Matthew Holt

Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up. (I’ll also be in the Surescripts booth talking about it at 3.45 Monday)

I want to put this essay in the context of my day job as co-chairman of Health 2.0, where I look at and showcase new technologies in health. We have a three part definition for what we call Health 2.0. First, they must be adaptable technologies in health care, where one technology plugs into another easily using accessible APIs without a lot of rework and data moves between them. Second, we think a lot about the user experience, and over eight years we’ve been seeing tools with better and better user experiences–especially on the phone, iPad, and other screens. Finally, we think about using data to drive decisions and using data from all those devices to change and help us make decisions.

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This is the Cal Pacific Medical Center up in San Francisco. The purple arrow on the left points to the door of the emergency entrance.

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Cal Pacific is at the end of that big red arrow on the next photo. On that map there’s also a blue line which is my effort to add some social commentary. To the top left of that blue line in San Francisco is where the rich people live, and on the bottom right is where the poor people live. Cal Pacific is right in the middle of the rich side of town, and it’s where San Francisco’s yuppies go to have their babies.
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Last year, on August 26, 2014 at about 1 am to be precise, I drove into this entrance rather fast. My wife was next to me and within an hour, we were upstairs and out came Aero. He’s named Aero because his big sister was reading a book about Frankie the Frog who wanted to fly and he was very aerodynamic. So when said, “What should we call your little brother?” She said, “I want to call him Aerodynamic.” We said, “OK, if he comes out fast we’ll call him the aerodynamic flying baby.” So he’s called Aero for short.

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Thus began the Quest for Intra-Aero-Bili-ty –a title I hope will grow on you. The Bili part will become obvious in a paragraph or two.

Something had changed since we had been at Cal Pacific three years earlier for the birth of Coco, our first child.

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If you look carefully at the top of Amanda’s head, there’s now a computer system. Like most big provider systems, Sutter–Cal Pacific’s parent company–has installed Epic and it’s in every room or on a COW (cart on wheels). Essentially we have spent the last few years putting EMRs in all hospitals. This is the result of the $24+ billion the US taxpayer (well, the Chinese taxpayer to be more accurate) has spent since the 2010 rollout of the HITECH act. Continue reading “In Search of Intra-Aero-Bili-ty”

Digital Doctor
Bob Wachter has been about as influential an academic doctor as there’s been in recent years. He more or less invented the concept of the hospitalist, he’s been a leader in patient safety, and even dressed up and sang as Elton John at the conference he runs! (He’s also pissed off lots of doctors by being a recent one year chair of the newly controversial and perhaps scandalous ABIM). But for the last 2 years he’s been touring the good and the great of health care and IT to try to figure out what the recent introduction of EMRs at scale has meant and will mean. The resulting book The Digital Doctor is one of this year’s “must reads” and yes we will have Bob as the keynote at this Fall’s Health 2.0 Conference.

The immersion research he conducted was fantastic. Bob interviewed just about anyone you’ve ever heard of and a few you wish you hadn’t (more on that later). And in fact he’s been running interviews on THCB and elsewhere sharing some of the stuff that didn’t get in the book. But I’m still wrestling a little with what I think about the book itself. And I think it’s because I largely agree with him and his angst.

There is lots of wonderful stuff in this book. The change in the role of radiology post PACS, how patients are using open notes, whether Vinod Khosla agrees with Vinod Khosla about algorithms replacing doctors–all this and much more are here. But the book is largely about the introduction of the current generation of EMRs into the everyday practice of ordinary clinicians. There are by and large three camps of opinions about what’s happened.

One is that the EMR is a pox visited on physicians that costs a fortune, has worsened quality, heightened medical errors, blown up successful processes, and ruined the lives of doctors–unless they were given scribes. The second is that because of the “rush to judgement” caused by the HITECH Act and Meaningful Use, we put in EMRs that were based on 1990s client-server technology but they were the only ones mature enough for the job. Most of this camp thinks that they were way better than paper, will slowly improve, and that doctors and patients will find that these technologies will soon integrate with easy to use iPhone-like apps as their APIs open up–and that if we hadn’t mandated EMRs when the great recession gave us the chance, nothing would have happened. The third camp agrees that EMRs are better than paper but felt that the way HITECH was rolled out kept a bunch of dinosaurs in business, and is preventing the health IT equivalent of Salesforce displacing Siebel (or Slack displacing email). Continue reading “The Digital Doctor – The Review”

