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Postgaming Sunday’s Graham-Cassidy Action

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Another day, another draft of Graham-Cassidy. And yet another slew of special deals for Alaska, which I have criticized as unconstitutional elsewhere. Congressional Republicans must pass their recent version of Obamacare repeal by September 30 to avoid the filibuster rules that are usually applicable, and which would require a 60 vote threshold. Until then, they need only 50 of the Senate’s 52 GOP Senators to eke out a victory. John McCain has said he won’t vote for the bill; Susan Collins has said she is leaning against it. Rand Paul, after signalling early disapproval of the bill because it did not go far enough, is now negotiating with the bill’s authors to roll back even more patient protective regulations.
 
If Paul shifts, eyes once more will turn to Lisa Murkowski. In anticipation of this, news outlets are once more reporting sweeteners to Alaska that characterized earlier versions of the bill. The reporting is somewhat vague and sometimes inaccurate, so I thought a deper dive would be helpful.
 
I must caveat all of this by noting that this analysis is based on a quick read of a bill that was released just today—I welcome any corrections or additions.

An Op-Ed Ghostwriter Speaks

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Is it “a breach of trust” for a publication to publish an opinion piece that was written with the participation of public relations professionals?  That was the conclusion of a recent article in Health News Review, a publication that bills itself as “Your Health News Watchdog.”(“Another ‘breach of trust’ at STAT: patient who praised TV drug ads says pharma PR company asked her to write op-ed”).

The article traces the origins of an op-ed that appeared in STAT, the respected medical blog published by the Boston Globe,  headlined  “You can complain about TV drug ads. They may have saved my life.” Health News Review managing editor Kevin Lomangino found that a public relations firm working for Gilead, a pharmaceutical company that makes the hepatitis C drug Harvoni, had reached out to a patient named Deborah Clark Duschane and asked her to write about her experience with drug ads.

Lomangino quotes Charles Seife, a professor of journalism at New York University, who called the situation a “breach of trust.”

“The whole point of ghostwriting is to hide the hand of an actor — to make an industry position seem like it’s coming from an unaffiliated individual,” Seife said. “That’s deception. It’s meant to disarm the natural skepticism that we have when an industry makes self-serving statements. And when someone tries to disarm our skepticism, well, it ain’t good.”

As a professional ghostwriter, who has been hired by public relations professionals to work with authors on op-eds that have run in respected publications, I disagree.

Microsoft Set To Demo VR/Mixed reality Physician Education Platform

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Dr. Simon Kos had big shoes to fill when he took over the role of Microsoft Chief Medical Officer from Dr. Bill Crounse last year. Dr. Kos said himself that they were some “big scrubs to fill”. However, at the time he had already been with Microsoft for six years and in Health IT for more than a decade before that, so he was no doubt up to the challenge.

As Chief Medical Officer, Dr. Kos is responsible for providing clinical guidance, worldwide thought leadership, vision and strategy for Microsoft technologies and solutions in the healthcare industries. He made the move to Health IT after working a few years as a Medical Officer in Sydney, Australia. It was then that Kos decided to go back to school to study software engineering, and later his MBA. He then worked with  InterSystems and Cerner and helped them to implement e-Health initiatives in Australia. In 2010 he joined Microsoft as a Health Industry Manager “with the appreciation that improving health and healthcare was about more than just putting in EMRs.”  Even back then Dr. Kos had the vision to know that the future of healthcare would be in the data analytics and the AI applications that Microsoft would eventually release.

In a recent conversation, with the team here at Health 2.0, Dr. Kos talked about Microsoft’s current framework of digital transformation and highlighted their four pillars; Patient Engagement, Clinician Empowerment, Advanced Analytics, and New Models of Care. As a once practicing doc, he knows that technology needs to help not hinder the healthcare workforce and that AI will be able to improve diagnosis speed and accuracy without replacing or interfering with the clinician. He is a fervent believer that it is important to be constantly evaluating the tech models that may not be viable today but will be in the future. He is excited about Microsoft’s work on patient chatbots and VR/Mixed reality physician education platforms and will be demoing that technology on the Health 2.0 Stage on Monday, October 2nd.

Register today! 

Interview with Paul Black, CEO, Allscripts

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Paul Black is CEO of Allscripts and he’ll be with me at Health 2.0 on October 1-4. Paul has been CEO of Allscripts for about five years, taking over from Glen Tullman who grew the company aggressively by acquisition over the previous decade. Paul has been steering Allscripts through a pretty big transformation for the past few years, and they’ve been the major EMR vendor that has most aggressively reached out to the startup tech community. This is an edited transcript of an interview we had in late August. — Matthew Holt

Matthew Holt: Paul thanks for talking with me today, but also we’re going to have you on for a quick chat when you’ll be on the main stage at Health 2.0, of which Allscripts has been a great supporter. Your colleagues Tina Joros and Erik Kins have been there for many years  but not you, so I ‘m thrilled to have you coming in early October. Paul, welcome!

Paul Black: Thank you very much. It’s a pleasure to be on the call with you today.

