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Category: Health Tech

EMR use: on the steep part of the S curve, or being replaced by a new idea?

Ten plus years ago, I was giving talks suggesting that at some point relatively soon the EMR was going to become a reality. In 1999, at Harris Interactive I actually got the chance to launch a study which I hoped was going to soon show a relatively steep growth in EMR use in physicians’ practices. (The study was called Computing in the Physician’s Practice). Sadly because the study wasn’t a huge financial success and because I wandered off to do other things, it was only fielded in late 1999 and early 2001.

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Management guru Tom Peters likes Health 2.0, Wennberg, PLM, Millenson, but not the medical establishement

I didn’t know that Tom Peters (the In Search of Excellence guy) knew or cared about health care, but he certainly does.

In just one blog posting he reveals his impatience (putting it mildly) with the general level of doctors skills, his approval of Michael Millenson’s and the Dartmouth group’s work on medical quality variation, and he shows that he likes Health 2.0 and PatientsLikeMe — not least because he thinks that the medical establishment is reacting negatively to them!

Now, Sleepless in San Francisco

Having returned from Seattle, the persistent itching from the sand-fly bites of Roatan has awakened me at 5 a.m. So I’m commenting on three pieces of news, which I’ve commented on before here and at Spot-On.

First, United HealthGroup has introduced two new things this week. One is is a consumer portal/WebMD competitor called myOptumHealth, which gave a sneak preview (and was a sponsor) at the Health 2.0 Conference in October.

At first blush I like the look of what they’ve pulled together, although the about us section doesn’t exactly tell you much about who owns Optum! But the really interesting product United launched this week was aimed right at me. It’s an option to repurchase your individual health insurance without being re-underwritten and rejected.

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Sleepless in Seattle

In a 36 hour span I left the mountains of Copa Ruinas in Western Honduras, had dinner in South Beach, Miami and after stopping off to see that Health 2.0 central in SF hadn’t collapsed, ended up in Seattle. I woke up early (had to get that in there to match the title) and hustled off to the main symphony hall because it’s the 25th anniversary of the Group Health Center for Health Studies. (The research arm of Group Health Cooperative of Puget Sound)

There the question of the day is, why haven’t integrated group practices (like Group Health & Kaiser) spread across the nation? And is there something that the new Administration can do to help make it so?

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Is much more than we think really possible?

On THCB today Maggie Mahar basically tells the health reform crowd to be patient. But two members of the unreconstructed left in other venues don’t agree. In the NY Times Paul Krugman says that deficit spending is OK, and correctly points out that Obama has a real mandate to fix the underlying problems of middle America (and yes that would include health care). And yes polling data shows that on balance America is as liberal now as it was in the 1960s. 35 years of blind-ish belief in conservatism is more or less over.

And if you want to see the optimist’s view on what Obama might do, Jonathan Cohn has a long article in The New Republic called Surgical Prep explaining why now is the time for health care reform and how the brass knuckles approach is being put together to get it done.

I’m not sure I’m there but let’s not underestimate how big a political win this was.

What I want to happen and what I think will happen

Election day. At last it’s over. A gazillion dollars, mostly wasted making TV stations richer. Two years of
campaigning resulting up in 3–4 months where rushed decision making will create a future that we all have to live with.

It looks pretty clear that Obama will win, with an increase in Congressional control for the Democrats. Although we Dems are used to losing when it never seemed possible…

So what do I want to happen? Certain things need to be done straight away.

1) Guantanamo Bay must be closed & torture renounced.

2) Rampant spying on Americans, national security letters & government abuse of power must be ended.

3) We need a declared route out of Iraq, immediately. (And a truth commission to deal with the lying sacks of **** who got us in there to reward themselves and their now much richer friends wouldn’t be a bad idea).

4) America must rejoin the international community, including
abiding by the principals of Kyoto, the International Criminal Court
& the UN Human declaration of human rights.

5) The drug war should be ended and a rational system of regulation introduced (OK I know I’m dreaming on this one).

6) A Manhattan-type project should be set up to really push the development of alternative energy. (I have some hope this will happen)

7) Complete house cleaning in the Federal departments and agencies
like Justice, EPA, FDA and many more, which have been over-run by
politicization and an attack on science. And a re-adoption of a serious
role for government.

8)  A really broad effort to fix the discriminatory, unfair American health care system

But what do I think will happen?

Less than that I’m afraid. But let’s stick to health care reform
which (other than the drug war) of all the above is the least likely to
happen.

The conventional wisdom is still probably correct.

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Perhaps Obama will have to do rather more than he says he will

I feel like Mrs Miggins in my favorite comedy show, Blackadder. It’s the scene when Blackadder says “The hustings are down, the candidates have spoken and after the madness of a general election, we can return to normal” and Mrs Wiggins says “Has there been an election? I’ve never heard about it?” (Yes that is a much younger version of Dr House playing the Prince Regent).

