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Building Health into the Delivery System, Take Two
The following is a guest post from Rushika Fernandopulle, MD, MPP,
Co-Founder of Renaissance Health. This is part of a continuing series of blog entries cross-posted here, on the Center for Information Therapy Blog, and the Health Affairs Blog, the conference’s Media Partner in advance of the first-ever “Health 2.0 Meets Information Therapy” Conference in Boston on April 22-23.
Rushika provides another physician perspective on the same question answered by John Halamka this week,
“How do we build Health 2.0 into the delivery system?” Both Rushika and
John will participate in a debate on this topic in Boston.
I am an internist who has been working for the last 5 years to
design, build, and test radically new models of delivering primary care
to improve experience, outcomes, and affordability of care. I currently
serve as Medical Director of one of our redesigned practices in
Atlantic City, NJ. Yesterday afternoon, Mr. Santos, a 53 year old
Hispanic doorman at a local hotel, came in to see me quite visibly
distraught. His prior primary care doctor had without asking him or
discussing the issue checked a PSA (Prostate Specific Antigen) as part
of his “routine” blood tests and the results were mildly positive
(6.5). He was told, “Your screen for Prostate cancer was positive, you
need to see a urologist right away to have it taken care of.” All he
heard, of course, was “cancer” and “positive” in the same sentence.
Before Mr. Santos had time to even form the first of the dozens of
questions he had, the doctor had already strode out the door. Over the
next few weeks, Mr. Santos went online to read about PSA and prostate
cancer (which yielded over 6 million pages on Google), and started
talking to his friends at work about the issue. What he surmised, quite
correctly, is that the way forward for him was not at all clear, and
that instead of finding answers he only had more (but better)
questions. What really was his chance of having Prostate Cancer? If he
did what really were the benefits of catching it so early? Were the
risks of the biopsies worth this benefit? What were his other choices?
How Do We Build Health 2.0 Into the Delivery System?
By JOHN HALAMKA
The Health 2.0 Meets Ix conference, will take place April 22 and 23 in Boston, Massachusetts. As part of the lead-up to the conference, which will focus on the interplay between the Health 2.0 and Information Therapy (Ix) movements, the THCB, the Health Affairs Blog and other participating blogs will feature a series of posts discussing ideas that will be featured at the conference.
The post below by John Halamka is the second in this series. The first post in the series described the background and main themes of the Health 2.0 and Ix movements. In his post, Halamka offers a vision on how best to build Health 2.0 into the health care delivery system; he will participate in a debate on this topic in Boston. Halamka also recently contributed to a Health Affairs online package on implementing the health information technology provisions of the recently passed economic stimulus legislation. The package was published in conjunction with the Health Affairs March-April issue on health IT.
Over the past few months, I’ve seen a convergence of emerging ideas that suggest a new path forward for decision support and information therapy. I believe we need Decision Support Service Providers (DSSP), offering remotely hosted, low cost knowledge services to support the increasing need for evidence-based clinical decision making.
Beth Israel Deaconess has traditionally bought and built its applications. Our decision support strategy will also be a combination of building and buying. However, it’s important to note that creating and maintaining your own decision support rules requires significant staff resources, governance, accountability, and consistency. Our Pharmacy and Therapeutics Committee recently examined all the issues involved in maintaining our own decision support rules and it’s an extensive amount of work. We use First Data Bank as a foundation for medication safety rules. We use Anvita Health to provide radiology ordering guidelines based on American College of Radiology rules. Our internal committees and pharmacy create and maintain guidelines, protocols, dosing limits, and various alerts/reminders. We have 2 full time RNs just to maintain our chemotherapy protocols.
Op-Ed: No Need for Alarm Over Need for Foreign Nurses
Recent news coverage (“Amid Nation’s Recession,
More Than 200,000 Nursing Jobs Go Unfilled,” Reuters, March 8th) validly
and vividly calls attention to a nursing shortage in the U.S. healthcare system that
“threatens the quality of patient care even as tens of thousands of
people are turned away from nursing schools, according to experts.”
That article adds, “The shortage has drawn the
attention of President Barack Obama. During a White House meeting on Thursday
to promote his promised healthcare system overhaul, Obama expressed alarm over
the notion that the United States
might have to import trained foreign nurses because so many U.S. nursing jobs are
unfilled.”
Importing internationally-trained nurses is no cause for
alarm. The fact is, at least in the short term, the U.S.does have to
import these nurses, and plenty more of them, if we are to meet our rapidly
growing healthcare needs. Don’t understand why? Consider the
following:
Kaiser Permanente CEO George Halvorson on reform and life after IT
George Halvorson is the CEO of Kaiser Permanente, and the driving force behind both the HealthConnect EMR implementation and a national player in the health reform debate. I got to talk to him at HIMSS where he’d just finished giving the Monday keynote. We discussed KP HealthConnect, and the impact it’s having internally (good), why KP is making such a high-profile fuss about it (no, they’re not planning on expanding nationally or internationally), what AHIP and the insurers might face in the future (a choice between Canada and Switzerland), whether chronic care management can work without integration (he says yes), and whether the big guys will cast the smaller insurers adrift. You’ll have to watch for that answer.
Psilos Seeks $450 Million Health Care Fund, Defying Crunch
April 7 (Bloomberg) — Psilos Group, a New York venture-
capital firm focused on health-care technology and services,
plans to raise a $450 million fund, its largest ever, an
investor in Psilos’s most recent fund said.
The firm told some investors of its plans to gauge their
interest in a new fund, said Tom Reilly, managing member at
Fernwood Investment Management LLC in Quincy, Massachusetts. He
and his clients have invested with Psilos before.
Psilos’s investments include companies that drive
information technology into health care, an area promoted by
President Barack Obama, Chief Executive Officer Al Waxman said.
Its fundraising may also benefit from a wave of health-care
mergers, as companies seek combinations to contain costs amid
increasing pressure for lower medical expenses, said D. Brooks
Zug, senior managing director at HarbourVest Partners.
“The one area in private equity that has done really well
recently is health care,” said Zug, whose Boston-based firm
invests in venture funds on behalf of institutions. “It’s the
one area with a merger market that’s active. And you’ve got
Obama’s health plan. Those are two reasons to think it might be
a place to put some of your money.”
Glen Tullman, CEO of Allscripts
Glen Tullman, Allscripts CEO is one of the more charismatic, opinionated and politically connected players in health IT. I grabbed a few minutes with him at HIMSS 09 on how he’s positioned Allscripts to be a survivor in the coming consolidation, why he likes CCHIT (he’s a happy cat!), if SaaS (and AthenaHealth) is a real threat, and whether his buddy Barrack Obama (for whom he was on the original fundraising committe) is going to whisk him off to DC any time soon….
Advances in Online Care and Telehealth
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
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
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.
