engage on health care reform, we must focus on the need to change the way we deliver care."

The pilot program integrates nursing and pharmacy teams that work with heart disease patients and their doctors. The team is connected by technology tools, such as Kaiser's HealthConnect, that help deliver care to improve health outcomes. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events are all coordinated through the program, which helps guide the patient through both short- and long-term care decisions.

The program achieved the following results:

* Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
* The number of patients meeting their cholesterol goal went from 26 percent to 73 percent and;
* The number of patients screened for cholesterol went from 55 percent to 97 percent.

For more: kp.org/future.

Lapses in Health IT Continue to Cost Americans

2009-03-26T00:27:00.000-04:00

Studies continue to be published to evidence that continued delays in health IT adoption over the past 14 years have had a significant negative effect on Americans. Health care stakeholders continue to make the necessary changes to reverse this escalating problem - changes to IT and revenue streams. The State Health Access Data Assistance Center (SHADAC) at the University of Minnesota averaged data from the U.S. Census Bureau from 1994-1996 and compared it with average figures from 2006-2007:

* More Americans are uninsured. The total number has increased by nearly 9 million, to 45.7 million. 22 percent of men are uninsured, up from 19 percent; 18 percent of women are uninsured, up from 16 percent.

* More working people are uninsured. The number of working uninsured adults has increased by more than 6 million, to 26.9 million. Currently, nearly one in five working adults (18 percent) is uninsured.

* More kids have insurance. The rate of uninsured kids has fallen by 13 percent, to 9.2 million, which experts attribute to more children being covered by government insurance programs like Medicaid and the Children's Health Insurance Program (CHIP).

* Fewer people have private health insurance. The percentage of nonelderly people who have private insurance has dropped to 67 percent, down from 73 percent. Alaska, North Carolina, Utah, Vermont, and Virginia have all seen the percentage of privately insured residents erode by 10 percent or more.

* Workers' insurance costs have risen far faster than incomes. Average costs for an individual insurance policy have increased 61 percent - from $2,560 in 1996 to $4,118 in 2006. The amount that employees pay for an individual policy has increased 79 percent, with wages in the U.S. increasing just 10 percent over the period.

What has been clear is that health care has increased in cost but decreased in effectiveness. The big question remains as to where this additional cost outlay is going? Much of it likely can be attributed to the inability to leverage efficiencies operations and the inability to duplicate services. In addition, doctors and administrators are rewarded for promulgating treatment that earns them revenue with no incentive to carefully weigh the cost effectiveness. Given the lack of transparency due to an absence of data that is generally acquired through a business operations technology platform, this will continue until health care adopts IT on a critical mass scale. Otherwise, Americans will continue to guess as to why health care costs continue to escalate.

No other industry - other than defense - seems to enjoy the lack of transparency and complicated revenue streams afforded health care. Like the financial industry - and its debacle and wealth theft during the past several years - perhaps health care has hit the tipping point.

Press release here: http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/03-24-2009/0004993455&EDATE=

"The rising cost of health care has largely been borne by workers who are not getting raises because of it and employers who are seeing these costs eat into their profit margins," said Lavizzo-Mourey. "Fixing our broken health care system is a critical part of fixing the economy, but it will not happen overnight and it won't be easy. Fortunately, a lot of people are working together this time - government and business, doctors and patients, Democrats and Republicans - so that we can achieve real reform. When all Americans have access to affordable health care, everyone will benefit."

The report with state-specific data is being released during Cover the Uninsured Week, a nonpartisan campaign organized by RWJF to advocate for health coverage for all Americans. Now in its seventh year, Cover the Uninsured Week (March 22-28) has become the largest, nonpartisan mobilization in history seeking solutions for the millions of Americans who are uninsured. Thousands of people will participate in Cover the Uninsured Week events held across the nation. To learn more, log on to www.CoverTheUninsured.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org

Big Press Release, But No Deployment

2009-03-22T20:52:00.000-04:00

Sometimes that chasm is just too far to cross in a short amount of time. In this case, the chasm is The Mayo Clinic's and Cleveland Clinic's use of Microsoft's Health Vault and Google's Google Health PHR solutions, respectively. Announced over a year ago, apparently no movement has been made by either in adopting a PHR due to HIPAA concerns. It seems inconceivable that advisers for either entity could not secure the requisite comfort level through an appropriate opinion from internal or external counsel, or simply a response from the Office for Civil Rights in the HHS, the Federal government agency that enforces HIPAA. In addition to the $19 odd billion that the Stimulus Act has bestowed on health IT infrastructure, the Federal government must set up a task force to fast-track the resolution of the myriad of issues that will arise during the technology build out process. Otherwise, health IT and the efficiencies that come from it will become like two Dr. Seuss characters whose paths cross, and neither agrees to alter course in even the slightest of ways.

More at http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090316/REG/303169937&nocache=1&nocache=1

Obama Names Health IT Lead

2009-03-22T20:24:00.000-04:00

Released last Friday and appearing in one online resource is the announcement of Obama's appointment of the individual who will guide the government's $19 billion plus expenditure for health IT. Who is this person? Dr. David Blumenthal will serve as the National Coordinator for Health Information Technology and is a former Harvard Medical School professor and Massachusetts General Hospital's director for its Institute for Health Policy. It is unclear what technology experience the good doctor possesses, but the press release speaks to his commitment to it.

http://www.hhs.gov/news/press/2009pres/03/20090320b.html

Comparative Effectiveness Analysis Works with IT

2009-03-13T20:18:00.000-04:00

The New York Times reported that many doctors oppose the $1 billion allocated to comparative effectiveness analysis, a method to objectively quantify the effectiveness of a particular procedure based upon a set of health measurements. Sadly, this aversion to "objectivity" exists by many, legacy providers who shun methods that introduce transparency and accountability to the health care process. But perhaps these legacy providers have a point given health care's low adoption of IT. Unless you have good data - and that means a sufficient sample size - and a scalable and seamless way to capture and process it, it is difficult to properly analyze the effectiveness of any treatment. However, because the infrastructure doesn't yet exist is hardly cause for abandoning a tool that providers know will improve the health of their patients. IT, and specifically starting with EMRs, will gather a quanta of data that can be used to gleen the effectiveness of treatments based upon certain health information. The business intelligence aspect to health IT is simply frosting on the cake, as health IT will at the very least enable providers to operate more efficiently, saving themselves - and employers, taxpayers, consumers - money.

