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Matthew Holt

Google Health finally up and open for business

May 20, 2008• 3

After a long time in discussion, Google publicly launched Monday its free online personal health records. The operation first made headlines a couple of months ago when Google announced it at the Healthcare Information and Management Systems Society (HIMSS). I was invited to the Googleplex, but due to a prior engagement, had to miss the chance to get it from the horses mouth.

Much like the "non-PHR" HealthVault, Google now allows consumers to download records from its eight initial partners and store them for free.

As the WSJ Health Blog points out, only a minority of medical practices keep records electronically. But the good news is that Google has been thinking not just about EMRs, but also about the rest of data that’s most useful (Rx and lab results) and has some big players, such as Medco, Walgreens and Quest on its list of initial partners.

Google will also have to spend more time now dealing with the privacy zealots and not just leaving it all to, well, me!

Although I wasn’t there, a much more famous health IT person was. John Halamka is the Chief Information Officer at one of Google’s initial partners, Boston’s Beth Israel Deaconess Medical Center (and of course colleague of THCB regular Paul Levy, and more recently himself a blogger). BIDMC has offered its patients a PHR for more than 7 years, and now that data can be brought into Google Health (and I assume vice versa). John’s post about the launch is below — Matthew Holt

By John D. Halamka

Beth Israel Deaconess Medical Center is now live with Google Health. In the interest of full disclosure, I am a member of the Google Health Advisory Council and have not accepted any payments from Google for my advisory role. BIDMC is also working with Microsoft Health Vault and Dossia.

I’m now at Google Headquarters in Mountain View with the Google Health team – Roni, Missy, Maneesh, Jerry etc. and several dozen reporters.

Here’s the functionality we’ve launched.

When a user logs into Google Health and clicks on Import Health Records – the following choices appear:

BIDMC
Cleveland Clinic
Longs
MEDCO
Minute Clinic/CVS
Quest Laboratories
RxAmerica
Walgreens

They are all early integrators with Google Health.

At BIDMC, we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google’s personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health. Once these records are uploaded, patients receive drug/drug interaction advice, drug monographs, and disease reference materials. They can subscribe to additional third party applications, share their records if desired, and receive additional health knowledge services.

Humana’s competition for change

May 20, 2008• 6

By Jen McCabe Gorman

Health benefits heavyweight Humana Inc. (HUM – 11.5M members) recently launched ChangeNow4Health, an ambitious, optimistic coalition inviting anyone to submit ideas to fix America’s ailing health care system.

The top three entries receive a $10k prize, and the top 20 get publication exposure galore, including a spot in Humana’s forthcoming e-book, “Tomorrow’s Health Care.” The big winning concepts have a chance to secure further funding and incubation support from Humana.

Full Disclosure: Shortly after this interview was conducted, ChangeNow4Health became a sponsor of The Health care Blog. However, if you think that in any way influenced the content of this article, you don’t know the Health 2.0 folks very well…

Cn4hds

On the second day of World Health care Congress 2008 in Washington D.C., I interviewed Elizabeth Bierbower, Humana’s Vice President of Product Innovation.

Bierbower, who has spent her career working with consumers, told me that ChangeNow4Health is looking for doable ideas that can quickly be put into play in the game as it is now, not how we wish it were.

They’re also harnessing the power of the semantic Web by partnering with Innocentive.com, an online community that posts projects from groups like the Rockefeller Foundation.

The contest has 4 categories:

Helping Consumers Make Smarter Health Care Decisions

Simplifying the Business of Health Care

Preventing Sickness and Maintaining Health

General Innovations in Health Care

The contest runs through July, and winners will be announced in August. Judges include industry experts, who are looking for “both an idea’s potential to bring about true change in a tangible way” and “feasibility for implementation now.”

Here’s a transcript of my conversation with Bierbower.

The Technology Hype Cycle: Why bad things happen to good technologies

May 19, 2008• 4

By Robert Wachter

Robert_wachter
Fresh on the heels of my recent bar coding epiphany comes another “unintended consequences” article. It turns out that the whipsawing that accompanies the adoption of new technologies is completely foreseeable, the “Why doesn’t this thing work right?” phase is as predictable as the seasons.