When the latest post from Michael Cannon–he who seeks to sink the subsidies attached to the Federal exchange–hit my inbox, I wondered, “Why don’t his opponents stop arguing the specifics, and instead explain what the Supreme Court ought to do. I also don’t see why Mark Andreeseen (@pmarca) should have all the fun with long Twitter essays. So in only 5 tweets complete with misspellings and other contortions to get my thoughts into 140 characters, this is what I sent back

Daniel Palestrant was one of the first big stars of the early Health 2.0 movement, and he was often at Health 2.0 conferences and on THCB. He founded the biggest (US based) online doctor network Sermo in 2005, rode it like a rocketship, and then left with little explanation in late 2011. Rumors swirled about the company, then it was bought by WorldOne, while Palestrant (and colleague Adam Sharp) was seen in a series of photos with a cutout of an obscure economist. He then seemingly vanished. Now he’s back, and the company named for that economist, Par8o, just announced a funding round of $10.5m and a series of impressive clients.

But what happened at Sermo? And how did that get him to Par8o? I met Dan for a in-depth reminiscence. But briefly in his words; all the investors (including him) in Sermo were happy with the WorldOne buyout; what he learned from the ACA was the inspiration for Par8o; and, he’s now building the underpinning health care operating system. We’ll have more later this week, but watch our catch up.

My 2015 prediction

Gautam Gulati crowdsourced a whole lot of predictions by asking health care types what they expected to see in 2015, and you can see them all on his site. Mine is above–Matthew Holt

I’ve been posting my personal end of year email on THCB for a few years now–here’s 2014′s edition–Matthew Holt

Dec 31 2014: Last year I claimed laziness and failed to write or send out my End of Year Issues email for the first time since I started in 2000. Perhaps it was the stress of being 50, or the fact that despite having 15,000 of my closest friends follow me on Twitter I cant seem to reach people on email, or people miss my Facebook posts. But this year I’ve been guilted back into it by altogether too many people asking me where it was?!

If you don’t know, this is a letter I write mostly to myself about what happened in the year and what I should do about it–mostly in terms of making donations while it’s still 2014. Obviously a few of you like reading it and hopefully one or two of them that does will put their hand into their pocket (or click on the link and use their Paypal account or whatever the electronic equivalent is). And if you don’t like it, well feel free to hit delete, or go onto the next picture of a cat being cute…and I love comments on the blogs/Facebook/Twitter or by email.

Continue reading “Matthew’s end of 2014 charity & issues letter”

This was a comment I submitted submitted to this proposed set of regulations on health plans participating in the ACA. (Use ctrl-F to search “provider directory” within the page). HHS is proposing forcing insurers to make their provider directories more accurate and machine readable, and it would be great for consumers if that was made the case–especially if APIs (which means basically giving access for other computers to read them) were mandated–here’s why:

Subject–Immediately updated  provider directories machine readable via APIs should be mandated for health insurers.

Finding accurate information about providers is one of the hardest things for consumers to do while interacting with the health care system. While regulation cannot fix all of these issues, these proposed regulations in section  156.230 can greatly help, But they should be strengthened by requiring (under subsection 2) that health insurers immediately add new information about providers in their networks to a publicly available machine readable database accessible via a freely available API.

Currently companies trying to aid consumers in provider search and selection tell us that the information pertaining to which providers are in a particular network is the least accurate of all data they can receive. For consumers the biggest question for plan selection is trying to find out which provider is in their plan, and at the least this requires searching multiple websites. Worse, particular insurer’s plans can even have the same name but can have different networks (in one instance in our personal experience Aetna in New York state had two different plans with effectively the same name but different networks). This is essentially impenetrable for consumers and that is assuming that the information on the websites is accurate or timely–which it is often not.

Continue reading “Let’s Have APIs for Those Provider Directories!”

Yesterday XPRIZE announced the 11 finalists for the second phase of the Nokia Sensing XCHALLENGE. This is a $2.25m prize competition to advance the ability to use sensors to measure and manage health, and it’s something that we’re fascinated by at Health 2.0. You may recall that the first round’s winners were unveiled live on stage at the 2013 Health 2.0 Fall Conference by our friends at XPRIZE and Nokia.