The Times article here: http://economix.blogs.nytimes.com/2009/03/13/cost-effectiveness-analysis-and-us-health-care/?hp

Follow the Money

2009-03-13T14:17:00.000-04:00

Health IT News reported that several thought leaders convened to contemplate the meaning of the Stimulus Act's $17 billion effect on health care. The unsurprising conclusion was that unless providers are rewarded for adopting changes that focus on the health and convenience of patients, they won't change their behavior. Much like any other industry - albeit that doctors do take the Hippocratic oath - providers will only adopt behavior that pays them. As we saw with the crash of the financial markets, despite that fact that bad decisions were passed from real estate agents to mortgage brokers to mortgage bankers to sellers of packaged mortgages, people made an enormous amount of money on bad products while passing along the risk. Although an exaggeration, providers are engaged in a level of care that is less than what can be delivered for less money. So, the challenge is to properly align cost with accountability, and rewards with behavior. In order to do that, we need an credible, objective and scalable tool to capture true indicators of patient health. We can't get there without IT, and those who believe we can have only to look at health care's history - and decline in the health of its patients with an increase in cost - to fully understand the scale of health care's failure. In industries other than health care, business drives innovation and technology adoption because it allows them to provide a better value to consumers for less money. In health care, IT adoption is a bit of a "chicken or the egg" quandary. If what Catherine Chen of Kaiser said of providers is true - and we all know that it is - providers must either be paid on metrics that can only be measured by IT or receive reimbursement for IT that will ultimately enable them to provide better care. The Stimulus Act attempts to do that very thing.

The story is here: More at http://www.healthcareitnews.com/news/frontline-expertsweigh-promise-healthcare-it

Stimulus Kills Thousands of Patients - News in 2011

2009-02-25T21:00:00.000-05:00

The Stimulus, although a fantastic political play to leverage the serious damage done by Bush into positive change and investment into health care, energy and education for Americans, may unwittingly kill people. Yes, a provocative statement. However, think for a moment the number of Health IT sales in the pipeline that have just been frozen due to the mechanics of the Stimulus' reimbursement model. With just a significant investment in EMRs will come more time and better information for doctors to focus on their core competency: patient care. And with EMRs reaching a critical mass will come another paradigm shift in their practices: preventative care in which they will be paid.
As written, the Stimulus gives pause to any health care organization currently considering an investment in EMR solutions, because they may not be reimbursed in 2011 for solutions acquired now. The Stimulus, and those who implement it, should encourage the innovators/early majority to adopt now and realize the immediate and long term gains that EMR and practice management solutions will bring, in addition to reassure them that their behavior will be eligible for Stimulus reimbursement. Otherwise, the net effect of the Stimulus for the next two years will impale an industry that is beginning to see the benefits of greater adoption due to the cost benefits.

Stimulus to Pump Over $19 Billion into Health IT - in 2011

2009-02-19T19:40:00.000-05:00

It's official. The American Recovery and Reinvestment Act of 2009 will inject over $19 billion into health care for information technology initiatives, but the bulk of the funds will not hit businesses until 2011. The New England Journal of Medicine reports that Medicare and Medicaid will give eligible doctors between $40,000 and $65,000 and hospitals up to $11 million for "meaningful" use of health information technology, such as the electronic exchange of data and reporting of clinical quality measures. Starting in 2015, providers who do not use health IT will be penalized. "The Congressional Budget Office projects that the incentives will boost the proportions of physicians and hospitals adopting comprehensive electronic health records by 2019 to 90% and 70%, respectively, from the 65% and 45% that would be expected to do so anyway." What is not clear is whether providers who purchase health IT now can receive the stimulus when it is available. If that is the case, it will freeze the entire health IT sales pipeline. And judging by the other provisions of the bill, this was a serious oversight by Congress.

The Act also officially creates the Office of the National Coordinator for Health Information Technology as part of the DHHS and will fund it with $2 billion. It is charged with ensuring that every American will have a certified electronic health record by 2014 through two committees: one for standards and the other for policy. These committees will work with the private sector and consumer groups to create interoperable technology for all stakeholders in health care. These standards are to be developed in 2009 and tested and certified in 2010; the DHHS will certify specific products. So what of the products currently available? Why would a provider acquire any health IT when it can't possibly be certified. Hopefully as the committees are formed more thoughtful rules will be practiced. As it stands now, everyone will simply wait and see - a significant problem that has afflicted every aspect of commerce.

It's painfully clear that the government, like Wall Street, is fundamentally incapable of providing value to the American people.

More at: http://content.nejm.org/cgi/content/full/NEJMp0900665?query=TOC

It's Official. Health IT is the Way

2009-02-16T20:08:00.001-05:00

Healthcareitnews reported that three significant health care stakeholders have publicly shared that health care IT is a critical first step in curing what ails the health care system. In a document entitled "Shared Roadmap and Vision for Health IT," John Tooker, MD, John D. Halamka, MD, and Mark Leavitt, MD, the executives of the National eHealth Collaborative (NeHC), Healthcare Information Technology Standards Panel (HITSP) and Certification Commission on Healthcare Information Technology CCHIT), respectively, stated that "[t]he nation's business competitiveness is threatened by growing healthcare costs, while at the same time our citizens risk losing access to care because of unemployment and the decreasing affordability of coverage."

More at http://www.healthcareitnews.com/news/three-national-panels-
release-shared-vision-health-it

IBM Pushes UnitedHealth Care Revenue Model

2009-02-08T23:45:00.000-05:00

The New York Times reported that IBM and UnitedHealth have teamed up to test a new payer system that pays providers based upon the health of their patients, instead of simply for treatment of patients. Apparently the success of the project depended upon IBM's commitment to try the new health plan design, as UnitedHealth had failed in the past primarily due to its poor reputation with physicians. However, IBM was persistent given what it regarded as declining care at increasing costs.

This pilot program will be seminal in its design to leverage health care IT in order to enable providers to better monitor the health of patients while introducing transparency in its provision of value (care). Although the story did not explore the additional IT purchases required of participating providers, it is likely that at a minimum EMR and home monitoring solutions will be required to allow the intake, measurement and sharing of patient information to negate duplication of services, diagnosis of conditions and overall health. It is clear that payers and employers have hit the tipping point in demanding that IT be used to lessen the waste so entrenched in provider's business models - although rewarded by the existing revenue model for traditional care.

Full story: http://www.nytimes.com/2009/02/07/business/07medhome.html?_r=1&ref=business

The Other M. Leavitt Speaks

2009-02-06T21:16:00.000-05:00

Mark Leavitt in his open letter to Washington makes the standard - and correct - ROI arguments related to the benefits of the adoption of health IT.

