TECH: An Anonymous Bit of Cynicism, by Anonymous

Sometimes THCB’s anonymous contributors really stick the boot in—I got this email last week after Wal-Mart Dossia progress was announced.

Twenty-odd Wal-Mart employees (including the VP of benefits / former CIO) are piloting a ten-year-old PHR system (built by Children’s Hospital Boston in 1998) and it makes the front page of iHealthbeat and InformationWeek .

The same VP of Benefits / former CIO is "pleased with the progress" of the pilot, whatever that means. I’m sure we’ll hear that same will be announced as “transforming healthcare” at HIMSS in a few weeks. It’s really sad what passes for “progress” in the world of health IT these days.

I was going to write up some thoughts on the CHCF report on NHIN progress (or lack there-of) and how the people in charge of "the plan" are now describing how it was a bad idea/approach from the start (kind of like the retired generals who are now saying that they would have invaded Iraq with more troops), but I got distracted by the Wal-Tard story…

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5 replies »

  1. Thanks to both JDs. Let me confirm that a) the anonymous poster here is well known to me, but currently unable to post in his open name due to his/her current job, b) jd (lowercase) is a different person also known to me who comments frequently on TCHB and is probably wise not to post more openly, due to his/her job, and c) JD Klienke is of course a well known Health care IT commentator and latterly has been involved deeply in PHR development.
    All three are un-connected and I hope all three will continue to comment & write on TCHB!
    Thanks, Matthew

  2. I’d like to clarify that the comments posted above by “JD” are not mine, as many readers of this blog, followers of my work, and spectators of my organization’s recent experience with Wal-Mart might assume. Omnimedix is currently in the process of resolving a legal dispute with Wal-Mart and the other Dossia corporations regarding the development and operation of the Dossia PHR system. And while this dispute has been an annoyance for us and no doubt for Wal-Mart, I’d like to make it clear that we support Wal-Mart’s overall health care ambitions, which involve not only PHRs for their own employees, but an expansion of health benefits for those employees, and the creation of a modern, affordable, accessible health care delivery system. Think whatever you want about this oft-vilified mega-retailer; Wal-Mart has the singular ability to bring a low-cost, low-friction, high-value, high-access alternative to health care delivery in the U.S., one we have desperately needed for decades. In building out a “cash-and-carry” health care system across the country, Wal-Mart clearly recognizes that our third-party payer driven, fragmented health care system is overengineered, too costly, inconvenient, and ridiculously inefficient. Its plans to integrate affordable and accessible primary care with low-cost prescriptions and other in-store health services is exactly what a large percentage of the American public – particularly the uninsured, underinsured and working poor – so desperately need.

  3. MG,
    Web-based PHRs generally have enormous scalability, so the number of people isn’t really the problem. Assuming the PHR software is finished enough for a 1.0 launch, the main barrier I see is to the complexity of loading the data from different sources. Does anyone know if all Wal-Mart employees who take Wal-Mart insurance are using the same TPA?
    The biggest problem will be Wal-Mart employees who don’t go with the company health plan. It’s unlikely that they will be able to load claims data into the PHR for all of them (or any) by the end of the year. For those folks, the PHR would be available in the much less useful form of a template for self-entering health data, but Wal-Mart and Dossia could at least say that they were offered a PHR. Of course, a lot of those remaining folks already have a PHR that they aren’t using from their health plan, whoever it is. The rest are uninsured.

  4. Actually Mandl and Crawford really have there stuff together at Children’s Hospital and run a strong informatics shop.
    The Indivo Health architecture that is utilized by the Dossia project (of which Wal-Mart is a part of) is really robust and if PHRs are going to get any kind of traction in the next 2-3 years, it is going to be through this type of platform approach that is web-based.
    Dossia has a pretty lofty goal of rolling out their PHR solution to all of their employees, dependents, and retirees by the end of the year. Given that is over 3 M people, I don’t see that happening.
    I don’t understand why they released this story (or non-story). Probably just some of the PR folks who are a part of Dossia who are looking to demonstrate they are making progress after the falling out with the OmniMedix Institute. Not really a big deal.

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