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TECH: Intel inside, but inside what?

I spent Monday morning at a press conference where Louis Burns, the head of Intel’s health initiative, talked about what Intel is up to in health care, and Robert Pearl, the CEO of TPMG (the Kaiser doctor group), talked about their move to EMRs.

Kaiser is clearly making some progress—for instance they’ve now got messaging between physicians and patients running in N. California. Pearl repeats the line, which I buy, that the medical groups which have electronic clinical records and manage chronic care for their patients automatically will produce superior quality patient care. Unfortunately, there are two major problems. First, getting people to move to a Kaiser (or equivalent) from the disaggregated FFS doctors that 90% of Americans now use will require Kaiser to be cheaper than competitive plans (which it’s not any more) and to get employers to force their employees to move to those integrated systems. Something that has been really tricky for employers to do. Second, when I asked Pearl about it he said, speaking personally, that employers (and America as a whole) were going the wrong way by moving towards high-deductible health plans because it was a short-term way of cutting costs, and reduced the sensible use of preventative care.

Intel’s health group wants to move towards more preventative care (and less reliance on intensive acute care). They are pushing technology to create smart homes, and easier communications between patients, caregivers, and clinicians. They’ve spent a ton of effort researching all of this on an ethnographic layer, and in ergonomic use cases.

The problem is that not much seems to changed since Andy Grove’s 1996 Fortune article. Health care sucked then. Intel spent a fortune over a decade trying to change it. Health care sucks now.

So what’s Intel really doing? Well it’s helping on standards (that’s original, huh!). It’s doing lots of (free?) consulting with hospitals. And it has a new tool that looks like a more advanced version of Health Hero’s health buddy with video, and a new prototype for a portable tablet that’s designed for health care. And some snappy videos showing how it might work out. But 6 years with 200 people working away? Is that all Intel has come up with? I’m afraid it appears so.

But in some ways it’s worse; as I wrote in Spot-on a couple of weeks ago, on the benefits side it’s changing its health plan into the style that actually is pushing individuals away from integrated health plans like Kaiser. So to some extent, while they’re featuring Pearl and Kaiser, they’re not really corporately pushing the solution that would increase the adoption of the technologies they think will improve health care.

So what’s the real problem? The real problem is that America’s system is so screwed up, that just saying that “every other industry has changed and health care will” as I heard many times at the conference, is not realistic in the cottage industry that they also kept saying it was. And we’ve spent a decade of massive dislocation staying a cottage industry. And the change in the payment system required to move this is a long way away in time.

Meanwhile, Intel (as with Cisco) will continue to do fine so long as health care keeps buying new IT. But I remain confused as to what their health care initiative is going to actually do to improve their bottom line any time soon. I don’t really think that educating tech journalists about health care (which was what yesterday seemed to have been about) advances the agenda too much. And the industry-wide problems that they are recounting are well beyond Intel’s control.

I hope that I’m missing something here. As their hearts are clearly (both logically and emotionally) in the right place.

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8 replies »

  1. > Why doesn’t Intel stick to making chips?
    I’m sure there are lots of Intel stockholders saying the same thing. If they wanted to be invested in a healthcare company, they could buy Cerner stock.
    But I hardly think Intel is going to slow anything down. And if they did, who would notice?
    t

  2. Blogreader is very close to the truth. 90% of the reason that Intel is in the health care business because of Andy Grove’s experience in 1995. (See the link in the article). And obviously there’s no natural place for them here, hence the problem they’re having finding one.
    On the other hand I’d rather have them funding the ergonomic research that they are, than just ignoring it like most of the other hardware guys…

  3. Why doesn’t Intel stick to making chips? Is that too much to ask of a chip making company?
    I suspect that this came down as an order from the CEO saying that they should disverify their business so some VP got the bright idea that they should be involved with health care standards (WTF?). Now he has a budget of millions and a staff of 200 and needs something to show for it. So we in the health are field are getting these 800 pound gorillas which act to just slow things down as that’s what gorillas do.
    If Intel wants to make money in healthcare work on making their chips more affordable and putting them into different form factors so that technology can be more pervasive in the doctor’s office.