Matthew: Let’s dive in to the current state of play. There’s been some changes over the last five to seven years since the HITECH dollars came in, as more and more physicians, and more and more hospitals put in electronic medical records.

Obviously, Allscripts, was, I think, it’s right to say, built by Glen and Lee Shapiro via  lot of acquisitions, especially with the Eclipsys purchase, with the goal of becoming a big player in that meaningful use world. And obviously, you have your old company, Cerner, and your friends from Wisconsin, Epic, who have been very dominant becoming a single platform for many large integrated delivery systems.  Can you give me your sense of where the mainstream enterprise EMR market is at the moment?

Paul: I think that the mainstream EMR market in United States is becoming a mature market. And by that I mean it’s a marketplace in which almost every institution, almost every hospital, almost every post-acute facility, almost every ambulatory facility, has some semblance of an electronic medical record system. And certainly, they have an electronic billing set of capabilities. So, from that standpoint, almost everybody has something with regard to the ordering the management of and the documentation surrounding a clinical series of events.

Matthew: Give me a sense of how you think that’s changing in terms of the split between the integrated systems which are covering in-patients and out-patients, with physicians using the same system on both sides of the fences were, and the continued, I would say growth, but probably more accurately the continued existence of a large ambulatory-only segment of the market? After all that’s different for not only the way that the health systems and medical groups organize, but also the way that they’re served by organizations like you and Epic and many others. Is that system integration continuing or do you think that trend is kind of stopping?

Paul: I’ll take it from a couple of different angles. One is from an integration at the industry level, what has been vertical integration of large integrated delivery networks, or large multispecialty groups, especially practices, or in some cases, payers who are acquiring assets.  I tend to see that while there was a lot going on over the course of the last four, five years, I’m starting to see people be more focused on what they’ve already acquired, and looking at operational efficiency and looking internally to ensure that they’re gleaning the expected returns, both clinically and financially,  of the original goals of how they built those enterprises. That means from a culture standpoint, from an operation standpoint, and from a financial standpoint.

So, I don’t sense that there is as much of a, if you will, a go-go attitude to the continuation of acquisitions.  I don’t think it’s necessarily been a conscious pause, but in some cases there’s been a lot of affiliations and acquisitions that have caused people to really have to  make sure that they’ve done the things they need to do to really operationalize and to optimize the assets and the people that they are now a part of a new overall enterprise. I think from an industry standpoint of the people that serve that marketplace, us and some of the companies that you mentioned today, I see it’s just a natural progression of the other point that you’ve started with about where do we find ourselves in the state of the industry.

As Ohio Goes, So May Go the Nation:  The Patient Access Expansion Act

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According to recent Ohio statistics, 1.3 million people have limited or no access to primary care physicians. Based on the 2015 Ohio Primary Care Assessment, 60 of 88 Ohio counties have medically-underserved populations.  The Patient Access Expansion Act (HB 273), co-sponsored by Representative Theresa Gavarone (3rd District) and Representative Terry Johnson (90th District), specifically addresses healthcare access by prohibiting physicians from being required to comply with maintenance of certification (MOC) as a condition to obtain licensure, reimbursement for work, employment, or admitting privileges at a hospital or other facility. 

Recently, I spoke with Representative Gavarone on the critical importance of this legislation for Ohio.  Physician family members have grumbled about the expense of MOC compliance however, a practicing cardiologist better clarified the connection between MOC regulations and the growing physician shortage.  “He shared his frustrations at the time and money involved participating in a program that has absolutely no scientifically-proven benefit for patient outcomes,” said Representative Gavarone.  The cardiologist discussed numerous hours wasted preparing for an exam with little to no bearing on his day-to-day work serving his patients.

Maintenance of Certification: Who’s Regulating the Regulators?

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When four physician certification boards founded the American Board of Medical Specialties (ABMS) in 1933, those forward thinking organizations—and their professional society sponsors—launched a national movement toward ever increasing physician accountability. Back then, quackery was rampant, so “board certification” meant a lot to patients. The ABMS has since grown to 24 member boards, all ostensibly dedicated to serving “the public and the medical profession by improving the quality of health care through setting professional standards for lifetime certification.”

Because information and technology now advance so rapidly, those one-time lifetime certificates from years ago may no longer be enough. A doctor who passed a test in 1990 isn’t necessarily competent today. The boards have thus changed their approach to certification; for newly minted physicians, time-limited (e.g., 10 year) endorsements now replace the lifetime ones granted to their predecessors. Initially contingent on additional examinations each certification cycle, these newer time-limited endorsements now additionally require ongoing participation in Maintenance of Certification (MOC®) programs.

How the Government is Failing Health Tech Startups and What to Do About It

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As the Senate debated the fate of the Affordable Care Act (ACA) in Washington this past summer, healthcare was front and center in newspapers and conversations around the country. While insurance coverage and the affordability of care certainly warrant the level of nationwide attention they received, they comprise only one dimension of the systemic deficits in US healthcare: access to care. Meanwhile, the pressing need to reform our broken delivery and payment structures and address the more than $1 trillion of waste in our system was being overlooked by lawmakers in DC.