Thanks to Dr. Mark Wheeler, Director of Clinical Informatics of PeaceHealth, for introducing me last week to the “Technology Hype Cycle” concept. The Cycle, originally described by the IT consulting firm Gartner, is comprised of an all-but-inevitable series of phases that technologies tend to traverse after they are introduced. The five phases are:

Technology Trigger – The initial launch; a new technology reaches public or press attention.

Peak of Inflated Expectations – A few successful applications of the technology (often by highly selected individuals or organizations) help catalyze unrealistic expectations, often aided and abetted by hype driven by word of mouth, the blogosphere, or vendor spin.

Trough of Disillusionment – Virtually no technology can live up to its initial PR. As negative experience mounts, the balloon is pricked and air rushes out. The press moves on to cover another “hotter” technology, like a moth flitting to the light (see Phase II).

Slope of Enlightenment – A few hardy individuals and organizations, seeing the technology’s true potential, begin experimenting with it unencumbered by inflated expectations. Assuming that the technology is worthwhile, they begin to see and demonstrate its value.

Plateau of Productivity – As more organizations ascend the “Slope of Enlightenment,” the benefits of the technology (which by now has improved from its initial clunky phase) become widely demonstrated and accepted. The height of the plateau, of course, depends on the quality of the technology and the size of its market.

Going off the Grid – The Rise of ‘Direct Practice’ Medicine

May 19, 2008• 3

By Scott Shreeve

Grid (grĭd) n.

1. Something resembling a framework of crisscrossed parallel bars, as in rigidity or organization

2. An interconnected system for the distribution of electricity or electromagnetic signals over a wide area, especially a network of high-tension cables and power stations.

3. The interconnected system employed by the Medico-Industrial complex to create a third party payment systems which artificially creates complexity, increases costs, reduces quality, eliminates accountability, and destroys the patient-physican relationship.

As has been documented in this blog, I have been on a health care finance reform journey for the last six months. I was fortunate to be given the opportunity to work with Lemhi Ventures (outstanding group of health care innovators) on looking at new models of health care delivery, financing, and insurance. During the course of that project, I learned a ton about the nature of health insurance, current status of health plans (there has been plenty of interesting news the last six months on them here, here, here, and here), followed closely the presidential debates on health care reform and become familiar with many of the innovators within this space (Prometheus, Alan Goroll, etc)

A new article just published by MDNG Live (the same magazine that featured my cover story “Meet Your New Patients” last month) showcases Jay Parkinson with the catchy title, “Jay Parkinson Sells Out!” Catchy because one thing I don’t think you will be able to call Jay is a sellout. In fact, his “stick to my guns; this is how I believe medicine should be practiced” approach has enamored him to the public media and vicariously documented the groundswell of interest in this “new” health care delivery model. “New” in quotes, of course, because there is nothing new about this model of care delivery – a patient and a physician entering into a trusted relationship wherein the physician provides services that are valued by the consumer who pays cash for them. The millennial update is that physicians can now do this in new ways, with new devices that have become commonplace in every day life except for in the inane and archaic world of health care.

Malpractice premiums fall in Massachusetts

May 19, 2008• 3

By THCB Staff

Bay State doctors paid lower malpractice insurance premiums on average in 2005 than 1990, according to a new Health Affairs study. The study clashes with popular beliefs frequently touted by sponsors of legislative efforts to cap damage awards.

“If you don’t find a crisis here, you’re probably not going to find one nationally,” lead author and Suffolk University Law School scholar Marc Rodwin told The Boston Globe. “Clearly there are some increases in premiums and high premiums for a small percentage of doctors in three specialty groups, but that’s entirely different for the rest of doctors.”

Malpractice settlements in Massachusetts are the fourth highest in the nation, and the American Medical Association lists it as one of 21 states being in a crisis due to high medical malpractice payments and lack of laws to cap settlements, the Globe reports.

The Suffolk study found that most Massachusetts physicians paid an average of $17,810 in premiums in 2005, slightly less than the $17,907 paid in 1990, after adjusting for inflation.

The researchers analyzed data from 1975 to 2005 provided by ProMutual Group, the insurer for about half of the state’s doctors.

Rates for specialists in obstetrics/gynecology, neurological surgery, and orthopedics involving spinal surgery increased on average from $66,220 in 1990 to $95,045 in 2005.

So is malpractice reform a distraction from real health reform debate? Probably, but it is one that must be dealt with to get docs on the side of real health care reform.