Jump-Starting Health IT: An Open Letter To President Obama And Congress
BY MARK LEAVITT, HEALTH AFFAIRS

President Obama and members of Congress:
Please accept my heartfelt congratulations for recognizing
health information technology (IT) as one of the most promising
targets for public investment at this crucial moment.
As a (formerly practicing) doctor, I’d diagnose our economy on
the verge of a Code Blue, and our health care system with a
more chronic but equally threatening condition.You’ve recognized
how these two illnesses interrelate, with spiraling health
care costs damaging business competitiveness and job losses
threatening health care coverage. If I may offer a second opinion,
I concur 100% with your decision to apply the chest paddles
now, charged with $20 billion of investment in health IT.
Now I would like to offer this promise: I and my fellow health
IT leaders are passionately committed to ensuring that this
treatment not only succeeds, but delivers a substantial positive
return far exceeding the amount invested. How can we be so
confident? Well, even a 1% improvement in the efficiency of our
$2.2 trillion health care spending would put us in positive payback
territory. But we can do better than that, and here’s why.
Health IT Products Are Ready Right Now
I chair a nonprofit organization that tests and certifies health IT
products, so I’m very familiar with the state of that industry and
the behavior of potential purchasers. In the past three years,
we’ve certified over 160 electronic health record (EHR) products
for doctors’ offices, hospitals, emergency departments, and
more.We rigorously check not just what the software can do,
but also for interoperability — the ability to share information
with other providers — and the security of the systems as well,
all against established standards. Most doctors know they need
EHRs, and many will respond to an economic push right now.
And the industry supplying those EHRs is a competitive, diverse
marketplace that will respond to growing demand with
increased capital investment and job growth.
We’ve Learned How To Structure Incentives Toward The
Desired Outcomes
Nobody is advocating a massive, unqualified handout of dollars
to doctors. Outright grants may be appropriate for providers
in rural and underserved areas, and for safety-net clinics, but in
other environments, financial incentives should be structured as
a series of incremental rewards for progressive achievements.
In the private sector, the Bridges to Excellence program sets an
excellent example, while the recently launched Medicare EHR
Demo provides a public-sector prototype. These programs
offer initial incentive payments for purchasing appropriate technology
— a certified EHR — and then a second round of
money when successfully implemented. Beyond that, bonuses
are paid only as the provider demonstrates improvements in
quality or efficiency. Health care payment reform and health IT
— twins separated at birth — must grow up and mature
together to achieve their full potential.
An Investment In Human Capital
Every experienced IT hand knows that technology is just a tool
and that returns on IT investment require strong leadership
and dedicated change management. So some of the stimulus
funds should be used to develop the skilled workforce needed.
It may be possible to redeploy IT personnel from other industries
to lay broadband infrastructure for health care, but we’ll
also need to boost health IT training programs. And doctors
and nurses being asked to change their habits are best motivated
by one of their own –a clinician champion.There are plenty
of clinicians who have successfully led these projects, and we
can’t afford to have their experience locked up within their
own organizations. Let’s find a way to put them on a health IT
inspirational speaking circuit.
Empowering Patients
You’ve also wisely recognized the need to redirect our health
efforts toward prevention, helping people make better choices
early in life and eventually reducing the burden of expensive
interventions near the end.To do this,we need to empower citizens
with health knowledge, allowing them to make better
health choices and to become more discriminating health care
consumers. Personal health records (PHRs) will emerge as a
platform for this new information flow.The organization I lead
is also preparing to certify these PHRs, to ensure that they are
secure and private and can exchange information with EHR
systems in doctors’ offices and hospitals. Projects in this field are
a promising area for government investment.
The Final Frontier: Health Reform
You’ve recognized the need for dramatic improvements in
health care, but you’ve decided not to attempt a radical rip-andreplace
approach.That’s a wise choice. In many towns, hospitals
themselves are the major source of jobs; a massive disruption
could even shut them down and further weaken the economy.
Fortunately, almost every illness of our current model is amenable
to improvement with an assist from better information.

More at http://healthaffairs.org/blog/2009/02/03/jump-startinghealth-it-an-open-letter-to-president-obama-and-congress/

IBM, Google and Personal Health Devices

2009-02-05T12:32:00.000-05:00

IBM, Google and Continua Health Alliance are teaming up to help hospitals capture vital patient information from personal health devices real time and place it into the patient's Google health record. IBM has stormed into the health care IT space as it has with green/clean IT. Whether they have the expertise or not, IBM at least understands where the opportunities are. IBM will provide the interface between personal medical devices and Google's personal health record product. Continua, presumably, will aid in the interoperable standards. Continua is an association of every major payer and payer/provider vendor (http://www.continuaalliance.org/about/roster) and perhaps will pave the way for interoperable standards where the Federal government has failed for telehealth tools. Continua describes itself as "a group of technology, health care and fitness companies dedicated to establishing an ecosystem of connected personal health and fitness products and services, making it possible for patients, caregivers and health care providers to more proactively address ongoing health care needs." The group is focused on the significant effects of chronic illness and obesity which is the majority of cost in health care today.

http://money.cnn.com/news/newsfeeds/articles/marketwire/0471635.htm

Reason No. 3,473 to Use Health IT

2009-01-30T14:06:00.000-05:00

Rueters reported that yet another study has shown the benefits of a provider's use of health IT for patient care. To summarize, "[h]ospitals in Texas that used computers to keep track of patient records and manage care had lower rates of deaths, complications and costs, U.S. researchers said on Monday, offering a strong argument for hospitals to go "paperless." In the study, researchers found that patients treated in hospitals ranked highest in their use of IT to manage patient records and physician notes were 15 percent less likely to die than those patients at hospitals with less IT.

Another study evaluated the use of IT in urban hospitals. Rueters reported:

They surveyed doctors at 41 urban hospitals in Texas and divided the hospitals into three groups according to their use of technology.

Then, they checked the records of more then 160,000 patients over age 50 to see if there was a link between information technology and the care given for one of four conditions: heart attack, heart failure, heart bypass and pneumonia.

The researchers looked at four types of information systems -- those that automate notes and records, manage tests results, manage doctor's orders for patient care and those that help doctors make medical decisions.

Overall, patients treated at hospitals where information technology was used the most by doctors had 16 percent lower odds of having a complication than patients where information technology was used less.

"They found that increased use of information technology was associated with both lower costs and better outcomes," said Dr. David Bates of Brigham and Women's Hospital in Boston, whose editorial on the study appears in the same journal.

Different software programs were associated with different benefits. Hospitals that scored high in the use of software to automate patient records and notes had 15 percent lower odds that patients would die during their hospital stay.

At hospitals with high scores in use of software to track a doctor's orders, heart attack patients had 9 percent lower risk of dying and bypass patients had 55 percent lower odds of dying compared with hospitals used the technology less.

