Matthew Holt

It’s always interesting to talk with John Halamka, and last week–after athenahealth bought the IP but apparently not the actual code of the Beth Israel Deaconess Medical Center (BIDMC) web-based EHR he’s been shepherding for the past 18 years–I got him on the record for a few minutes. We started on the new deal but given that had already been covered pretty well elsewhere we didn’t really stay there. More fun that way–Matthew Holt

Matthew Holt: The guys across town (Partners) ripped out all the stuff they’ve been building and integrating for the last 30 years and they decided to pay Judy Faulkner over a billion dollars. And you took all the stuff that you’ve been building for the past 15 to 20 years and sold it to Jonathan Bush for money.  Does that make you a better businessman than they are?

 (Update Note 2/11/15: While I’ve heard from public & private sources that the cost of the Partners project will be between $700m and $1.4 billion, Carl Dvorak at Epic asked me to point out less than 10% of the cost goes to Epic for their fees/license. The rest I assume is external and internal salaries for implementation costs, and of course it’s possible that many of those costs would exist even if Partners kept its previous IT systems).

John Halamka:  Well, that is hard to say, but I can tell you that smart people in Boston created all these very early systems back in the 1980s. On one hand, the John Glaser group created a client server front end. I joined Beth Israel Deaconess in 1996 and we created an entirely web-based front end. We have common roots but a different path.

It wasn’t so much that I did this because of a business deal. As I wrote in my blog, there is no benefit to me or to my staff. There are no royalty streams or anything like that.  But sure, Beth Israel Deaconess receives a cash payment from Athena. But important to me is that the idea of a cloud-hosted service which is what we’ve been running at Beth Israel Deaconess since the late ’90s hopefully will now spread to more organizations across the country. And what better honor for a Harvard faculty member than to see the work of the team go to more people across the country?

MH: There’s been a lot of debate about the concept of developing for the new world of healthcare using client server technology that has been changed to “sort of” fit the integrated delivery systems over the last 10 years, primarily by Epic but also Cerner and others. In particular how open those systems are and how able they are to migrate to new technology. You’ve obviously seen both sides, you’re obviously been building a different version than that.  And a lot of this is obviously about plugging in other tools, other technologies to do things that were never really envisaged back in 1998. You’ve come down pretty strongly on the web-based side of this, but what’s your sense for how likely it is that what has happened over the last five or ten years in most other systems including the one across the street we just mentioned is going to change to something more that looks more like what you had at Beth Israel Deaconess? Continue reading “Halamka Speaks: athenahealth & the Future of AMCs as Tech Innovators”

Erick & Linda von Schweber started Surveyor Health around the time Health 2.0 started back in 2007, with the BHAG of massively improving medication safety using some very complex technology. And it has taken them a long time to embed themselves in the bowels of some huge health care organizations and to start getting traction. But it is finally happening and the impact may be substantial. I interviewed Erick and he gave me a comprehensive demo and update on their latest results. If you care about drugs and clinical care, this is compelling (if not lightweight!) viewing. (I suggest you switch to full screen for the demo).

Long time (well very long time) readers of THCB will remember my extreme frustration with Patients Privacyflying cadeucii Rights founder Deborah Peel who as far as I can tell spent the entire 2000s opposing electronic health data in general and commercial EMR vendors in particular. I even wrote a very critical piece about her and the people from the World Privacy Forum who I felt were fellow travelers back in 2008. And perhaps nothing annoyed me more than her consistently claiming that data exchange was illegal and that vendors were selling personally identified health data for marketing and related purposes to non-covered entities (which is illegal under HIPAA).

However, in recent years Deborah has teamed up with Adrian Gropper, whom I respect and seemed to change her tune from “all electronic data violates privacy and is therefore bad”, to “we can do health data in a way that safeguards privacy but achieves the efficiencies of care improvement via electronic data exchange”. But she never really came clean on all those claims about vendors selling personally identified health data, and in a semi-related thread on THCB last week, it all came back. Including some outrageous statements on the extent of, value of, and implications of selling personally identified health data. So I’ve decided to move all the relevant comments to this blog post and let the disagreement continue.

What started the conversation was a throwaway paragraph at the end of a comment I left in which I basically told Adrian to rewrite what he was saying in such a way that normal people could understand it. Here’s my last paragraph

As it is, this is not a helpful open letter, and it makes a bunch of aggressive claims against mostly teeny vendors who have historically been on the patients’ side in terms of accessing data. So Adrian, Deborah & PPR need to do a lot better. Or else they risk being excluded back to the fringes like they were in the days when Deborah & her allies at the World Privacy Forum were making ridiculous statements about the concept of data exchange.

Here’s Deborah’s first comment Continue reading “Is Deborah Peel up to her old tricks?”

In an exclusive interview with Matthew Holt, American Well President and CEO Roy Schoenberg, MD shrugs off the threat of emerging competitors, predicts that United Healthcare will own a telehealth company within the next 12 months, and reveals that his company has “turned the corner” in terms of generating revenue from telehealth services. Schoenberg also shares details of the company’s recently announced integration with Apple HealthKit and the growing use of scheduled telehealth visits to treat chronically ill patients.

Lygeia RiccardiMaking Sense of Blue Button, Meaningful Use, and What’s Going on in Washington  …

At the recent Health 2.0 Conference in Santa Clara, co-chair Matt Holt expressed frustration about the difficulty of getting copies of his young daughter’s medical records. His experience catalyzed a heated discussion about individuals’ electronic access to their own health information. Many people are confused about or unaware of their legal rights, the policies that support those rights, and the potential implications of digital access to health data by individuals. The Health 2.0 conference crowd included 2000 entrepreneurs, consumer technology companies, patient advocates, and other potentially “disruptive” forces in healthcare, in addition to more traditional health system players.

