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Health 2.0 Will Benefit from Obama’s HIT Stimulus

The Obama team is talking very seriously about including health information technology in his “main street” stimulus package. While I generally agree with the predictions of doom and gloom for providers saddled with the burden of data entry, this creates a potentially huge opportunity for Health 2.0.

As very publicly warned in this forum and others, a stimulus package focused entirely on existing EMR/HER technology would not only offer no proven health benefits (Linder, et al. Arch Intern Med. 2007) but also would financially harm clinical practice. Kaiser Permanente’s Hawaiian experiment with EMR added approximately an hour a day of data entry work per physician (Scott et al., BMJ 2005).

This impact will fall disproportionately on primary care.

Primary care doctors often confront patients without a diagnosis,
making a forms-based approach impractical, and their work is much more
in assessment than action, with a 15-minute encounter can result in as
much effort in unreimbursed data entry as a three-hour surgery. Primary
care can’t afford to shoulder this burden: an article in Health Affairs (Colwill, et al., 2008)
predicts a dramatic deficit in primary care physicians. They anticipate
a 29% increased in the demand for such physicians through 2025 but as
little as a 2% increase in the supply. PBS’s Newshour’s health unit reported last Tuesday on multi-year waits to get on some primary care physicians’ panels.

This opens a tremendous opportunity for Health 2.0. Patient
participation is most effective in assessment and monitoring, reducing
that load on primary care. Even without financial incentives it should
not be too challenging to enlist primary care doctors in support of
Health 2.0, transitioning their role from detective to analyst as
Health 2.0 tools help them to arrive at appointments with data in hand.
User-generated healthcare fits nicely between the extremes of suffering
at home and interventional medicine, facilitating the primary care
physician’s role as strategic consultant and advisor and advocate for
medical intervention. In a project for a national HMO, my team provided
patient-engagement software that, for example, cut the number of office
visits from three to one in the protocol for a common diabetic
medication change. In another controlled experiment, we significantly
shifted problems from emergent to routine through on-line monitoring.
When self assessment identified a potential problem, we scheduled a
routine office visit.

One of two results will come from the Obama Health IT stimulus:
either physicians will be overwhelmed with inefficient health
databases, or Obama’s team will take the advice of Drs. Kibbe and
Klepper and will earmark money for improving the process of health data
collection as well as the medium for its storage. In the first case,
Health 2.0 will come galloping to the rescue of physicians desirous of
sharing the burden of data entry with their patients; in the latter,
Health 2.0 will be integrated into the process. Frankly, many of us
with experience in process re-engineering in the web era will find the
first case more familiar.

Peter Schmidt, Ph.D. is an investment banker specializing in health IT at Cronus Partners LLC.
He has a Ph.D. in computer simulation for healthcare. Prior to joining
Cronus, he was president of DGL, a New Zealand-based
patient-connectivity software provider where he helped connect doctors
and patients at one of America’s leading provider organizations and
also provided systems for the care of Katrina victims. He also was the
CTO and COO of an e-learning joint venture of Oxford, Stanford, and
Yale universities.

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8 replies »

  1. Okay, for the general public, please define
    “open source, web-based, cloud computing applications.”
    Again, one challenges Dr. Kibbe et al. to produce a simple, consumer-oriented glossary of IT terms. Otherwise, the general public, meaning The Patient, cannot enter the debate.

  2. With regard to the KP experience you cite:
    I have been studying the impact of EHRs in KP for 8 years. The KP Hawaii article reflects early experience with an early attempt at an EHR (‘CIS’) ultimately not used by the organization.
    Our experience with our EHR, ‘KP HealthConnect’ is that there are benefits and value generated by the EHR with right leadership for implementation and the right physician leadership to leverage the tool. A forthcoming article in Health Affairs elaborates on some of those impacts, in fact, in the region of Hawaii. There are many ways to do a thing wrong. No solutions in the complex arena of healthcare are ‘bullet-proof’. We try to keep our eye on the possible and move to that.

  3. @Peter
    Thanks for that, I agree that any imminent reform will need to address the predicted crisis with primary care availability. Online information therapy and patient consults can boost provider productivity and offload some responsibilities to patients, hopefully resulting in better-informed patients and better outcomes. As such, initiatives that incorporate these features should be funded at least as proof-of-concept.

  4. @Wendell
    My goal is not to make Health 2.0 go away. I do not expect this to just instantly happen. As long as there are enough people who need a dream to believe in, there will always be a huckster to give them what they want.
    I speak to people who actually care about the difference between hype and reality – the buyers. Back in the real world, they are thinking much clearer and have to live with consequences of their decisions. So as much as Mr. Holt is a hit with the seller crowd, I am very happy with the reception of my ideas among buyers who need help sorting through crap.
    RE: interoperability, HL7, etc. I looked at the technologies and standards in depth myself and happy to leave them to people already involved. These things move at glacial pace and I rather focus on projects where I am doing something no one else is in the position to do.

