Author Archives

Matthew Holt

AskDrRob (ADR): LOL, EHR, Oprah

Jun 19, 2010• 4

By ROB LAMBERTS, MD

It’s been a very long time since I did an Ask Dr. Rob post. It’s also been a long time since I shot a spitball out of a straw and hit someone behind the ear during social studies class. I realize that just because it’s been a long time since I’ve done something, it doesn’t mean the world is better off with me doing it again.

Still, there have been some interesting questions that have come up and I think it’s time they should be answered. They are both along the same line:

Question 1: What is the difference between health care and healthcare? I see that you contribute to the Health Care Blog, but you write about healthcare all of the time. What’s the deal?

Question 2: What is the difference between EMR and EHR? It seems that some people feel that it is vile and uncouth to call it “EMR”, only accepting people who call it “EHR” into their secret societies of people who are smarter than everyone else. What’s the deal?

To Space or notto Space

These two questions focus on a very important issue in our society:
the place of grammatical elitism in modern society. You see, the folks who write “health care” are very suspicious of those who write “healthcare,” as they feel that they wantonly leave out spaces between words and endanger the very fabric of the space time continuum by doingso. The “healthcare” camp, on the other hand, thinks that the “health care” crew is just dealing with pent-up frustration from being pottytrained (potty trained) too late and becoming the laughingstock (laughing stock) of the daycare (day care) center.

Alere interviewed at AHIP

Jun 19, 2010• 3

By Matthew Holt

At the AHIP conference in Vegas earlier this month I sat down with the CEO of Alere, Tom Underwood, and long-time friend of The Health Care Blog, Gordon Norman (Alere’s SVP of Innovation). I asked Tom about the services they provide within personal health support and their recent acquisition of RMD Networks.

Gordon got the big question: does disease management program really work? Tom got the easy questions about the future of the business.

Job Post: THCB Editorial

Jun 19, 2010

THCB is looking for talented interns to
assist with editorial, research and web production tasks as our web
site undergoes a major expansion. Perfect for a grad or med student
with an interest in journalism, public policy, and/or the business of
health care. Work out of a great home
office location in the Princeton area or remotely, convenient to both Princeton
University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research
opportunities may also be available in our San Francisco offices for
qualified candidates.

The Primary Care Workforce: Help is on the Way

Jun 18, 2010• 28

By GLENN LAFFEL, MD, PhD

The best electronic health record on the planet isn’t going to help anybody unless a physician uses it. The HITECH incentive scheme should enhance the woefully poor EHR uptake rates among US providers, as should innovative vendor business models that remove cost-barriers which have prevented many from getting in the game.

But there’s an even more fundamental issue, which is a looming manpower shortage among the ranks of US primary care physicians, a topic we’ve covered numerous times, most recently here. There simply aren’t enough physicians to use those EHRs!

Communities across the nation have long suffered from a lack of PCPs. The problem is expected to worsen as baby boomers age and the number of medical students who enter primary care continues to drop. If nothing is done to change current trends, the Association of American Medical Colleges estimates our country will be short 21,000 and PCPs in 2015 and a whopping 47,000 in 2025.

Now, finally, something is being done. And while it may not be enough, it certainly points us in the right direction. More importantly, it sets a precedent for future interventions by the federal government.

This Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius announced $250 million worth of new investments designed to support the training and development of more than 16,000 new primary care providers over the next five years. The investments were mandated by the Affordable Care Act, that controversial health care bill signed into law by President Obama in March.

Patient Communities… at Walgreens?

Jun 18, 2010• 2

By Susannah Fox

In
May, I spoke at the Chronic Care and Prevention Congress about my most
recent report, “Chronic Disease and the Internet.”

I talked
about the social life of health information and the internet’s power to
connect people with information and with each other. Living with
chronic disease is associated with being offline – no surprise. What’s
amazing and new is our finding that if someone can get access to the
internet, chronic disease is associated with a higher likelihood to not
only gather health information but to share it, to socialize around it.

I built
my talk around two examples of how health care can either take advantage
of patients’ shared wisdom (and innovate) or ignore it (and fail).

My
innovation example was CureTogether’s crowd-sourced migraine findings: 147 treatments were evaluated
and ranked according to their effectiveness and popularity, with some
surprising results. My fail example was taken from Diana Forsythe’s
classic essay, “New Wine, Old Bottles.” Designers of a migraine
information resource asked a single doctor what he thought patients
should know, rather than going directly to the patients. Not
surprisingly, the number one question asked by newly diagnosed migraine
sufferers was not addressed: Am I
going to die from this? Ridiculous to a doctor, but
essential to a patient.

Care, Primarily

Jun 17, 2010• 18

By ROB LAMBERTS, MD

He came in for his regular blood pressure and cholesterol check. On the review of systems sheet he circled “depression.”

“I see you circled depression,” I said after dealing with his routine problems. ”What’s up?”

“I don’t think I am actually clinically depressed, but I’ve just been finding it harder to get going recently,” he responded. ”I can force myself to do things, but I’ve never have had to force myself.”

“I noticed that you retired recently. Do you think that has something to do with your depression?” I asked.

“I’m not really sure. I don’t feel like it makes me depressed. I was definitely happy to stop going to work.”

I have taken care of him for many years, and know him to be a solid guy. “I have seen this a lot in men who retire. They think it’s going to be good to rest, and it is for the first few months. But after a while, the novelty wears off and they feel directionless. They don’t want to spend the rest of their lives entertaining themselves or completing the ‘honey do’ list, but they don’t want to go back to work either.”

He looked up and me, “Yeah, I guess that sounds like me.”

“What I have seen work in people, especially men, in your situation is to get involved in something that is focused on other people. Volunteer work at the food pantry, work for Habitat for Humanity, or anything else that lets you help other people. I think the reason people get depressed is that they turn their focus completely on themselves, which is not what they are used to when they are working.” (I knew that this man had a job that helped disadvantaged people).

