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Update on Modular EHR Technology: Harvard’s SMArt Research

Oct 6, 2010• 6

By DAVID C. KIBBE, MD and BRIAN KLEPPER, PhD

ONC awarded four Strategic Health IT Advanced Research Project (SHARP) grants earlier this year to

”…address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high-performing, learning health care system.”

One of these grants was awarded to a Harvard group led by Drs. Ken Mandl and Isaac Kohane, based in Children’s Hospital Boston and Harvard Medical School. This research team is tackling the problems associated with developing an ecosystem of modular, plug-and-play medical applications, what we have referred to as Clinical Groupware. (Disclosure: DCK is on the Harvard SHARP grant’s advisory board.)

The research is aimed at creating a “medical apps store” based on the iPhone/iPad model of substitutable applications running on a device or platform. The name of the project, SMArt, stands for “Substitutable Medical Applications, re-useable technology.” The approach could impact both the EHR industry and the federal regulatory and standards process, possibly within a relatively short period, i.e., 1-3 years, so we think it merits your attention.

Patients 2.0, HealthCamp and Health 2.0

Oct 6, 2010• 1

By Matthew Holt

Health Innovation Week is charging ahead. Eight events have already happened, but today begins the really heavy part for the Health 2.0 team*

We start at Healthcamp. Todd Park from HHS and Jack Cochran from Permanente kick this off. Danielle Cass, Mark Scrimshire, Mike Kirkwood & Maren Connary will host 200 of their closest friends in a great unconference setting at the Kaiser Garfield Center. That one’s sold out.

Next we race back to DC to VC, a meeting where (as you might suspect) the government types are talking to the VC types. That one is oversubscribed too.

We are then super excited about Patients 2.0 which will be a new type of meeting—driven by patients for patients, or by citizens for citizens. There are a few spots for that still open (about 175 patients signed up so far) and we want to encourage patients of all types to come join us for an amazing facilitated discussion in which everyone will contribute. That’s 3pm-6pm at the SF Hilton. See Gilles Frydman’s post on e-patients.net to get you fired up

Finally we’re at around 1,000 registered attendees for Health 2.0 which kicks off with a sponsors and speakers party on Wednesday night, and then the full two days of complete amazingness. Seriously—what you are going to see will knock your socks off. We can accommodate just a very few more, so we’re not going to post the “sold out” notice but the walk-in price will increase today. So if you’re on the fence, sign up by noon.

* The Health 2.0 team is my partners & co-Founder Indu Subaiya, Executive Producer Lizzie Dunklee, Marketing & Sales Whiz Hillary McCowen, Customer Service Star Bianca Grogan, Graphics Genius Lauren Golik and amazing interns from Norway Line Lie and Ida Seljeseth, Oh, and me too. They have all worked incredible hard and I am so grateful to them all

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Oct 6, 2010

What is a Patient?

Oct 5, 2010• 36

By ROB LAMBERTS, MD

What is a patient? What do they do? What’s their role in the doctor’s office? Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science?

Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs?

It depends. It depends on the situation. It depends on perspective.

Some physicians are very offended when the “consumer” and “customer” labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” – a sort of smart vending-machine made out of flesh.

Reckless REC Wrecking

Oct 5, 2010• 16

By MARGALIT GUR-ARIE

The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.

Overview

The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.

Funding

Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.

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Oct 5, 2010

Seeds of Destruction

Oct 4, 2010• 11

By JONATHAN BUSH

I never used to talk much with hospital CEOs. After all, if you’re running a hospital, improving the revenues of the physician practice by 6%, when the physician revenues only make up 10% of your overall revenues, doesn’t really make it to the scheduling screen.

Now it seems that hospital CEOs are the only new people I meet. In fact, I recently had dinner with over 100 of them at a meeting of the Leadership Institute in Washington, D.C. I gave the breakfast speech the next morning…it was awkward.

You see, I’m dying to be liked by these people—all people really—but these are health system/hospital CEOs and CMOs, many of whom are currently thinking about adding hundreds or even thousands of doctors to their payrolls. For a guy who does business services for doctors, who better to be friends with?! And yet, the only thing I could think to say to them was that they were sowing the seeds of their own destruction! I try to be smooth and cool when I get up in front of these groups, but somehow, when the microphone turns on, I can’t keep what’s on my mind from pouring out of my mouth!

I’m not exactly sure how I said it then, but let me try to say it like a grown-up now.Continue reading…

A more palatable path to rationing

Oct 4, 2010• 3

By DAVID WILLIAMS

Rationing is a very dirty word in America, evoking grim images of wartime Great Britain and –in the health care context– withholding of needed care from patients based on cost. But cut back on costs we must, and with magical thinking about the deficit becoming every more popular, we’ll have to find other ways to convince folks to do it.