  5. “physicians desirous of sharing the burden of data entry with their patients”
    That is what should happen. The primary objective of EHR or EMR systems is clinical data entry at only initial point of care or ahead of time that is easy, ensures clean data to the extent possible and allows for accessible and manipulatable date elements. That is the bread-and-butter so to speak.
    I agree with physicians when they complain about the software (initial licensing and so-called maintenance costs) of much of the commercial software in the marketplace.
    “open source, web-based, cloud computing applications”
    FOSS yes, web-based, helpful but not absolutely necessary, cloud, I guess for the sake of utilizing existing storage capacity in cyberspace but still not necessary given the low cost of storage anyway.
    I reiterate my pitch for an Apache Software Foundation sponsored project or the equivalent under similar auspices. Unfortunately chances are that the lobbying juggernaut will take hold to represent the interests of large software vendors and implementers.
    Bad news because not only will that be expensive to all (likely most expensive to tax-payers who foot the bill with little to show for it), but also expensive in terms of poor implementations and half-hearted adoption by physicians who as usual are the crucial participants in this and therefore have to be fully “invested” in all ways for anything to work well.
    Dmitriy: for as much as I agree with you and applaud your efforts, your arguments will only fall on deaf ears. Health 2.0 like any XXX 2.0 or whatever faux versioning is a marketing concept to sell something – the hazier and more jargonistic the more successful in selling to those who are ignorant. As such it will not go away.
    Take advantage of your technical skills and focus on interoperability issues either through using the HL7 protocol and related data standards or through the use if web services. In my humble opinion it is an area that needs advocates for simple, inexpensive, workable applications using already well-developed open-source tools.

  6. I agree with other writers in this space that the stimulus package will fail if it merely throws money as existing EMR technology.
    What about channels where much less money could have a bigger impact, like mobile applications in the hands of patients?
    The Dept of Defense is linking injured soldiers to case managers using texts sent over everyday mobile phones. Wouldn’t investing in this kind of technology produce a better ROI for taxpayers? See link below for details.
    http://www.marketwatch.com/news/story/allone-mobilesm-provide-armys-wounded/story.aspx?guid={94E66F0B-3DF2-4D89-ACB7-69C24D83C0AC}&dist=msr_4

  7. Don’t hold thy breath! The mainstream enterprise EHR vendors plowed this field many years ago and planted their little seeds. The feds aren’t even going to invest in Health 1.0 applications, let alone 2.0. The federal initiative should be, as Rick Peters argued earlier, open source, web-based, cloud computing applications , but it’s just too early . . .
    A possible exception will be the AthenaHealth/Availity companies that offer realtime access to healthcare payment. These are really successful, “nose to the grindstone” survivors of the first Internet bubble.
    The people who will really profit from federal generosity here will be . . . consultants and policy analysts who will be asked to “implement” the program and evaluate the heck out of whatever is done.
    Health 2.0 is too tiny and speculative to “bail out”. It isn’t even on the radar.

  8. Looks like Mr. Holt is really inviting me to keep commenting on Health 2.0, so here it goes.
    The idea that HIT stimulus bill will include a Health 2.0 bailout is typical pie-in-the-sky we have come to expect from this “movement”. No one who is even close to making actual decisions about the stimulus even hinted about Health 2.0 bailout. The stimulus bill is yet to be written, not to mention pass the scrutiny of congress and lobby groups. We have not yet heard from Deborah Peels of the world. Nobody with any real influence in the process has any reason to push Health 2.0, they have their own interests to protect. Sure, physicians would just gladly hand over control over data entry of the records that document their liability. What a genius idea!
    Of course we have usual intellectual shell games whereas Health 2.0 term is used to take credit for technologies and ideas that have existed for a long time and have absolutely nothing to do with recent Web 2.0 bubble. Like home monitoring, physician-patient communication, health self-assessment, health education and the like. While I bet many of these tools will get broader adoption via the stimulus they have nothing to do with Health 2.0.
    With financial meltdown and disintegration of the venture capital system, the only hope for Health 2.0 is federal bailout. However, the politics to pull this off is simply not there. If you want to start lobbying campaign, I recommend building upon a related proposal: Web 2.0 Is Too Big to Fail: Drama 2.0 Announces Web 2.0 Bailout Plan
    Don’t stop believing!

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