Tech

Tech

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I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)

Intersystems has grown dramatically in recent years as its Cache database tends to get sold in conjunction with Epic’s EMR. But Intersytems not only has its own EMR (sold outside of the US) but is a big player in the HIE business. At HIMSS 2015 they unveiled a new solution called the “Healthshare Personal Community” which allows providers and others to build patient accessible records on top of their HIE solution Healthshare. I interviewed Paul Grabscheid, VP of Strategic Planning about the company, the technology and what he’s seeing. (Ignore the last question as I ran out of disk space before he could answer!)

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tRACTION

Who will be the Startup Champion of Fall 2015? Traction is the perfect opportunity to hone your skills and impress these venture capitalists to invest in your startup!

Traction will be launching the Health 2.0 Annual Fall Conference on Monday, October 5, 2015 at 8 AM. This competition specifically recruits companies ready for Series A in the $2-12M range.

Enter your company TODAY and pitch your startup to venture capitalists, angel investors, government officials, and even healthcare industry experts. Increase media exposure while forming connections with leading investors, while gaining the opportunity to gain advice from over 30 mentors and experts to further refine your business model.

The application deadline is TODAY Friday, August 14th at 11:59 ET.

In early September, 10 teams will be selected as finalists for two different tracks: professional facing and consumer facing tools. Emerging live at the conference, the competition will grant these lucky finalists access to exceptional mentors and fight for the title of “Startup Champion.”

Apply today to be selected as one of the 10 finalists to pitch live at Health 2.0’s Annual Fall Conference!

And of course you can buy tickets to Traction as an add on to the Health 2.0 conference itself.

Jennifer David is a program manager at Health 2.0

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The health information technology (HIT) world has been hit by a watershed event like no other. The Department of Defense (DoD), widely respected for its indiscriminate generosity to contractors, has awarded the most coveted prize in recent HIT memory – the Defense Healthcare Management Systems Modernization (DHMSM) contract.

And the winner is… Leidos, the contractor formerly known as SAIC. A couple of years ago, when the race for the DoD contract began, Leidos/SAIC selected Cerner as its EHR of choice for this contract. The smart money though was on Epic and its Big Blue partner because they are and seemingly always have been the safest procurement choices for top brass in any large organization.

A stunned HIT “community” initiated its favorite game of providing post facto authoritative explanations ranging from cute to grotesque. Here are the most common and least specious opinions:

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When Ben Horowitz was asked last November by Stanford Professor Tom Byers how the venture capital firm Andreessen-Horowitz (“a16z”) became so successful so quickly, and was able to crack open what had been an exclusive and self-perpetuating club of top VCs, Horowitz replied, “We were the first VC firm to super-aggressively market itself.”

Presumably one manifestation of this strategy is a phenomenal podcast series the firm produces, featuring senior partners, distinguished guests, and frequently both, discussing with some granularity a topical issue in technology or entrepreneurship.

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I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)

This interview is with Xerox’s Tamara StClaire (Chief Innovation Officer, Commercial Healthcare) and Gail Croall, Chief Medical Officer, Healthspot.

Xerox has a big business in inpatient analytics–I interviewed Justin Lanning who runs their Midas+ Division back in 2012, and does lots of government based claims-processing (especially for Medicaid) and customer service centers. It even was one of the many companies building health exchanges (and struggled like many others!). In May this year (after this interview was shot) Xerox bought a community based visualization company called the Healthy Communities Institute which sells dashboards about public health issues to towns and counties–and has been a big player both at Health 2.0’s Healthy Communities Data Summit but also winning a couple of our challenges.

In late 2014 Xerox invested in Healthspot a telehealth company that builds kiosks. That partnership is the main focus of this interview. Below the fold there’s another video which is a tour of the Healthspot hub that you can expect to see cropping up in RiteAid pharmacies across Ohio and later the nation.

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new adrian gropper

A few weeks ago a post by David McCallie discussed the ongoing efforts and challenges toward achieving health information interoperability. McCallie presented a list of “sufficient conditions for interoperability” and argued that “Congress should accordingly define the ‘what’ and let the U.S. health care stakeholders define and achieve the ‘how.'”

Engaging the patient-consumer in the interoperability design around the EHR interface can speed interoperability and reduce the burden of regulation. A convergence of patient, physician, and institutional strategies for interoperability around the JASON Public API (application programming interface) can reduce the risk of congressional intrusion in complex technical standards.

The U.S. healthcare stakeholders include patients and individual physicians. Unfortunately, these two stakeholder groups are seldom represented in technical standards organizations and, more importantly, have almost no purchasing power when it comes to electronic health records or health information technology. This contributes to the slow rate of progress and has created significant frustration among both patients and physicians.

The Public API addressed by the JASON Task Force is compatible with both institutional and patient-directed interoperability. At HIMSS-15, a group led by the Veterans Administration, the Office of National Coordinator (HHS-ONC), and Patient Privacy Rights demonstrated “Privacy on FHIR” . We showed how a single FHIR API could bridge the interoperability requirements for institutional health information exchange, exchange of sensitive health data covered by 42CFR Part 2, exchange of data with patient-controlled apps, and even with patient wearables.

Let’s review McCallie’s list (in italics)  from the perspective of patient-driven interoperability as we began to show in Privacy on FHIR:

I believe that the sufficient conditions for interoperability include the following:

*A business process must exist for which standardization is needed. As Arien Malec put it recently, ‘SDOs don’t create standards de novo. They standardize working practices.’

