Month: April 2009

Advances in Online Care and Telehealth

Apr 6, 2009• 12

By DAVID C. KIBBE

At a recent symposium on Online Care in Hawaii , two Family Physicians and a primary care Internist participated in a panel in which they described their experiences with Online Care and Telehealth.

– Ron Dixon, MD is the Director of Massachusetts General Hospital’s Virtual Practice Project. He talked about his practice using videoconferencing for patient visits, and discussed results of his research on e-visits, which includes the largest randomized comparative trial to date of videoconferenced medical visits versus face-to-face visits.

– Peggy Latare, MD is Chief of Family Medicine at the Hawaii Kaiser Permanente Medical Group, and the physician lead charged with the implementation of KP HealthConnect in the Hawaii region. For over two years she has used Kaiser’s online tools on a daily basis for communicating with and caring for her patients.

– Dr. Michele Shimizu, a native Hawaiian, is a family physician in private practice on the Big Island, and uses the American Well platform for Online Care to maintain relationships with her former patients on Oahu, despite being separated by more than 100 miles of Pacific Ocean, and to treat new patients as well. She uses the web-based Telehealth system made available through HMSA, the Blue Cross Blue Shield of Hawaii , on average three times a day, mostly in the evenings.

It’s, err, gulp, HIMSS time

Apr 6, 2009• 2

By Matthew Holt

Yes, the annual cavalcade of boat-show sized booths and late night partying—interspersed with frequently mind-numbing presentations that most people skip— is on. In Chicago in a snowstorm! I touched down on Sunday midday and managed to compound the craziness in HIMSS by starting in London (thanks to American Airlines for the free upgrade this time!), but I did make it to bed before midnight. And yes, there was 3 inches of snow/slush in Chicago and I did throw snowballs.
Before I got in there appears to have been a rather odd session on Health 2.0 (at least judging by this report, it seems it was all about hospital marketing and excessive use of FaceBook which I don't think is the whole point).

Dennis Quaid Overlooks Too Much

Apr 6, 2009• 3

By Michael Millenson

Anyone who cares about patient safety has to be grateful to Dennis Quaid
for the way he and his wife Kimberly reacted to the near-death from a
medication error of their twin baby girls. Using his celebrity and his
contacts as an award-winning actor, Quaid launched a crusade to stop
similar errors from ever happening again. He has appeared on 60 minutes , testified before Congress and, Sunday, came to HIMSS to tell his story once again.

At HIMSS, Quaid was amusing (“I am not a doctor [and] I have never
played a doctor on television or in the movies”) and moving, as he
detailed how two massive heparin overdoses turned his newborn twins’
blood to the consistency of water and left them bleeding inside and
out. He was also generous and humble, repeatedly thanking the HIMSS
membership for the work they did in developing the technology that can
prevent inevitable human error from causing harm.

Andy Slavitt, Ingenix

Apr 6, 2009• 8

By Matthew Holt

So we're going to start with one of the more controversial people I'm meeting at HIMSS, Andy Slavitt the CEO of the newly discovered and reviled by the Senate Ingnix. As you may recall, despite the fact that (not entirely to Andy's pleasure) I called them arms dealers, I was not entirely unsympathetic to what Ingenix was up to in the recent mess. So I talked to Andy about that, about what Ingenix actually does and whether it made sense for a health plan to own a big informatics company (his short answer…they don't!) An interesting interview you can see immediately below.

Op-Ed: Let’s Pay Nurses Minimum Wage!!

Apr 5, 2009• 114

By ANGRY AMERICAN

Every morning I wake up and thank God that we still have some Republicans in Congress. Representative John Shadegg (R) from Arizona, is one of those blessings. He has introduced a bill in Congress called the Nursing Reform Act of 2009. The bill calls for increasing work visas for foreign nurses (and their spouses). When passed, it will eliminate the nursing shortage!