Full story here: http://www.reuters.com/article/bondsNews/idUSN2639121120090126

The Trouble with a Democracy

2009-01-30T13:22:00.000-05:00

In a recent Kaiser Family Foundation/Harvard School of Public Health poll of Americans, the lack of critical thinking ability of Americans really shines through. In this poll, available here http://www.kff.org/kaiserpolls/posr011509pkg.cfm, 60 percent of those polled favored keeping the expenditure for health care IT to the same levels as it is today - meaning roughly zero (in scale to other expenditures) - but favored increasing certain health care provisions, including SCHIP and veteran care. Perhaps this is an indication that the technology industry and the government have failed in communicating the significant benefits of IT: principally that it will allow better, more effective and efficient care with the same resources. IT is the only way to leverage this country's limited resources in many sectors, including energy policy. The low hanging fruit in health and energy remains to improve the efficiency of current operations, even sans fundamental change necessary to include coverage for all Americans. It must be communicated that health IT and fundamental reform are not mutually exclusive, but can run in parallel, ensuring that we stop wasting resources while sacrificing care for those who need it.

Health IT to receive Needed Funding.... Finally

2009-01-29T20:20:00.000-05:00

What the Bush administration so splendidly failed, Obama and a Democratic Congress may just deliver if the current $819 billion stimulus package is passed. It contains $20 billion for health care IT. In addition, the bill would provide incentive payments of $40-60,000 through Medicare and Medicaid for doctors who meaningfully use health information technology, whatever that means, to the tune of $2 billion.

Specifics of the proposed bill here: http://topics.nytimes.com/topics/reference/timestopics/subjects/u/united_states_economy/economic_stimulus/index.html

Lowering Health Care Costs and Ensuring Broader Coverage

Affordable and quality health care is key to strong American economic growth. The American Recovery and Reinvestment Act invests in bringing our health care system into the 21st century with information technology – that is proven to reduce costs, increase quality, and save lives. The package also protects health coverage for millions of Americans who have lost their jobs in this recession by providing up to 12 months of subsidized COBRA health insurance continuation coverage and a temporary state option to cover jobless workers through Medicaid. Modernizing our health care system will create hundreds of thousands of jobs. Economist Mark Zandi estimates that, overall, this recovery package will save or create more than 250,000 jobs in the health care and education sectors.

Modernizing Health Care System to Lower Costs and Save Lives

* Provides $20 billion to accelerate adoption of Health Information Technology (HIT) systems by doctors and hospitals, in order to modernize the health care system, save billions of dollars, reduce medical errors and improve quality.
* Includes significant financial incentives through the Medicare and Medicaid programs to encourage doctors and hospitals to adopt and use electronic health records that will streamline medical care.
* Has the federal government take a leadership role in developing HIT standards by 2010 – those standards will allow for the nationwide electronic exchange and use of health information in order to improve the quality and coordination of patients’ care, within a framework of enhanced security and privacy.
* Strengthens federal privacy and security law to protect personally identifiable health information from misuse as the health care sector increases the use of HIT.
* Creates hundreds of thousands of jobs – many in high-tech sectors – by promoting the adoption of HIT.
* Facilitates broad adoption of HIT systems. The nonpartisan Congressional Budget Office (CBO) estimates that, as a result of this legislation, approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next 10 years.
* Controls health care costs. The nonpartisan CBO also estimates that this proposal will generate tens of billions of dollars in “system-wide” savings, including a net reduction in private health insurance premiums for families.

Protecting Health Care Coverage for Millions Through Medicaid

* Protects health care coverage for millions of Americans during this recession, by providing an estimated $87 billion in additional federal matching funds to help states maintain their Medicaid programs in the face of massive state budget shortfalls, over a two-year period.
* This funding is vitally needed because states are facing an unprecedented, massive fiscal crisis. Total state budget gaps for FY 2009 (generally running from 7/1/08 through 6/30/09) are about $91 billion – $48 billion in gaps before state budgets were adopted last summer, which were closed by cutting services or raising revenues; and $43 billion in gaps which have opened up since then.
* Budget deficits are also already projected for 39 states for the upcoming FY 2010. Initial estimates of these shortfalls total over $80 billion. As the full extent of FY 2010 deficits become known, state shortfalls are likely to equal $145 billion.
* In response to these shortfalls, at least 22 states have already proposed or implemented cuts that will affect eligibility for Medicaid or reduce services covered. For example, South Carolina is limiting coverage for many Medicaid services, such as psychological counseling, physician visits, and routine physicals; and California and Utah are reducing services covered by their Medicaid programs. Additionally, the governor of California has proposed cuts that will cause more than 400,000 adults to be denied Medicaid.
* This $87 billion in State Medicaid Fiscal Relief will help states avoid cutting eligibility for Medicaid and scaling back the health care services covered. In addition to shoring up existing Medicaid coverage, increased federal assistance for Medicaid is an excellent economic stimulus. According to economist Mark Zandi, every dollar of federal Medicaid aid results in $1.38 in increased economic activity.

Providing Health Insurance for Unemployed Workers

* As millions of people are losing their jobs in this recession, they are also losing their health insurance. This bill has two provisions to help maintain health insurance coverage during this downturn.
* COBRA currently provides temporary coverage for workers between jobs, but it is expensive. A typical family premium on COBRA is over $1,000 a month. To help people maintain their health coverage, the bill provides a 65% subsidy for COBRA premiums for up to 12 months for people who were involuntarily separated from their jobs between 9/1/08 and 12/31/09.
* Recognizing that not all workers are eligible for COBRA, the bill also provides states the temporary option of offering coverage to unemployed workers through their Medicaid programs, with the federal government matching 100 percent of the costs of benefits and administration
* Those two provisions are estimated by the Joint Committee on Taxation and CBO as providing health insurance coverage to more than 8 million people.
* The bill also provides that COBRA-eligible workers who are 55 or older, or have worked for an employer for 10 years or more, can extend their COBRA coverage, at their own expense and with no federal cost, until they become Medicare-eligible at age 65 or secure coverage through a subsequent employer.

Investing in Prevention and Wellness

* Makes the single largest investment in prevention in history – by providing $3 billion for a new Prevention and Wellness Fund.
* Includes funding for immunization programs that enable public health departments to operate childhood, adolescent, and adult immunization programs.
* Includes funding for the Preventive Health and Health Services Block Grant, which provides needed resources to state and local public health departments to address prevention and wellness at the local level.
* Funds hospital infection prevention programs to reduce the incidence of hospital-acquired infection.
* Also assures funding for evidence-based clinical and community-based prevention strategies.
* Over 75 percent of total health care dollars are spent on patients with one or more chronic conditions, including diabetes, heart disease, and high blood pressure. Numerous studies have shown that making increased investments in preventing these chronic conditions is one of the most effective ways to reduce health care spending, saving billions of dollars a year.

Providing Other Key Health Care Investments

* Provides $1.1 billion for comparative effectiveness research, in order to help patients and doctors determine the effectiveness of different medical treatments. This research will improve the quality of care.
* Provides $1.5 billion for community health centers, including $500 million to provide quality health care to more uninsured Americans and $1 billion to renovate clinics.
* Provides $600 million for the training of doctors, dentists, and nurses – to address the shortage of primary care providers.