Anyway I’ve had my head so far up the Health 2.0 rear that until this week I haven’t really paid too much attention to the election. In all honesty (speaking as a Democrat who could never conceive of a Republican win in the current circumstances) I’ve been trundling along expecting an Obama win with the same set of Democrats running Congress but not with the vicious efficacy that Tom Delay & friends showed in getting their bills passed in 2001–2004. So I haven’t been expecting that much change in the healthcare system.

But if you do believe something is going to happen, over at the HuffPo Susan Blumenthal, whom I saw earlier this week, nudges me towards her side by side comparison of the  U.S. Presidential Candidates’ Health Care Plans.

On the other hand, and I’ll be writing more about this before the election, if the recession is bad enough—and this morning’s numbers suggest that it could be—what Obama is proposing may be torn up and we might do something much more radical. It sounds crazy, but then again a year ago you wouldn’t have thought that the US taxpayer was going to own the biggest insurance company and most of the banks. After that actually IS socialism according to Lenin’s “owning the commanding heights of the economy” definition, no matter how much Sarah Palin rails against it. And socialism in health care makes rather more sense than socialism in banking, or autos.

So if there are 90 million uninsured and 15% unemployed, perhaps a Federal rescue package for health care is on its way—we just haven’t seen it poke its head out of the water yet. And if it does, it will likely be much more radical than the gentle proposal Obama is starting with, which the conventional wisdom says is a non-starter anyway.

The latest on technology-enabled DM

I sat in on another session at Connected Health about A Progress Report on Medicare’s CMHCB (Care Management for High Cost Beneficiaries) Pilot. This is the medical group alternative to Medicare Health Support operated via providers not health plans. Some quick notes…

Suneel Rataan from Health Hero: We know that we can make DM work using the Health Buddy and supporting nurses in the VA. But could they make it work in a community setting under Medicare Fee for Service. We know how badly Medicare Health Support has gone, what about this one (CMHCB)? “We can’t talk about the results but our program has not been terminated!” (Actually they have applied for an extension & expansion of the project).

Couple of others, one from Montefiore in the Bronx another from Partners—the Partners one has a variety of practices and the problem is that they need to have the consistent program across those.

Health Affairs makes an apPaul(y)ing choice

Health Affairs ran a couple of partisan analyses last week. Joseph Antos, of AEI, Gail Wilensky, former Bush 41 HCFA administrator, and Hans Kuttner labeled the Obama plan as excessive tax and spend socialized gulag regulation.

In the other analysis, four liberal academic wonks — Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz — derided the McCain plan as the counter-productive ravings of a right wing nutjob. OK so they didn’t exactly say that, but you get the message. No surprises here.

The McCain plan is so far out of the mainstream that, when Bush proposed something very similar in 2006, he could not even get it introduced into a Republican-controlled Congress. Obama’s plan is a wishwashy centrist Democrat plan that doesn’t even pretend to get to real universal coverage and ignores the fact that the vast majority of Democrats prefer a straight single-payer plan (and so does he when scratched hard!).

So who does Health Affairs chooses to create a middling compromise between these two?

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23andme gets unwanted publicity

Sergey Brin, Google co-founder and husband of 23andme co-founder Anne Wojcicki, has announced that he has the gene for Parkinson’s disease and that his mother carries it to. She already has the disease, as did her aunt. Sergey has written about this on his new blog Too and it was picked up by the NY Times. Unlike the issues around Steve Jobs and his cancer, there’ll be no impact on Google’s business. If—and it’s only an “if”—Brin develops Parkinson’s it’ll be many many years from now. However, Parkinson’s is a very serious condition which people are right to dread—the father of one of my best friends has it, and his life is extremely grim.

Coincidentally I was doing my “spit” for 23andme just a few minutes ago when this story went on the NY Times site. So I can’t tell you about my results from them yet. I have though had my genome sequenced by Navigenics. Thus far none of the results have been compelling enough to make me actually do anything.

That of course is also Brin’s problem. At the moment there’s nothing he can actually do. In Genomics diagnosis is now running far far ahead of capacity for treatment.

But the hope of services like 23andme, Navigenics, DeCodeMe, and others aimed at promoting cures and treatments like CollabRx and Cure Together, is that the body of knowledge from both genomics and overall patient experiences will advance fast enough that the current situation of “more diagnosis with less ability to change the outcome” will slowly change to one where knowing your likely health future will help you avert some of the worse consequences.

Let’s hope so for Sergey’s sake and all of ours.

UPDATE: Just to clarify the headline, I don’t mean that 23andme does not warrant or deserve this publicity, or that they have done anything at all bad here. When I say "unwanted" I mean they are getting publicity for their service because of a situation that no one would want to happen to them (or to Sergey Brin). But of course that’s true for many many great health care services of all stripes.

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