This bill is great on so many levels. For one, everyone knows that healthcare is costing us an arm and a leg (pun intended). The biggest causes are obviously nurses and nursing unions. Nurses are way overpaid, but unfortunately the healthcare corporations have not been able to break the nursing unions because of the shortage of nurses. By bringing in lots of foreigners, they can flood the market with labor, break the unions, and get nursing salaries down to where they belong — somewhere around what retail pays. If only there weren’t that law capping the number of foreign nurses we allow in the country… As a side benefit, the bill allows for nurses’ spouses to get unrestricted work visas as well, so it will help bring down salaries in all sorts of other industries as well!

The true brilliance of this bill (thank you Mr. Shadegg!) is in the way it is written. It doesn’t bring them all in at once. It starts out with 50,000 new visas the first year, which is a low enough number that people will “buy it” and the bill can get passed. Supporters of the bill have had to go to great lengths to say that nursing salaries will be unchanged, which of course will be true at first. However, the genius in the bill (evil grin) is that the number of allowable visas automatically goes up 20% per year, so it will be 60,000 visas in year two, 72,000 visas in year three, 86,400 visas by year four, 103,680 by year five, and a whopping 124,416 by year six! The bill states that “According to the Department of Labor, the current national nursing shortage exceeds 126,000.” Therefore, the nursing shortage will be solved in about six short years, and healthcare companies can get back to earning the kind of money they deserve! Incidentally, this is just the approach that was so successful in cutting the salaries earned by information technology workers about 10 years ago. Corporate profits were getting impacted by high IT costs, so our brilliant Congress increased the number of H1-B visas, and companies were able to hire cheap workers from India and other places. Thank you, Congress! Later, many of these foreign workers returned to their homelands and brought the work with them. Now, corporate America doesn’t have to pay high salaries, and they don’t even have to look at the foreigners anymore — they can just write a little check to India. Bravo! Fortunately, information technology salaries have never rebounded to the levels where they were.

“Mr. Obama, Tear Down These (Hospital) Walls”

Apr 4, 2009• 6

By ROBERT WACHTER

I like readmissions. Well, that didn’t come out quite right, did it?

What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions, thereby improving quality and lowering costs. And compared to mortality (the other hot outcome measure), the need for case-mix adjustment is a bit less critical, and there is no such thing as “a good readmission.”

I also like DRGs. Paying hospitals a fixed fee for a given diagnosis has created the only corner of sustainable capitation in our healthcare system, one that is otherwise awash in inappropriate expenditures driven by the dominant fee-for-service payment structure.

But the DRG system created a big black hole, and it is time to fill it. It’s called the post-discharge period. And one large part of the detritus emerging from that hole is readmissions.Continue reading…

Commentology

Apr 4, 2009

J Bean was among the commenters who took offense at the line of argument in Steven McKinney’s “Response to Doctors Raise Doubts on Digital Health Data.”

“I guess I have to admit that the EMR industry seems to have hit on a really unique marketing angle. “We have a crappy, overpriced product that would make the buyer’s life worse rather than better, but if they don’t want to buy it, it’s only because they have a psychological hang up. Why wouldn’t that work? Perhaps GM could give it a try too. Of course,
while GM’s cars used to suck, they’ve actually worked to make their
product better. Now they just have to overcome their bad reputation …”

Response to “Doctors Raise Doubts on Digital Health Data” S. Lohr NY Times

Apr 3, 2009• 6

By STEVE MCKINNEY

1410 Cambridge, England. Minor Canon Thomas Rangle did a final count of the books at Trinity Hall. He counted 122. Most of the books are biblical in nature or celebratory of our good and righteous benefactor Pope Urban V. Few have access to these fine artifacts because of their enormous value (costing as much as a farm or vineyard) and the cloistered clergy and Master of the university are unwilling to share their contents.

1448 Mainz, Germany. Goldsmith and known spendthrift Johannes Gutenberg invented the printing press with move-able type. It is known in town that he has printed school book texts and some indulgences; although, word is out that he is working on a fine bible. Cost is 30 Florins or the equivalent of three years working wages.