Patient safety is a promising guise under which to achieve cutbacks, especially in costly areas where the dangers are real. The new radiation protection bill signed into law in California yesterday is a great example. From AuntMinnie (Calif. governor signs medical radiation bill into law):

The bill requires that radiation dose be recorded on the scanned image and in a patient’s health records, and that radiation overdoses be reported to patients, treating physicians, and the state Department of Public Health (DPH).

The law is clearly focused on overdoses, but once patients realize how much radiation they’re being exposed to –especially by repeated CT scans– many will start cutting back on what they request or accept. Over time, perhaps this attitude will spread to other areas of medicine such as surgical procedures and prescription drugs, where the risks are not always recognized today.

The federal government has done a great job whipping people into a sustained frenzy about airport security. All the time I hear people say they’ll put up with whatever hassles it takes at the airport in the name of security, and it almost seems the greater the hassle, the more satisfied people are to be subjected to it. I don’t admire this approach in airport security, but if the same zeal were devoted to patient safety (with the idea of reducing health care costs) I think it could succeed.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at Health Business Blog, where this post first appeared.

“What is… Wegener’s Granulomatosis?”

Oct 1, 2010• 4

By BOB WACHTER

A terrific article in The New York Times Magazine this summer described the decade-long effort on the part of IBM artificial intelligence researchers to build a computer that can beat humans in the game of “Jeopardy!” Since I’m not a computer scientist, their pursuit struck me at first as, well, trivial. But as I read the story, I came to understand that the advance may herald the birth of truly usable artificial intelligence for clinical decision-making.

And that is a big deal.

I’ve lamented, including in an article in this month’s Health Affairs, on the curious omission of diagnostic errors from the patient safety radar screen. Part of the problem is that diagnostic errors are awfully hard to fix. The best we’ve been able to do is improve information flow to try to prevent handoff errors, and teach ourselves to perform meta-cognition: that is, we can think about our own thinking, so that we are aware of common pitfalls and catch them before we pull our diagnostic trigger.

These solutions are fine, but they go only so far. In the age of Google, you’d think we’d be on the cusp of developing a computer that is a better diagnostician than the average doctor. Unfortunately, computer scientists have thought we were close to this same breakthrough for the past 40 years and both they and practicing clinicians have always come away disappointed. Before getting to the Jeopardy-playing computer, I’ll start by recounting the generally sad history of artificial intelligence (AI) in medicine, some of it drawn from our chapter on diagnostic errors in Internal Bleeding:

HIT Trends Summary for September 2010

Oct 1, 2010

By MICHAEL LAKE

This is a summary of the HIT Trends Report for September 2010. You can get the current issue or subscribe here.

Look beyond the EHR to healthcare transformation. A big idea that continues to emerge this month is to think beyond the EHR and Stage 1 meaningful use incentives toward future stages and healthcare transformation. Last month, in this column, we reported on a McKinsey analysis arguing that hospitals need to take the long view toward EHR and look for ROI beyond the meaningful use incentives. This month we learn from a CHiME survey that hospital CIOs are optimistic about earning federal incentives, although KLAS reports that many express that they are not getting their money’s worth from current IT investments. Epic users seem to be the major exception.

The answer according to Daniel Marino, CEO at Health Directions, is to seek an ROI through deeper connections with physicians and patients. These ideas are confirmed as well by a Deloitte report out this month that looks at HIT and patient-centered medical homes and by John Glaser’s outline of an HIT roadmap for accountable care organizations. CIOs are also asking to be included in the work of the regional extension centers (RECs) through a CHiME network. This seems like a good idea as we learn from an eHI report that progress at RECs has been slow.

Mobile health will be a growing part of the solution. PricewaterhouseCoopers (PwC) and Deloitte each released reports on how mobile health is increasing in importance. The PwC report predicts a $8B-$43B mobile health market with the key being provider payment reform. It proposes three emerging business models supporting transformation: operational-clinical, consumer and infrastructure. The applications include provider-patient communications from simple texting to virtual online visits. There is some evidence that consumers will pay for getting detailed clinical information to providers for review. The Deloitte report focuses on mobile personal health records (mPHR) and sees potential applications in obesity, post-acute, home care and diabetes. An innovative partnership between Roche and InterComponentWare underscores these issues with a marriage of Roche’s mobile Accu-Chek software and ICWs secure application infrastructure creating communications solutions for diabetes.