The business process for patient engagement already exists as the patient engagement component via a patient or beneficiary portal. Almost every HIPAA and non-HIPAA health service provider already offers an online patient portal. This includes key stakeholders such as health insurance payers that figure prominently in most healthcare transactions.

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Yesterday Harris Corporation sold its health care operation–mostly based around the former CareFx HIE product (now named FusionFx)–to Patrick Soon Shiong’s NantHealth. This follows close on the heels of NantHealth’s cross-investment in Allscripts, which of course has its own HIE product DBMotion. While NantHealth’s strategy under Soon-Shiong’s grand vision is extremely wide (and a little tough to predict) it certainly involves moving huge amounts of data around.

But what does Harris do in health? I’ve had an interview in the can from April 2015 with Eileen Rivera, VP of Marketing at Harris, which explains what they do and gives some hints as to why NantHealth decided it needed them. So this is as good as time as any to release it!

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Arthur C. Clark and Stanley Kubrick predicted supercomputers more intelligent than humans.  In 2001: A Space Odyssey, the HAL states, with typical human immodesty, “The 9000 series is the most reliable computer ever made… We are all, by any practical definition of the words, foolproof and incapable of error.” Forty years later, IBM’s Watson pummeled humans in Jeopardy – a distinctly human game.

Watson is a big shot oncology fellow at MD Anderson – he is already impressing nurses and the attendings.  The supercomputer presented patients in the morning rounds, parsed data within seconds, and made few mistakes. The real oncology fellow, the human I mean, flabbergasted by the efficiency of his binary colleague, relayed to the Washington Post, “Even if you work all night, it would be impossible to be able to put this much information together like that.” Watson doesn’t have to worry about duty hour restrictions.

CEO of IBM, Ginni Rometty, claims that Watson 2.0 will interpret medical imaging like a radiologist.  In its third iteration, the supercomputer will “debate and reason.” Why hire radiologists who sap productivity with lunch breaks and sleep?  Watson will never complain about the dearth of vegan food in the cafeteria, never get tired, and – best of all – never whine about Medicare reimbursement cuts.

But forgive me for snoring at night without fear of the Robo-Radiologist. The reasons are simple.

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Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are [itching] to steal their jobs. We have plenty of work in India,” reassured Dr. Sumer Sethi, director of TeleRad Providers of New Delhi.

A tech-savvy blogger, Sethi founded TeleRad Providers in a flash of inspiration and an appreciation of market forces.

“There is unimaginable competition in private medical imaging in New Delhi,” he said.

A new radiologist wishing to set up shop in one of India’s metropolitan areas faces large upfront costs: There is little discount for a 1.5-tesla MRI scanner. This means one must have abundant spare change floating around — or ancestral wealth. And once the shop is set up, the aspiring radiology entrepreneur embarks on a long and uncertain road toward establishing reputation and market share.

Employment models in the U.S., such as partnership tracks and buying into a practice, are not generally available to Indian radiologists. The alternative to entrepreneurship is working as a salaried employee for a corporate hospital, private imaging center, or government hospital. That was not the career pathway for Sethi, whose teleradiology practice is a pure fee-for-service model.

“It’s a low-cost operation,” he explained. “We read from home.”

An elegant model

The costs of an Indian teleradiologist are certainly low. Sethi does not have to deal with intermediary agents. There are no concerns about using the wrong billing code, and there are no separate state licenses to acquire. The model is elegant in its simplicity. He gets a study, renders a report, and gets paid.

However, the low operating costs belie the actual effort that is required of Sethi to grow his practice. He negotiates with hospitals directly. Being an entrepreneur means recognizing the need for teleradiology, and persuading others of the need and its solution.

Most of Sethi’s clients are hospitals in tier 2 and tier 3 cities in India, the equivalent of Dayton, OH. The hospitals have the machines and patients but not always the radiologists.

“We mostly plug the gaps in the rota at these places,” Sethi said.

This must mean that the radiologists at these centers welcome his efforts, I surmised.

“The scrutiny of our reports is intense,” he said. “This does not mean all our reports are overread. But were we to miss something, we could lose the contract, as the local radiologists would say, ‘See, this is a report from a teleradiologist.’ I tell my team that we must be at the top of our game, always.”

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flying cadeuciiInteroperability in health care is all the rage now. After publishing a ten year interoperability plan, which according to the Federal Trade Commission (FTC) is well positioned to protect us from wanton market competition and heretic innovations, the Office of the National Coordinator for Health Information Technology (ONC) published the obligatory J’accuse report on information blocking, chockfull of vague anecdotal innuendos and not much else. Nowadays, every health care conversation with every expert, every representative, every lobbyist and every stakeholder, is bound to turn to the lamentable lack of interoperability, which is single handedly responsible for killing people, escalating costs of care, physician burnout, poverty, inequality, disparities, and whatever else seems inadequate in our Babylonian health care system.

When you ask the people genuinely upset at this utter lack of interoperability, what exactly they feel is lacking, the answer is invariably that EHRs should be able to talk to each other, and there is no excuse in this 21st iCentury for such massive failure in communications. The whole thing needs to be rebooted, it seems. After pouring tens of billions of dollars into building the infrastructure for interoperability, we are discovering to our dismay that those pesky EHRs are basically antisocial and are totally incapable or unwilling to engage in interoperability. The suggested solutions range from beating the EHRs into submission to just throwing the whole lackluster lot out and starting fresh to the tune of hundreds of billions of dollars more. When it comes to sacred interoperability, money is not an object. It’s about saving lives.