From Health 2.0 meets Ix: A Breathtaking Display of Possibilities

Apr 2, 2009• 5

<p class="byline"By BRIAN KLEPPER

(Boston) Jane Sarasohn-Kahn and I were quickly comparing notes this morning. Our impression is that, compared to past meetings, this one seems more characterized by doers than observers.

This conference brings together a dizzying array of tools and experiences, which is testament to the organizers’ encyclopedic handle on the vast diversity of activity in this sector. Josh Seidman, Indu Subaiya and Matthew Holt have done yeomans’ jobs in putting these impressive presentations together.

Mingling, I’ve spoken to person after person actively involved in mostly consumer-oriented ventures, leveraging science and user-generated information to facilitate a more favorable patient experience. There are some real steps forward, like the demo that Mayo and Microsoft showed, that takes information entered into Health Vault and applies the rules that Mayo has developed through many years of experience. Or the work that groups like Up-To-Date and HealthWise are doing, that continually, organically update descriptive information throughout medicine and health care.

National HIT Symposium at MIT, June 29 – July 2, 2009

Apr 2, 2009

OVERVIEW

The recently-enacted American Recovery and Reinvestment Act will
provide more than $35 billion in funding for health information
technology. The health care reform debate in the Congress seems to be
coming to a head this summer. In this context, health care leaders are
grappling with how new emerging policies will impact their
organizations and how to assure that their organizations are
well-positioned to access the significant stimulus funding now emerging
from the federal government.

The HIT
Symposium, conducted at the Massachusetts Institute of Technology in
Cambridge, MA, is a must-attend event, that will help leaders from
every sector of health care, including those representing consumers,
employers, payers, providers, and vendors, gain timely intelligence and
practical insights on how to benefit from the health IT programs and
provisions of the American Recovery and Reinvestment Act. Participants
will hear from the policy leaders responsible for many of the programs
within the federal government, as well as nationally recognized experts
on topics such as privacy, financing, standards, and technical
assistance. In addition, practical insights on how to effectively
access funds from grant programs, and how to support effective health
IT adoption will be shared by veterans in the field. The final day of
the Symposium will be devoted to the role of health IT in health care
reform, which promises to be a hot topic as Congress deliberates health
care reform legislation in the next two months.

The
Health Information Technology Symposium at the Massachusetts Institute
of Technology is the only in-depth executive education event on health
information technology in the United States. It is a must-attend event
for anyone who is responsible for leading and developing programs
responsive to the health IT provisions in the American Recovery and
Reinvestment Act. Register today!

WHO SHOULD ATTEND

Clinicians
Hospitals and Other Healthcare Providers
Health Plans
Employers and Healthcare Purchasers
State, Regional and Community-Based Health Information Organizations
Public Health
Pharma, Biotechnology and Devices
Healthcare IT Consultants, Suppliers and Vendors
State and Federal Policy Makers
Health Services Researchers
Academics

Two options for attendance include:

Traditional Onsite AttendanceSimply register, travel to the conference city and attend in person.Pros: subject matter immersion; professional networking opportunities; faculty interaction

Live and Archived Internet AttendanceWatch the conference in live streaming video over the Internet and at your convenience
at any time 24/7 for the six months following the event. The archived conference includes speaker videos and coordinated PowerPoint presentations.Pros:
Live digital feed and 24/7 Internet access for next six months;
Accessible in office, at home or anywhere worldwide with Internet
access; Avoid travel expense and hassle; No time away from the office

A Hybrid Conference, Internet Event and Professional Certification Training Tool
The Leading Forum on Preparing for Federal Stimulus HIT Funding and Successfully Implementing EHR Programs
Sponsored by the eHealth Initiative and the MIT Center for Digital Business of the Sloan Business School
Onsite at Massachusetts Institute of Technology, Cambridge, MA
Symposium Hotel: Marriott Boston Cambridge
June 29 – July 2, 2009
Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months

To learn more and to register go to: www.HITSymposium.com