“That’s great advice, doc.” he said, with a brighter expression on his face.

“It’s from experience,” I responded. ”I’ve seen a lot of retirees start to feel like they are on a hamster wheel, just entertaining themselves until they die. I know I wouldn’t want to retire that way. Knowing you, I wouldn’t imagine you would either.”

We talked for about 15 minutes about the various groups around town that would need someone of his skills. I told him about how my parents went to Africa for a year after Dad retired. He actually taught physics over there, but that is what they needed. Of all the time I spent with him, over half of it was regarding his post-retirement “blues.” He wasn’t clinically depressed, so I couldn’t charge for depression as a diagnosis. The code I used? 99214 for Hypertension and Hyperlipidemia.

Healthcare Reform, Payment Models & Acquisitions

Jun 17, 2010• 5

By JOHN MOORE, CHILIMARK RESEARCH

Earlier this week, GE announced the release of Centricity Advance, their solution for the ambulatory market. Centricity Advance is basically a build-out/rebranding of MedPlexus an SaaS EHR solution vendor that GE acquired in March 2010. GE now joins others (see below) in the EHR market who are striving to provide a complete acute to ambulatory EHR portfolio.

Editor’s note: See also THCB founder Matthew Holt’s podcast interview this week with GE VP Mike Barber for more context on this story.

Recent weeks have seen a number of intriguing developments in this space, including:

AllScripts’ acquisition last week of Eclipsys.

NextGen, a traditional ambulatory EHR vendor whose parent, Quality Systems Inc. acquired Sphere Health Systems and Opus Healthcare Solutions to target rural acute care facilities.

While some may argue that the HITECH Act and meaningful use requirements are core drivers for these acquisitions (e.g. tap future incentives payments in new markets), the real reason is the need for large healthcare organizations to more closely align smaller affiliated practices to their operations in anticipation of healthcare/payment reform (bundled payments, patient-centered medical home, etc.). These large institutions are increasingly seeking out such fully integrated acute to ambulatory solutions and is one of the core reasons that EPIC (they started in ambulatory and grew organically into acute) has seen success in the market. It remains to be seen if those pursuing an acquisition strategy will be as successful as EPIC for it often takes years for two systems to be combined in a truly integrated fashion.

Op-Ed: Defending Regi

Jun 17, 2010• 32

By JOHN GOODMAN, PhD

Matt you can’t have it both ways.

First you attack a well-known Harvard professor, Regina Herzlinger, for accepting an invitation to become a director at a company that only later was publicly accused of accounting problems. Then you denigrate her when she goes public with her attempts to get the board to move more aggressively to tackle those problems and ruffles the feathers of several board members who retaliate. You then insinuate that she profited while shareholders suffered and yet you dismiss it as sour grapes when she resigns before her term ends (costing her a significant sum of money in the process).

And while we’re at it, how can a site with the name “The Health Care Blog” routinely ignore the ideas of one of the most creative thinkers in health policy? This field is so completely dominated by unoriginal thinking; I don’t know why you don’t welcome with open arms someone who is not just parroting the latest fad.

And speaking of character, we have just been through a period when an embarrassingly large number of leading health policy analysts sold their souls, their self-respect, their reputations and whatever is left of their intellectual honesty to the highest bidders in what we loosely call “health care reform.” In the midst of all that, I would think that someone also has shown the unimpeachable rectitude and character Professor Herzlinger has is deserving of a THCB award.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

Monsters Inside of Me

Jun 16, 2010• 6

By MICHAEL TURPIN

Why do they lock gas station bathrooms? Are they afraid someone will clean them?” Anonymous

Growing up in the era of “Walk It Off” parenting, I was never
allowed to get too in touch with my hypochondria. Occasionally, I might
get my hands on a National Geographic magazine that would feature
Amazon explorers, tribes that had never been touched by the outside
world or an expedition into the heart of darkest Africa. To properly
frame the perilous nature of uncharted corners of the world, the
articles would relate the hazards associated with indigenous people,
nasty flora, unpredictable fauna and myriad microscopic predators that
could all kill a man – often in bizarre and horrific ways.

I did not just want to know about the 1000 ways in which I could die
– – I wanted to witness them. The fact that most of these diseases,
parasites and insidious bacteria were transmitted through unclean
drinking water, monkey bites, and unnatural encounters in dark,
forbidden places did not matter to me. I was certain these germs were
lingering everywhere.

Learn from Your Competitors’ Mistakes

Jun 16, 2010• 1

By MERRILL GOOZNER

The Wall Street Journal (subscription required) reported last week on a Food and Drug Administration-supported effort to encourage companies to share data about their failed Alzheimer's Disease drugs.

Comment: We need more of this unmarket-like behavior. Consumer advocates have long pushed for companies to reveal the data from clinical trials for drug candidates that failed. Their concern is safety. They hope that data from failed "me-too" drug experiments might provide early clues signaling an entire class of drugs may have rare but deadly side effects.

But industry would also profit by sharing knowledge about its failed experiments. Knowing where one company fails would allow other companies to avoid going down the same unfruitful path. As things now stand, secretive companies reproduce each other's errors, which only adds to the declining productivity of industry R&D. It's also more ethical, since enrolling patients in a clinical trial that is testing a hypothesis that has already failed (but the results were kept secret) subjects them to risks with no hope of benefit.

Of course, when it comes to Alzheimer's, failure is the norm. As usual, Ray Woosley of the Critical Path Institute, who was once touted as a possible leader for the FDA but is now encouraging industry-FDA collaboration, hit the nail on the head. "We really believe drugs are failing because we honestly don't understand the disease," he told the Journal.