Health Care IT Comes Short of Potential - No Kidding

2009-01-10T20:25:00.001-05:00

Reuters reported that even the health care IT of the top providers in the country falls short of the ideal uses of information technology. No kidding. Thanks for stating the obvious, as health care is a technology laggard as it relates to the collection, analysis and use of vital patient records to provide effective, proactive preventative health care. The real story is what's in the pipeline of these early adopters. Like any ERP system - that's truly what's lacking in health care - it must reach a critical mass of relevant data points across the enterprise to become truly valuable. But, we have to start somewhere, and the massive scale of health care, including its many stakeholders, requires that certain of them begin before others.

The story here: http://www.reuters.com/article/technologyNews/idUSTRE50855M20090109

Bush is Gone. Get Over It Already.

2008-12-31T16:47:00.000-05:00

Don't be hatin' WSJ. It appears that the Fox "News" takeover of the venerable financial rag has seriously compromised its objectivity - dare I say relevance. A recent op/ed piece rang alarmist about President-elect Obama's health care strategy, although it didn't make much sense. It did drive home the old adage that if you're not part of the solution, you're part of the problem. The WSJ has that in spades, as it simply extrapolates policy from a few, meaningless data points and professes that the future will be a disaster for all. Well, we've all seen what that looks like during the past eight years, so perhaps the WSJ doesn't recognize positive change, or even the need for it, anymore.

We must change. That is a certainty. If we don't, the course set by Bush will continue to pull Americans into a spiral of uncertainty and poverty in all forms. 2009 is the year of opportunity, provided that people are willing to redefine their expectations. If you want to address significant challenge with novel solutions, and truly want to improve the health of all, then this is your decade. Information technology will redefine health care efficiencies, as well as aid in conservation efforts to reduce the countries dependence on nonrenewable energy sources. But if you want to continue the fear-based politics of the past eight years, read below:

http://online.wsj.com/article/SB123060332638041525.html?mod=googlenews_wsj

Politics as Usual

2008-12-30T09:27:00.000-05:00

I saw an op/ed piece in the Wall Street Journal/Fox News that professed great concern for the direction of health care: egad, universal health care will put the US into insolvency. I've got news for the WSJ/FN. We're already there. And not to perpetuate the mindless greed and partisanship that landed us where we are today, but I'm certain that most taxpayers would rather have something to show for their hard-earned tax dollars - such as health care for all in which they benefit - instead of bolstering the bonus packages for Wall Street bankers who were responsible for the prime lending debacle.

The author was seriously mistaken on his or her assumptions that health care, and the way we pay for it, won't see seminal change in its paradigm to prevent disease and chronic illness. Yes, existing chronic illness constitutes 80 percent of our health care burden, and that won't change in the short term, but unless we change the reward and payment structure of health care - much like the reward and bonus structure bankers enjoyed in prime lending investments - we will continue the path of repairing what's broken instead of preventing the malady in the first place. In addition, health care information technology, combined with a focus on the prevention of illness, will fundamentally change the information available to providers and patients, affording great transparency into what ails us - and the health care system.

The status quo is not sustainable. Yes, people who thrive on the current inefficiencies and reward structure of the current system are frightened. They should be. Change is coming because change must come. We have truly hit bottom, and like in Ayn Rand's "Atlas Shrugged", the world can't afford the dead weight of the establishment.

The editorial is here: http://online.wsj.com/article/SB123051170671838473.html

Leavitt Speaks

2008-12-23T08:43:00.000-05:00

Mike Leavitt, the Secretary of Health and Human Services under the Bush Administration, suggested that an investment in interoperable health care information technology be made part of the stimulus package in an op/ed piece in the Washington Post. Perhaps this message was intended for President Elect Obama, because much to the dismay of almost all Americans, George Bush is still President, and Leavitt is a member of his cabinet. However, given that Bush doesn't appear to have friends in health care that can benefit as his friends in the oil and gas industry have, perhaps he's simply not motivated to push millions into a venture that would positively affect all Americans.

Leavitt's rationale is sound and health care information technology requires a significant investment to reach a critical mass, as well as overcome a technology bashful group of professionals that we call "Dr." In addition, this can be principally an American solution, given that health care is delivered here to each of us. Interoperable EMR technology has been a significant opportunity for many, many years. Let's hope that we can soon look back at its adoption by the late majority.

Mike Leavitt's op/ed here:
http://www.washingtonpost.com/wp-dyn/content/article/2008/12/21/AR2008122101448.html

Health Care Reform is Spelled I-T

2008-12-19T12:28:00.000-05:00

With the failing economy, Obama's promised health care reform must begin with efforts to make the existing infrastructure more efficient and reward health care behaviors that save money in the long run. In short, we must implement change that has a fairly certain and rapid return on investment. Health care IT will ensure that we make the most out of a highly leveraged work force that is focused on treatment instead of the health of patients. Perhaps it may also begin to ascertain, from a scalable perspective, certain variables that are indicators of health, and not merely sysmptoms of a disease. This is a long term approach, as chronic illness such as diabetes and heart disease make up 80 percent of the cost of health care.

iHealthbeat reports that "the justification for a major health IT investment by the federal government and the opportunity for a major return on that investment lies in the use of health IT to accomplish fundamental reforms and improvements in the broader health care system."

In addition, "the ROI would come from significant improvements in administrative efficiencies -- both fiscal and clinical (avoiding duplicative tests, for instance) -- and in the improvement of clinical and operational quality (further empowering the development and utilization of evidence-based medicine and comparative effectiveness research)."

Like all IT investments, time wasting duplicative tasking, human error and business (health care outcome) intelligence are the obvious up sides. We can only hope that the sever economic downturn, the benefits of health care IT investment, and the upside of improving care for all while reducing current costs has created the perfect storm to finally make the sensible decision.

The full article here: http://www.ihealthbeat.org/Perspectives/2008/With-a-New-President-and-Congress-Coming-In-What-Lies-on-the-Horizon-for-Health-IT-Efforts.aspx

PWC Predicts

2008-12-11T13:22:00.000-05:00

PWC has released its top nine health care industry issues for 2009, and with a sliding economy and growing cost of health care, the challenges are daunting. However, the opportunities are equally large.

"The coming year will be a watershed for healthcare in the United States," said David Chin, M.D., PricewaterhouseCoopers' Health Research Institute Leader. "Severe economic conditions are placing pressure on hospitals, insurers, employers and patients alike. President-elect Obama has called for significant reform for healthcare and will have a Democratic Congress supporting him. The convergence of market and political forces will drive the greatest change in healthcare in a generation, changes that could benefit patients and make the health system stronger."