Wishing for a smart health search

May 18, 2008• 4

By Dan Kogan Dankogan

Health care consumers today want to use the Web to find information online about doctors, specialists and care in general. And they want it to be useful.

Unfortunately, in the vast health search space based mostly on ad revenue and keyword densities, consumers often spend hours clicking links into dead ends and wind up with no more knowledge for their trouble.

A semantic Web promises more accurate and meaningful results, yet this technology is in its infancy. And most “trusted” health sites do not yet support semantic searches. Moreover, semantic search requires some knowledge of how to construct a search query as opposed to a simple Google-style search.

Jay Parkinson readying for re-launch

May 18, 2008

By Matthew Holt

In an interview in MDNG, Bill Schu wonders whether Jay Parkinson has sold out.

Not really, but we love him because he’s got that confidence thing down:

On the June 1 launch of Hello Health“ It’s going to kick ass. We found a space that’s a perfect location and a perfect node. [We] think the real issue is going to be managing demand.”

Whatever you think of his style, (and I’m a fan) the interface that Jay showed at Health 2.0 in March was very ,very innovative. And I for one am looking forward to the next iteration which starts June 1.

Read more about Parkinson here on THCB. The uncoventional doctor gained celebrity status last year when the media learned of his entirely virtual medical practice. Visit Parkinson’s Web site full of Health 2.0.

Advice to future nurses: ask questions, be proud

May 18, 2008• 9

By Kim McAllister

It’s that time of year when nursing and medical students shed their label (and protection) of student and head out to the workforce with their new licenses. Over at Emergiblog, veteran emergency room nurse Kim McAllister shared advice with new nursing graduates.

Here are her words of wisdom.

To the new nursing classes of 2008:

Your first year will be the most difficult as you acclimate to your new role as a professional nurse. Hang in there! Keep your focus on why you went into nursing to begin with.

Keep your eyes and ears open. Watch the nurses around you. You will be surrounded by role models. Take the best of what you see and incorporate it into your own practice. It may be hard to believe, but by the time the next class enters the profession YOU will be the role model they look up to.

Health care coverage restored — good for patients, maybe too late for plans

May 16, 2008• 1

By Matthew Holt

Saint Lisa Girion (and I say that without a smirk on my face!) reports in the LA Times on the latest chapter in the story she started about the ongoing saga of the retroactive cancellations of health insurance by all the big players in the California individual market.

Now Kaiser Permanente (which really should have been above this type of a mess in the first place) has decided to reinstate over a 1,000 of its cancellations, and Health Net, which was fined $9m in arbitration for one cancellation alone, has added a few more. This will intensify the pressure on Wellpoint, United Healthcare, and Blue Shield (the only one still fighting for the right to rescind coverage retroactively) to similarly cave. Kaiser, by the way, is also paying a paltry $300,000 fine. Health Net must be envious.

However, even if the others cave in and reinstate coverage, and pay for claims they previously denied, there are three remaining issues dangling from the controversy.

First, the Department of Managed Healthcare, which brokered the Kaiser deal, only regulates HMOs. Some “insurance” companies, like the Wellpoint and Blue Shield subsidiaries which did some of the cancellations, are regulated by the elected State insurance Commissioner Steve Poizner, who despite the R after his name, has been very aggressive in going after them. Adnd the City Attorney of Los Angeles, Rocky Delgadillo, is suing Health Net and Wellpoint in related cases. So the insurers legal problems with the government certainly aren’t over.

Then there are the lawyers. William Shernoff, the attorney who’s been going after Wellpoint since the stories first came out, told the LA Times that …

He would tell clients to "accept the reinstatements because that’s wonderful to get the medical care — that is important." But, he added, "as far as damages for past harm, there’s no doubt in my mind that the best place for them to get their full damages will be in court rather than in an arbitration process."

In other words, the plans can’t get away with just paying back what they owe. Shernoff is still coming after them for more. And $9 million multiplied by lots of cases smells very tempting to a lawyer who knows he’s on the winning side.

Bitter doc wants more respect for primary care

May 16, 2008• 17

By Sarah Arnquist

A primary doctor ranted anonymously this weekend on Kevin MD’s blog about the lack of appreciation for primary care in his small Midwestern town and predicted its future demise.

The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:

"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."

His rant has struck a chord in the medical blogosphere.