Category: Uncategorized

Commentology

Apr 4, 2009

J Bean was among the commenters who took offense at the line of argument in Steven McKinney’s “Response to Doctors Raise Doubts on Digital Health Data.”

“I guess I have to admit that the EMR industry seems to have hit on a really unique marketing angle. “We have a crappy, overpriced product that would make the buyer’s life worse rather than better, but if they don’t want to buy it, it’s only because they have a psychological hang up. Why wouldn’t that work? Perhaps GM could give it a try too. Of course,
while GM’s cars used to suck, they’ve actually worked to make their
product better. Now they just have to overcome their bad reputation …”

Response to “Doctors Raise Doubts on Digital Health Data” S. Lohr NY Times

Apr 3, 2009• 6

By STEVE MCKINNEY

1410 Cambridge, England. Minor Canon Thomas Rangle did a final count of the books at Trinity Hall. He counted 122. Most of the books are biblical in nature or celebratory of our good and righteous benefactor Pope Urban V. Few have access to these fine artifacts because of their enormous value (costing as much as a farm or vineyard) and the cloistered clergy and Master of the university are unwilling to share their contents.

1448 Mainz, Germany. Goldsmith and known spendthrift Johannes Gutenberg invented the printing press with move-able type. It is known in town that he has printed school book texts and some indulgences; although, word is out that he is working on a fine bible. Cost is 30 Florins or the equivalent of three years working wages.

National HIT Symposium at MIT, June 29 – July 2, 2009

Apr 2, 2009

OVERVIEW

The recently-enacted American Recovery and Reinvestment Act will
provide more than $35 billion in funding for health information
technology. The health care reform debate in the Congress seems to be
coming to a head this summer. In this context, health care leaders are
grappling with how new emerging policies will impact their
organizations and how to assure that their organizations are
well-positioned to access the significant stimulus funding now emerging
from the federal government.

The HIT
Symposium, conducted at the Massachusetts Institute of Technology in
Cambridge, MA, is a must-attend event, that will help leaders from
every sector of health care, including those representing consumers,
employers, payers, providers, and vendors, gain timely intelligence and
practical insights on how to benefit from the health IT programs and
provisions of the American Recovery and Reinvestment Act. Participants
will hear from the policy leaders responsible for many of the programs
within the federal government, as well as nationally recognized experts
on topics such as privacy, financing, standards, and technical
assistance. In addition, practical insights on how to effectively
access funds from grant programs, and how to support effective health
IT adoption will be shared by veterans in the field. The final day of
the Symposium will be devoted to the role of health IT in health care
reform, which promises to be a hot topic as Congress deliberates health
care reform legislation in the next two months.

The
Health Information Technology Symposium at the Massachusetts Institute
of Technology is the only in-depth executive education event on health
information technology in the United States. It is a must-attend event
for anyone who is responsible for leading and developing programs
responsive to the health IT provisions in the American Recovery and
Reinvestment Act. Register today!

WHO SHOULD ATTEND

Clinicians
Hospitals and Other Healthcare Providers
Health Plans
Employers and Healthcare Purchasers
State, Regional and Community-Based Health Information Organizations
Public Health
Pharma, Biotechnology and Devices
Healthcare IT Consultants, Suppliers and Vendors
State and Federal Policy Makers
Health Services Researchers
Academics

Two options for attendance include:

Traditional Onsite AttendanceSimply register, travel to the conference city and attend in person.Pros: subject matter immersion; professional networking opportunities; faculty interaction

Live and Archived Internet AttendanceWatch the conference in live streaming video over the Internet and at your convenience
at any time 24/7 for the six months following the event. The archived conference includes speaker videos and coordinated PowerPoint presentations.Pros:
Live digital feed and 24/7 Internet access for next six months;
Accessible in office, at home or anywhere worldwide with Internet
access; Avoid travel expense and hassle; No time away from the office

A Hybrid Conference, Internet Event and Professional Certification Training Tool
The Leading Forum on Preparing for Federal Stimulus HIT Funding and Successfully Implementing EHR Programs
Sponsored by the eHealth Initiative and the MIT Center for Digital Business of the Sloan Business School
Onsite at Massachusetts Institute of Technology, Cambridge, MA
Symposium Hotel: Marriott Boston Cambridge
June 29 – July 2, 2009
Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months

To learn more and to register go to: www.HITSymposium.com

The Hive Mind

Apr 2, 2009• 9

By JOHN HALAMKA

Over the past few years, I've radically redesigned my approach to
learning. In the past, I memorized information. Now, I need to be a
knowledge navigator, not a repository of facts. I've delegated the
management of facts to the "Hive Mind" of the internet. With Web 2.0,
we're all publishers and authors. Every one of us can be instantly
connected to the best experts, the most up to date news, and an exobyte
multimedia repository. However, much of the internet has no editor, so
the Hive Mind information is probably only 80% factual – the challenge
is that you do not know which 80%.

Here are few examples of my recent use of the Hive Mind as my auxiliary brain.

I
was listening to a 1970's oldies station and heard a few bars of a
song. I did not remember the song name, album or artist. I did remember
the words "Logical", "Cynical", "Magical". Entering these into a search
engine, I immediately retrieved Supertramp's Logical Song lyrics. With
the Hive Mind, I can now flush all the fragments of song lyrics from my
brain without fear.