Of particular note is the prediction of the role of health care IT. The importance of Health care IT is found in no less than three of the nine categories below, with IT extending the range of care to patients in and out of the hospital, increasing the likelihood that patients will engage in accountable behavior, and serving the operational aspect of health care. A summary of the full report is below.

http://pwchealth.com/cgi-local/hcregister.cgi?link=reg/HRI_Top_9_issues_in_2009.pdf

http://www.marketwatch.com/news/story/PricewaterhouseCoopers-Identifies-Top-Nine-Issues/story.aspx?guid={177BB3FE-7A26-4094-8D22-2CDF83EC08BE}

NEW YORK, Dec 11, 2008 (GlobeNewswire via COMTEX) -- The financial downturn, a new President and growing public demand for health reform will force health organizations to react quickly in 2009, according to the Top Nine Health Industries Issues in 2009, published today by the Health Research Institute at PricewaterhouseCoopers LLP (PwC). In its annual review of the top concerns for health executives and policy makers, PwC says the health industry will face a plethora of challenges in the year ahead, including how to deal with more underinsured, adapt to new coding and payment methods, and fund new cures in a capital-starved market.
The report is an annual review of the most pressing issues for health executives and policy makers. According to PricewaterhouseCoopers' Health Research Institute, the top nine health industry issues in 2009 are:
1. The Economic Downturn Will Hit Healthcare
Although the health industry historically has been less vulnerable to economic downturns than other industries, the disrupted economy will hit healthcare in 2009. Hospitals and other providers, from family physicians to dentists, will experience an increase in bad debt and a drop in elective procedures. Investment portfolios for all health organizations have been affected. The payer mix is shifting away from relatively lucrative commercial insurers, as they are seeing a drop in enrollment and premium revenue-- a trend that will likely continue if employment drops further. Charitable donations and investment income are down, and improvement projects involving capital outlays for IT, facilities and equipment have been put on hold. Pharmaceutical and biotech companies have seen their valuations drop, which could further affect their access to raise additional capital. Health organizations that need to find new sources of capital will have to demonstrate that they're improving their core businesses, improving efficiencies and delivering value.
2. The Underinsured Will Surpass the Uninsured as Healthcare's Biggest Headache
The uninsured draw most of the attention, but the number of underinsured is growing even faster-- an estimated 25 million adults qualify as underinsured, an increase of 60 percent since 2003. With some but not enough health insurance, the underinsured often can't or won't pay the high deductibles and co-pays for the services they need. In 2009, we could see more bad debts for hospitals, more cost-shifting to commercial plans and more patients delaying or foregoing care. With growing unemployment, self-pay is becoming a major part of providers' revenue cycle processes. Many hospitals have begun to prequalify patients. Some are using credit card-like swipe machines to verify eligibility and estimate insurance coverage. Others are using credit cards and extending their own lines of credit. Not-for-profit hospitals must tread carefully, as they don't want to further complicate the credit for uninsured and low-income patients. Business operations will likely look to technology and processes from the retail, banking and credit industries to manage self-pay patients and the underinsured.
3. Big Pharma turns to M&A to build the drug pipeline
With revenue from existing pharmaceuticals slowing down and the decrease of approved new drugs in the pipeline, Big Pharma is focusing on acquisitions of smaller biotech firms to reenergize the drug pipeline. Cash- rich pharmaceutical companies may be able to find bargains in the mergers and acquisition market as the financial markets continue to hit turbulence.
4. From Vaccines to Regulation, Prevention Is on the Rise
Prevention will get a boost from drug makers, regulators and nonprofit benefactors, making vaccines one of the few bright spots for pharma sales. In addition, more state and local governments are regulating health-related behaviors, such as banning smoking in public areas and trans-fats in foods. Next up for consideration: Nutritional posting requirements for fast-food restaurants, limits on where cigarettes may be sold and fees for sugary sodas.
5. Genetic Testing Reaching a Price Point for the Masses
The direct-to-consumer market for genetic testing may begin to take off in the year ahead as costs drop, enabling people to purchase a complete map of their DNA to identify markers for specific diseases such as Alzheimer's. A federal ban on discriminating the use of genetic data could accelerate the use of these tests by the public. Research will focus on how genetics can affect pharmaceuticals and enable personalized medicine. The marketing of these tests bypasses traditional clinicians, raising questions about how the information will affect diagnosis and treatment. Regulations regarding genetics at a state and federal level will continue to develop.
6. The Internet and Social Networking Is a Powerful Health Extender
Technology will empower patients in new ways during 2009. The increased information and growing patient-to-patient interaction over social networking platforms and Web sites such as patientslikeme.com and americanwell.com are changing how healthcare is navigated and experienced by consumers, especially as electronic health records become more common.
7. Hospitals Must Perform to Get Paid
Medicare, Medicaid and insurance companies are increasingly basing reimbursement to hospitals on performance, and, despite resistance to it, pay for performance isn't going away. In 2009, healthcare providers will have to get serious about not only improving performance but documenting it. The Centers for Medicare & Medicaid Services (CMS) has proposed adding a new index: the total performance score. It's part of Medicare's move to value-based purchasing. If Congress approves, CMS would replace the current quality reporting system with one in which Medicare withholds between 2 percent and 5 percent of its reimbursements to hospitals. They will need to focus on process improvements to improve safety and avoid unreimbursed medical errors, known as "never events."
8. Payers and Employers to Give Incentives for Wellness Programs
More employers will give incentives to encourage responsible health behaviors and participation in wellness and disease management programs. Wellness programs don't work if employees don't participate, and most of them don't, according to research by PricewaterhouseCoopers' Health Research Institute which found that less than 15 percent of eligible individuals enrolled in wellness programs actually participate. However, they found that workers are two to four times more likely to enroll in wellness programs if they receive gift cards or other incentives. In 2009, health plans will begin to play a more active role in wellness program design, tools and support.
9. ICD-10 Will Require a Major Resource Investment
The conversion to a new International Classification of Disease code sets, known as ICD-10 will be a painful and costly process that health organizations will begin in 2009. The federal government has proposed an accelerated timetable for increasing the number of code sets used for billing and clinical classifications from 17,000 to 150,000. In addition to clinical process changes, the entire healthcare system-- from quality of care, to medical records, to incentive salary systems, to reimbursement-- will have to be adapted. The good news: When it's done, providers and payers will have far more data on which to document diagnosis, decisions and reimbursement.
A full copy of PricewaterhouseCoopers' Health Research Institute's Top Nine Health Industry Issues in 2009 is available online at http://www.pwc.com/hri/top9.
About PricewaterhouseCoopers' Health Research Institute
PricewaterhouseCoopers' Health Research Institute ( http://www.pwc.com/hri) is an unparalleled resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries.
About PricewaterhouseCoopers' Health Industries Group
PricewaterhouseCoopers' Health Industries serves as a catalyst for change and is the leading advisor to organizations across the health continuum, including payers, providers, health sciences, biotech/medical devices, pharmaceutical and employer practices in the public, private and academic sectors.
PricewaterhouseCoopers' Health Industries' clients include both 40 of the top 100 hospitals in the U.S. and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world's major pharmaceutical companies; all of the top 20 commercial payers in the U.S.; municipal, state and federal government agencies and many of the world's preeminent medical foundations and associations.
PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the U.S. dedicated to the health industries. Health industries professionals include a cadre of physicians, nurses, ancillary health providers and some of the nation's leading minds in medicine, science, IT, operations, administration and health policy.
About PricewaterhouseCoopers
PricewaterhouseCoopers ( http://www.pwc.com/) provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 155,000 people in 153 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.
"PricewaterhouseCoopers" refers to the network of member firms of PricewaterhouseCoopers International Limited, each of which is a separate and independent legal entity.
This news release was distributed by GlobeNewswire, www.globenewswire.com
SOURCE: PricewaterhouseCoopers