UPDATE–The hangout is embedded above. To find out a little more, please come to a Google Hangout at 10 am Pacific/ 1pm EST Wednesday where I’ll be chatting with Dr. Erik Viirre, Medical and Technical Director of the Qualcomm Tricorder XPRIZE and the Nokia Sensing XCHALLENGE; Jonanthan Linkous, Chief Executive Officer of the American Telemedicine Association; Jon Dreyer, President of Health IT Strategic Partners; Dr. Manas Gartia from team MoboSense, a Distinguished Award winner in the Nokia Sensing XCHALLENGE Competition #1; and Dr. Marc Bailey from Nokia Technologies.

You can also see videos of the finalist teams and their breakthrough technologies can be viewed and voted on beginning today through October 30 at http://www.nokiasensingxchallengevoting.org. More on the teams below the fold:

Continue reading “SENSING XCHALLENGE, with Google Hangout Wednesday at 10 PST”

Screen Shot 2014-05-30 at 8.36.11 AM
Yesterday phone and electronics giant Samsung rushed out its next step in health related hardware. Samsung was clearly trying to get this out the door and in the press before Apple’s forthcoming announcement of something health-related –or I assume that’s what their industrial espionage told them Apple was about to reveal (just kidding guys!). And some people (well, Techcrunch) were clearly unimpressed.

The most compelling moment which I captured (poorly) in the video above was the demo of the new SIMBAND–albeit a concept rather than an available product. (In fact a couple of their partners told me that no-one outside the company has one). In the SIMBAND are a stack of new sensors which attempt to use the wrist to monitor not only heart rate, but blood pressure, temperature, EKG and do it all continuously. You can see a rather better video of the demo from Gizmodo, which I cued up to start at the right place.

They also announced a fully open platform (what at Health 2.0 we dub the Data Utility Layer) called Samsung Architecture Multimodal Interactions (SAMI) to accept and spit out all types of health related data.

This is all potentially very impressive. Samsung’s first two attempts at Smart Watches have fizzled, but they tend to keep coming back, and now are pretty much the best at Smart Phones. (You fan bois can keep your teeny iPhone screens!) But can they make the health related smartwatch work? I’ve three quick assessments/questions.

Continue reading “Samsung Throws Kitchen Sink onto the Wrist”

The Administration has snatched victory from the jaws of defeat and enrolled 7 million people (give or take a million who may not have paid their premiums) into health plans under the ACA, and more into Medicaid. The Affordable Care Act (ACA) isn’t as big a change as some of us would have liked, But in this moment of modest celebration let’s remember what some of the sensible old men said all along.

Sensible old men said reform couldn’t pass without bring in the Republicans. Sen. Baucus tried hard to do that, and it’s beyond clear that no Republican would have ever supported it–even a moderate like Snowe who was quitting. It passed anyway.

They said that we’d see massive rate shock. Instead plans tightened networks and rates were in general lower than they had been before.

They said that the web site debacle meant no-one would sign up and we’d go into an insurance death spiral. The web site launch was a cock up, but Medicaid expansion (where allowed) has more or less been OK, and the exchange web site(s) now more or less work(s)–outside Oregon & Maryland. By the way this backs my argument for having one Federal exchange, which you may remember was in the House bill before we ended up being forced to take the Senate version due to Ted Kennedy’s death.

One wise old man (Robert Laszewski) was still saying that the exchanges would be financial disaster for insurers the very week Wellpoint raised earnings expectations because they had more enrollees than expected.

Let’s also remember that because of the politics of the nation, the ACA is a ridiculous hodge-podge of a law requiring–you’ll recall:

a) an opt-in to what’s basically a social insurance program (hey, let’s opt-in to fire protection while we’re at it!)

b) arbitrary tax (and now subsidy) distinctions between those who get insurance via an employer and those who don’t, and

c) arbitrary access to insurance (well, Medicaid) for the poor depending on their income and which side of a randomly drawn line they live.

Continue reading “The ACA– As Much As We Could Have Hoped For, Despite Sensible Old Men”

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