  4. Oh, you got me wound up.
    > Here is my wish list for hardware and software…
    …and it can’t break when you drop it, and it shouldn’t cost more than $300 per unit.
    Let’s see: you want “Windows type of OS with no fancy multimedia functions” except it has to have voice input and display medical images, which means color for those pathology slides, and full-motion video for ultrasounds and any number of other things. Which should be delivered to the device how? Oh yes! No nasty DVDs, No! No! Every bit of medical information on the PLANET must be in a “truly relational database that communicates well across domains” (whatever that means), to which your device has immediate, although highly secure access, fully configurable by a non-specialist, that preserves patient privacy, and strong encryption on the wire. Oooops! No wires, either. Nothing fancy here.
    I think you are stuck in the same old paradigm, what with keyboards and and voice input and large, easy to read screens on impossibly small devices. A truly useful Physician’s Workstation requires no audio or optical or mechanical I/O devices at all!
    It all works on brain waves: The Vulcan Interface. A Mind Meld: a computer that understands what is intuitive for you in every situation. If those Intel Boys can just build what you want, you and your patient will simply rest your fingers on a hockey puck and think about what you mean. The system does the rest. In the next generation, we will have the Uri Interface, where even physical contact is not required.
    Well, maybe in the 27th century. But by that time, most doctors will be holograms, and the remaining flesh-and-blood doctors will be doing research, and getting rich designing the next generation hologram doctor. So be careful what you ask for: you might get it. For now, it will be cheaper and more effective to assign one medical records person to every physician to follow him around all day with the computer terminal to interpret the scene, take dictation, and turn it into something useful. But that costs more than $300.
    Right now, you cannot even describe what is intuitive to you. And what is intuitive to you is counter-intuitive to the next physician. When you and your colleagues standardize vocabularies and workflows and treatments, a tiny fraction of what you want will begin to be possible. Intel, Microsoft, or even Linus Torvalds cannot solve this. Doctors are among the best and most passionate people working in the informatics and EBM fields, but it is up to doctors generally to put this stuff into practice and make it work.
    t

  5. I was at a recent meeting with healthcare CEOs and Intel folks and your assessment of “big hat, no cattle” is on the money.

  6. Intel need to send its programmers to the real life doctors offices to observe what doctors and healthcare workers do. They will be aghast with the perforamnce of the computing systems they dish out to us! Here is my wish list for hardware and software. How about a very slim, 2lb, large screen, superbly backlit tablet PC, with a reasonable size keyboard at the bottom,( just letters and numbers), extremely fast processor, simple networking protcol to define who is allowed to communicate with which machine and who is allowed to open, view and change folder contents using plain english( even an MD user should be able to set it up), Reliable voice recognition transcription, built in ultrahigh quality noise cancellation microphone to rival the performance of a boom headset for voice transcription, simple charger without docking stations, a stripped down, ?embedded, extremely reliabe and failsafe OS -easily upgradable, Windows type of OS with no fancy multimedia functions, except displaying medical images. On the software side, the programmers need to think outside the usual paradigms. NO pulldown menus, large easy to read text, intuitive popup screens into which one could dictate without activating it with pen or mouse. The relational Databases need to be truly relational, flexible and should communicate well across domains; using voice to digitally sign documents; producing universally viewable output such as Adobe pdf. I have had no success in convincing medical software programmers that they need to change their ways to make their produce useful to us. They have so many excellent programming tools, yet they generally produce such poor quality, unusable programs. Let us see if Intel can change things

  7. Matthew, I don’t know that the only way to drive EMR adoption is to make doctors work for (or “own”) hospitals. How about federal legislation to take health care away from employers, give that responsibility (and the money they were paying into it) to employees and create a national risk pool that payers could compete for? These two small steps would go far to remove much of the distortion from the health care “market.”
    God bless Intel for their persistence, but I have to agree with your assessment. Regarding standards, I think Julian Goldman at CIMIT stands a better chance of impacting standards than Intel.

  8. You have touched on what I believe is the real issue that (still) holds the key to cost, quality, and delivery in healthcare (and maybe access); and that is how medicine is organized. It seems that we all love to talk about how it is financed, and we like to talk about how it is delivered on the individual level. But what I don’t see enough of is real discussions about how it is organized at the provider level. Physicians don’t want to talk about it, so the hospitals won’t touch it (don’t piss off the doctors is any good CEO’s mantra). Matt – is there any good discussion about this anywhere? What am I missing? I can find all kinds of discussion here and at other blogs about financing, insurance, malpractice, IT, pharma, and policy. Why isn’t anyone talking about how doctors and hospitals organize to provide better care?

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