Reason #1,345 for Adopting EMRs

2008-11-28T16:59:00.000-05:00

Science Daily reported that a recent study found that a doctor's use of electronic medical records may reduce malpractice claims. No kidding. The study, based upon the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care, is described in the Archives of Internal Medicine and stated that the use of EMRs have been found to reduce paid malpractice settlements. Like any other industry, technology that affords a professional better information will likely improve the decisions based upon that information. The slow adoption rate of information technology by providers is certainly vexing, and clearly there does not exist one particular reason, but many, for this reluctance to join the 20th Century.

The article reported that the study found "[t]he investigators speculate that EHRs may decrease paid malpractice claims for a number of reasons. EHRs offer easy access to patients' history, which may result in fewer diagnostic errors, improved follow up of abnormal test results, and better adherence to clinical guidelines. In addition, the clear documentation of care allowed by EHRs can bolster legal defenses if a malpractice claim is filed."

Perhaps the pressure for providers to adopt EMR technology will be provided by another kind of insurance company: the malpractice kind. This study was funded by the Agency for Healthcare Research and Quality and the Massachusetts e-Health Collaborative.

Full story here: http://www.sciencedaily.com/releases/2008/11/081125141608.htm

Health Care IT A Big Opportunity - No Kidding

2008-11-23T20:42:00.000-05:00

Kaisernetwork reported that Rueters reported that despite contractions in the economy overall, health care technology remains attractive to many technology companies who have not yet served that industry. Gosh, it's only taken several years of the most obvious opportunity - outside of clean/green technology - for some companies to get it. Not to mention that they could also significantly improve the quality of patient care in the process as an added bonus. Of course the challenge remains the daunting existing health care system and its revenue streams that reward treatment and not preventative care, but a good argument can be made for health care IT to use EMRs to enable providers to have access to better information to base treatment decisions. The excerpt below:

Technology companies: Expectations for health care overhaul next year and a "desire of governments worldwide to drive costs of national health systems" have prompted more tech companies to "bet on health care and what many of them see as a lucrative -- but relatively untapped -- market," an "opportunity that tech companies underestimate at their own peril," Reuters reports. According to Reuters, a number of tech companies that previously had limited or no connection to health care have begun to develop tools to reduce health care costs and improve patient care. Andrew Rocklin, an analyst at Diamond Management & Technology Consultants, said, "Health care is a $2.5 trillion market in the United States alone," adding, "Anybody who chooses not to participate could be giving up a potentially large amount of revenue" (Kahn, Reuters, 11/21).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=55693

Microsoft, Gambling on Health Care

2008-11-18T09:51:00.000-05:00

InformationWeek reported that Microsoft has deveoped a new doctor/patient relationship tool that has been slow in finding adopters. But hey, a Harrah's casino in Las Vegas is already using it to allow patrons to order drinks and flirt with other patrons. Could there be more to this "technology" than simply a screen interface that enables a doctor - or bar patron - another way of interacting with a computer? Apprently, Microsoft displayed its Surface technology to clinicians, including doctors and pharmacists, as well as administrators and technologists to help Microsoft figure out how to make money with this product. Out of the "hundreds of ideas" came a few worth noting, apparently, and Microsoft believes that this product will truly enhance the manner in which information, including digital content, will be displayed by doctors to patients. Of course, doctors could do this now, but they choose not to. I'm sure the prospect of spending even more money on hardware and software that effectively duplicates the function of existing desk top computers will get them across the line. Hopefully, there's more to this product than a giant screen and an interesting GUI. More here:

http://www.informationweek.com/news/software/enterpriseapps/showArticle.jhtml?articleID=212002188

The Future of Your Health Care - As the Government Sees It

2008-11-15T12:48:00.000-05:00

The current director of HHS Dr. Michael Leavitt announced the publication of a report regarding the future of personalized medicine entitled "Personalized Health Care: Pioneers, Partnerships, Progress." Perhaps to better understand the direction of consumer health care - at least the Federal government's (and I mean the outgoing government) idea of consumer health care - it might be prudent to take heed. The Federal government, through MediCare and MedicAid, is the largest single payer of health care in the US.

The full report here: http://www.hhs.gov/myhealthcare/news/phc_2008_report.pdf

President Elect Obama Brings Hope for Health Care IT

2008-11-09T17:35:00.000-05:00

With the election of Barack Obama, it is more likely that this country will successfully integrate health care IT, beginning with electronic medical records. As President-elect Obama sets out in his health care, EMRs are key to enable the system to provide better health care outcomes, as well as help curb the escalating cost of care.

(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad
adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

Provided that the President elect can garner the requisite house support, this is a significant opportunity for the health care IT industry to increase efficiency on a massive scale. The questions remains whether the industry has the capacity for the workload that may result from this initiative. That would be a grand challenge to address.

http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf

Health 2.0: More of the Same

2008-10-26T21:46:00.000-04:00

The New York Times reported that Health 2.0 made a case for greater use of information technology in the United States. It was noted that despite health care expenditures that have reached 16 percent of this country's GDP. The bright spot is that countries outside of the US are adopting IT in health care, perhaps because there are fewer decision makers related to its universal adoption. For example, the UK's HHS has been an early adopter, as well as Canada.

More here:

http://www.nytimes.com/external/readwriteweb/2008/10/24/24readwriteweb-us_health_care_system_technology.html

Former Governor Pleads for Health Care IT Legislation

2008-09-28T17:22:00.000-04:00

Kaiser's daily reports discussed a op/ed piece in "The Hill" by former Governor of MI John Engler making the case for immediate adoption of health care IT legeslation before the election this Fall. The report is below:

The "life-saving, cost-reducing benefits" that health care information technology legislation "can deliver to the American public make its passage imperative this year" because next year a "new administration will take office and, in the shuffle, health IT legislation could stall, forcing Americans to wait even longer," John Engler, president and CEO of the National Association of Manufacturers and a former Michigan governor, writes in an opinion piece in The Hill.