Why is this topic so important? Until now, most people haven’t accessed their own health records, whether electronically or in paper, and I believe that making it easier to do so will help tip the scales toward more meaningful consumer/patient engagement in healthcare and in health. Access by individuals and their families to their own health records can empower them to coordinate care among multiple healthcare providers, find and address dangerous factual errors, and take advantage of a growing ecosystem of apps and tools for improving health-related behaviors, saving money on health services, and getting more convenient, personalized care.

A shorthand phrase for this kind of personal empowerment through access to digital health data is “Blue Button,” which is also the name of a public-private initiative in which hundreds of leading healthcare organizations across the US participate. The Blue Button Initiative is bolstered by the electronic access to health information requirements for patients in the “Meaningful Use” EHR Incentive Program, which is administered by CMS (the Centers for Medicare & Medicaid Services) with companion standards and certification requirements set by ONC (the Office of the National Coordinator for Health Information Technology). Continue reading “Getting Your Own Health Records Online: The Good and the Not So Good”

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Such a good question from my friend David Shaywitz, MD, PhD, (and co-author with me of the book Tech Tonics).  David has spoken and written about this this theme frequently, and most recently at the Health 2.0 conference held last week in Santa Clara, CA. He and I and 2000 of our closest friends were there to talk healthcare technology. Isn’t it ironic that it takes that level of human interaction to talk about the ways healthcare can disintermediate humans from healthcare?

What struck me so loudly at the conference was how easy it is for us all to forget how human the healthcare experience really is. I moderated and attended numerous sessions at the conference, each a twist on the theme of how technology can make healthcare delivery more accurate, more efficient, more effective than anything we have going today.

David participated in a session withMatthew HoltVinod Khosla and Dr. Jordan Shlain, who could not be farther part from each other on the topic of doctor vs. machine (David played the role of moderate guy in the middle), Mr. Khosla backed away or at least clarified his earlier statements about how 80% of doctors will be unnecessary in the coming new age of healthcare technology. His revision was that 80% of alldiagnosis will, in the future, be done by computers, not doctors, because computers are far better at seeing a holistic view of a patient and taking in all of the relevant data. He talked about how certain digital technologies can know everything about you, including when you are sleeping and when you are awake. It made me think that Santa Claus must be worried about being replaced by an app.

Continue reading “Wait, Maybe Technology Won’t Replace Doctors After All!”

In more stunning proof that America’s 18th century style governing process just doesn’t work, a subset of a regional Federal court ruled against part of Obamacare. The Halbig ruling is certain to be overturned by the full DC court and then probably will stay that way after it makes it’s way through the Supremes–at least Jonathan Cohn thinks so.

But think about what the Halbig ruling is about. Its proponents say that when Congress (well, just the Senate actually as it was their version of the bill that passed) designed the ACA, they wanted states only to run exchanges and only people buying via states to get subsidies. But that they also wanted a Federal exchange for those states that couldn’t or (as it turned out) wouldn’t create their own. But apparently they meant that subsidies wouldn’t be available on the Federal exchange. That would just sail through Logic 101 at any high school. Well only if the teacher was asleep, as apparently most Senators were.

Now two judges interpret what was written down to imply that subsidies should only be available on state exchanges–even though logic, basic common sense and fairness would dictate that if we’re going to subsidize health insurance we should do it for everyone regardless of geography.

Don’t forget that in the House version of the bill there was only a Federal exchange. Continue reading “Halbig corpus interruptus”

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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”

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Doximity, known as the LinkedIn for doctors and a frequent Health 2.0 participant, raised $54 million in a Series C funding round led by T. Rowe Price and Draper Fisher Jurveston with participation from Morgan Stanley Investment Management.

Doximity claims more than 40% of US physicians as active users, and in January of this year announced that their physician network has grown to more than 250,000 members.

Doctors can use Doximity to collaborate on cases, further their careers, and stay up to date on specialty-specific news, but that’s not where they make their revenue.

“There are a lot of things we can do to make medical networking more efficient,” Doximity CEO Jeff Tangney told Health 2.0 when asked how the funds would be used.

“If you think about it, how would your life be different if you weren’t able to use email in your job? How out of touch would you be? That’s what it’s like to be a US physician. We see a lot of opportunity to improve the connectivity of physicians as a new business area.”

Like LinkedIn, Doximity is a recruiting tool for people looking to hire doctors. Tangney didn’t reveal all the numbers, but he did say that Doximity was cash flow positive in January for the first time. He also said that Doximity has 55 employees, somewhere around 200 hospital clients, and that a subscription to the recruiting product costs $12,000 per seat per year to send 50 messages per month.

With some back of the envelope math, and a guess of a burn of about $10-12 million a year, it figures out to about four subscribed seats per hospital. With about 5,000 hospitals in the US and some other revenue streams to pursue, it looks like Doximity has room to grow at a bare minimum.

Continue reading “Doximity Raises Another $54M to Pursue LinkedIn’s Business Model Too”

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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FROM THE VAULT

The Power of Small Why Doctors Shouldn't Be Healers Big Data in Healthcare. Good or Evil? Depends on the Dollars. California's Proposition 46 Narrow Networking
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