Luckily, on the other side of the country, entrepreneurs and venture capitalists throughout Silicon Valley are paying plenty of attention to opportunities to improve the efficiency of healthcare. In the first quarter of 2017, while policymakers fought about repeal-and-replace, investors poured almost $1.5 billion into digital health startups (mostly in the San Francisco Bay Area). This is on top of over $29 billion invested in healthcare startups between 2010 and 2016. Many of these budding companies are poised to significantly improve the way healthcare is administered and enhance the experience of providers and patients in novel, tech-enabled ways. Unfortunately, in addition to the myriad barriers facing any new startup, healthcare startups also encounter several unique obstacles rooted in policy failures that severely limit their potential to disrupt a system badly in need of disruption.

Larry Weed’s Legacy and the Next Generation of Clinical Decision Support

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The following originally appeared as a guest post at the blog of the director of National Library of Medicine (NLM) and NIH Interim Associate Director for Data Science, Dr. Patti Brennan.

“Patients are sitting on a treasure trove of data about their own medical conditions.”

My late father, Dr. Lawrence L. Weed (LLW), made this point the day before he died. He was talking about the lost wealth of neglected patient data—readily available, richly detailed data that too often go unidentified and unexamined. Why does that happen, and what can be done about it?

The risk of missed information

From the very outset of medical problem-solving, LLW argued, patients and practitioners face greater risk of loss and harm than they may realize. The risk arises as soon as a patient starts an internet search about a medical problem, or as soon as a practitioner starts questioning the patient about the problem (whether diagnostic or therapeutic).

Ideally, these initial inquiries would somehow take into account the entire universe of collectible patient data and vast medical knowledge about what the data mean. But such thoroughness is more than the human mind can deliver.

This gap creates high risk that information crucial to solving the patient’s problem will be missed. And whatever information the mind does deliver is not recorded and harvested in a manner that permits organized feedback and continuous improvement.

Giving a Voice To Healthcare’s ‘Unacceptables’

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Humans are aspirational by nature.

We dream big and invest tools that help us dream bigger. But we forget—sometimes willfully—that many of us are being left behind—because of racial, cultural or gender biases; poor access to connected technologies; or social stigmas associated with loneliness and sexual assault.

But if working in healthcare over the past 10 years have demonstrated anything, it’s that we are ready and willing to do something about the problems that keep all of us from looking to brighter futures.

It’s why I am proud to introduce a special session at the 11th Annual Health 2.0 Fall Technology Conference—The Unacceptables. Healthcare has too many innovators, too many dreamers, to empathizers to tolerate forgotten populations.

Leveling the Playing Field

As our society grows increasingly diverse and gaps in health among different populations increase, there is an urgency to develop solutions for underserved communities and diversify the population of innovators who are creating these solutions.

Diversity in Healthcare. As part of its mission to improve health for all, the Robert Wood Johnson Foundation (RWJF) has placed special emphasis on creating diversity in healthcare leadership. Last year, RWJF launched four new leadership development programs to engage people working across a variety of sectors to build a Culture of Health. Hear Michael Painter, Senior Program Officer, discuss how RWJF engages professionals, community advocates and organizers, doctoral scholars, clinicians, and researchers across multiple fields, represented by participants with diverse backgrounds, perspectives, and specialties.

Women in Health IT. The numbers are startling. Women make up 80% of the workforce, but only 4% of CEOs. Women in health IT earn 20% less than their male counterparts, according to HIMSS. Progress has been made, but more could be done (hello, booth ‘girls’, for a start) to address gender roles in our industry. Lisa Suennen, Senior Managing Director Healthcare Investing, GE Ventures, lead Venture Valkyrie LLC, a publishing, and business advisory firm and is a founder of CSweetener, a not-for-profit company focused on matching women in and nearing the healthcare C-Suite with mentors who have been there and wish to give back, and which she writes about here.

Read my full article here

Bringing Behavioral Health into Primary Care Settings

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The integration of behavioral health into the primary care setting has resulted in a number of benefits. Traditionally, behavioral health and medical health operated separately, but in recent years, the integration of these two systems has improved access to care, ensured continuity of care, reduced stigma associated with seeking care and allowed for earlier detection and treatment of mental health and substance abuse issues. By bringing behavioral health specialists into primary care facilities, healthcare systems have streamlined care and brought down costs, working collaboratively and reducing the number of appointments and hospital visits.

At Carolinas HealthCare System, we use technology to take behavioral health integration one step further. A robust behavioral health integration project was developed through myStrength, using virtual and telehealth technology to ensure that every primary care practice has the capabilities for early detection of mental illness and substance abuse and upstream intervention, easing the connection between behavior health specialists and patients who might otherwise be averse to seeking professional help.

Mental illness touches each of us personally: one in five individuals struggles with mental health issues, yet access to care is one of the biggest issues facing North Carolina residents today.