"Working Americans face soaring health care costs, and employers continue to struggle to provide health benefits," Engler writes, adding, "Health IT has the potential to save millions of dollars for working Americans." HHS estimates that widespread use of electronic health records would save about 100,000 lives annually through a decrease in medical errors and reduce health care spending by as much as 30%, and RAND estimates that widespread adoption of health care IT would reduce spending by $81 billion annually over the next 15 years, Engler writes.

According to Engler, "Congress must pass legislation that creates a public-private process to develop national standards for health IT; offer financial incentives to spur the adoption of health IT; launch a campaign to inform consumers and patients about health IT; and establish leadership on issues related to health IT privacy and security." Both the "House and the Senate have drafted health IT legislation that has bipartisan support," and lawmakers "need to formalize what everyone already agrees about and pass legislation now," as "Americans have waited long enough," Engler concludes (Engler, The Hill, 9/11).

Here: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54425

Transforming Health Care with IT Confernce in LA

2008-09-28T17:16:00.000-04:00

The Fall Collaborative Communications Summit: Transforming Health Care through Health Information Technology announces an executive panel addressing the importance of greater collaboration amongst payers, providers and health plans will take place October 27-28, 2008 at the Sofitel Los Angeles.

New York (PRWEB) September 12, 2008 -- The Fall Collaborative Communications Summit: Transforming Health Care through Health Information Technology announces an executive panel addressing the importance of greater collaboration amongst payers, providers and health plans will take place October 27-28, 2008 at the Sofitel Los Angeles. http://www.ccsexpo.com/fallccs.html

The session entitled "Vision for the Future: Working with Payers and Health Plans" will take place on Tuesday October 28th at 1:30pm. Panelists will address how multi-stakeholder collaboration and interoperability underscore two of the biggest challenges healthcare executives face providing high quality patient care and strategic planning for the future. Closer collaboration between providers and payers alike can only result in a more cost effective and efficient healthcare system. This session will expose HIT considerations from the payers perspective and address critical issues to consider when formulating a strategy on how providers can more closely align IT initiatives with health plans.

Tom Check, CIO of Visiting Nurse Service of New York will moderate the session with presenters David Lansky, President & CEO of Pacific Business Group on Health, Julie Klapstein, CEO of Availity and Charles Kennedy, MD, VP Health Information Technology at Wellpoint.

The Fall Collaborative Communications Summit Transforming Health Care through Health Information Technology is geared toward provider, healthcare system, government agency CIOs, CMIOs, CTOs, and VPs of IT. The summit is designed to help top-level executives, legislators, regulators and technologists come to grips with the swirling forces of technology change, policy development and changing business models. The CCS Experience has been designed with feedback by previous attendees and leaders from the healthcare industry addressing the most pressing issues surrounding health information technology.

Alcatel-Lucent is a Platinum Sponsor with VeriSign, Welch Allyn and Minerva Advisory Group participating as Gold Sponsors. Other sponsors include Fulcrum Methods, Advanced Data Systems, YouMed, MDdatacor, Fierce Healthcare Markets, Corporate Research Group, Federal Telemedicine News, and Healthcare Informatics.

About CCS:
The Collaborative Communications Summit: Transforming Health Care through Health Information Technology is designed to help top-level executives, legislators, physicians, payers, regulators and technologists come to grips with the swirling forces of technology change, policy development and changing business models, giving you unparalleled insight into the forces that shape tomorrow's healthcare information technology markets. The CCS HIT provides attendees with an intimate, high level forum that facilitates open avenues of communication amongst executives and stakeholders in healthcare fostering the growth and adoption of HIT resulting in safer, more efficient and cost effective healthcare. Each summit brings together over 150 senior level executives. Attendees will walk away with timely and actionable information that can be immediately implemented in their respective organizations. www.collaborativecommunicationssummit.com

Ingenix Snubbed?

2008-09-08T21:08:00.000-04:00

Ingenix, one of the largest health care informatics providers and based in Mpls., failed to secure one of the largest e-health exchanges in the nation for Minnesota. Ouch. In a joint press release, MN HIE and Covisint - known long ago as the trading platform for automotive parts and now serving up health care IT - announced:

The Minnesota Health Information Exchange (MN HIE) provides a secure, electronic health information network designed to increase the safety and quality of care while decreasing costs. Leveraging Covisint technology, MN HIE will enable doctors at any hospital or clinic in the state to have patient-controlled access to medications and other patient-centric information.
"This program allows providers and health plans to collaborate to provide more seamless care for patients," said Mike Ubl, Interim Executive Director of Minnesota Health Information Exchange, LLC. "Immediate benefits for Minnesotans include real-time, point-of-care access to health information and an infrastructure to deliver future services, such as e-prescribing, lab test results, immunization records and communicable disease reporting."

The full press release here: http://www.marketwatch.com/news/story/minnesota-health-information-exchange-compuware/story.aspx?guid={AD044EFC-9DCD-49D5-8EC7-031A6C72DE35}&dist=hppr

Strong Criticism of State of Health IT from McKesson CIO

2008-08-24T15:43:00.000-04:00

Information Week online reported that McKesson's CIO called the lack of use of current information technology by the U.S. health care system a 'national tragedy' during his keynote address at LinuxWorld. Apt description to anyone who has followed Bush's failed health care IT program and laughable attempt at providing standards to the IT industry. Randall Spratt pointed out the obvious, and referenced the 550 people who die every two days due to avoidable medical errors that result from the lack of shared, scalable information.

Spratt referenced that "[h]ospitals today are running 30-year-old applications. For example, more than half of IT vendors in the health-care industry have to ship software written in MUMPS, a programming language developed in the late 1960s for writing database-driven applications."

The full story here:

http://www.informationweek.com/news/software/open_source/showArticle.jhtml?articleID=209903343

Over 80% of Americans Believe Health Care Must be Rebuilt

2008-08-09T21:28:00.000-04:00

In a recent study conducted by The Commonwealth Fund, 82 percent of Americans believe that the U.S. health care system must be completely rebuilt or fundamentally changed. This result, staggering in number, suggests that the existing value proposition of health care as delivered is flawed and fails to deliver to even the most base expectations of patients. Specifically, "adults' health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care."

Interestingly, average Americans' understanding of information technology issues is limited, so it is remarkable that a majority would identify this opportunity obvious to those experienced with information technology. Perhaps health care payers and providers may take a cue from their customers and invest in infrastructure that will help them become more efficient and deliver better care to their patients.

The survey is available here:

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=698138