On Clinical Groupware, Interoperability and the HITECH Bill

Apr 1, 2009• 6

By CHARLIE BIRMINGHAM

Was it not Aristotle who once remarked “Nature abhors a front end that is not connected to its backend?”

In his recent, insightful blog here on Clinical Groupware as an alternative “meaningful use” of IT under the Health Information Technology and Economic and Clinical Health Act (HITECH), contained in the American Recovery and Reinvestment Act of 2009, David Kibbe commented that the primary purpose for using these IT systems is to “improve clinical care through communications and coordination involving a team of people, the patient included…in a manner that fosters accountability in terms of quality and cost.”

Yet it takes a “connected” health care ecosystem to make this kind of communication possible, and thus HITECH is replete with references to “interoperability” and “data exchange.” Indeed, the concepts of “meaningful use” and “interoperability” are inextricably linked in HITECH. For example, Section 4102 states that hospital incentive payments are dependent on demonstrating, “that during such period such EHR technology is connected in a manner that provides, in accordance with standards applicable to the exchange of information, for the electronic exchange of information to improve the quality of health care, such as promoting coordination of care.”

Commentology > More On Natasha Richardson

Apr 1, 2009• 3

Dr. Cory Franklin dropped us a note in response to THCB contributor Sarah Arnquist’s piece on the controversy surrounding the death of British actress Natasha Richardson, “Leave Natasha Richardson Out of the Healthcare Debate.”

“I wrote the article and have been reluctant to respond to criticisms
but since I read your blog I will here. So many people, both sides, are
tied into their political beliefs about health care that virtually no
one is actually looking at the record as we know it and asking a quite
logical question.

1. Here’s what’s important- the facts of this case- check the 911
transcripts in the Globe and Mail. The paramedics document the patient
has a Glascow Coma Score of 12 upon arrival to the first hospital at
St. Agathe. That is the key. The medical literature is quite clear –
patients who present with scores in that range on presentation almost
always survive. Where are the Canadian neurosurgeons and trauma people
commenting on that? The questions that should be asked in light of that
are who made the diagnosis and when, who treated and when, and what was
the condition upon treatment. But it is clear that at 4 PM she was
neurologically intact enough to survive with the appropriate treatment.
By the way, this major ski resort is no further from Montreal than Vail
or Breck is from Denver. And the Canadian defenders talk about how
close it is by ambulance to minimize the medevac issue. You can’t have
it both ways.

Whose Data is it Anyway ?

Apr 1, 2009• 18

By DOUG KLINGER

As we know, the Federal Government is planning to spend $19 billion to help the healthcare system upgrade its 20th century, non-standard, paper-based and proprietary system-based health records systems to a more standardized, electronic solution which will empower the healthcare system and consumers alike. This may be a side benefit of electing our first Blackberry-toting commander-in-chief. But, it’s not clear that everyone is ready to get behind the President on this one.

The New York Times just published an article entitled “Doctors Raise Doubts on Digital Health Data”. The New England Journal of Medicine just published two articles outlining the challenges with making the electronic records dream a reality.

In a recent post on this blog entitled, “Better Records on Our Cars Than Ourselves“, we discussed the critical importance of better connecting consumers to the healthcare decision-making and delivery process. Without engaging consumers effectively, it will be difficult to drive meaningful changes in healthcare consumption, healthcare effectiveness and ultimately, healthcare cost.

While the recent flurry of media coverage on the subject of electronic health records points to many of the reasons why the Government’s plan cannot or will not succeed, let’s take a minute to focus on why it should succeed:

1. Health information belongs to the consumers whose health is in question. While the information may be generated by doctors and other members of the delivery system, it is generated on patients and generally paid for by the patients themselves or their insurers (private or government).

2. Patients can and should be able to access and share their health information. Is it really appropriate, as some have argued, for some doctors or other members of the delivery system to decide if we, as patients, are “qualified’ to have access to our own health information ?

3. Getting health records into a more standardized, usable and transferrable format will surely take time and cost a lot of money. One potential benefit of this investment of time and money may be a new partnership between those who deliver healthcare and those who consume heathcare. In an industry which is today characterized by battling between constituents over who gets what care and who pays for that care, a bit of partnership might go a long way. Cal it a pollyanna-ish view, but without a vision to make things better we are may well be destined to mediocrity.

Why not focus on what we can accomplish vs what we cannot ? Why not begin architecting a plan to migrate from reliance on proprietary systems and paper records to an open, electronic solution that brings healthcare information together vs keeping it in protected silos ?

In closing, as the New York Times and New England Journal articles discuss, it seems appropriate to debate how the new electronic information will be used to improve healthcare quality. But, this debate can proceed in parallel with an effort to make the information more readily available in the first place. Without substantive changes to how we collect, store and transfer health information, the healthcare quality debate may stay just that – a debate.

Doug Klinger serves on the board of MedCommons. Before joining MedCommons, spent ten years with CIGNA, where he served as CEO of CIGNA Dental, among other roles. His resume includes a stint with Monster.com, where he led the company’s North American unit.

Health 2.0 NYC Chapter, has meeting, needs a place!

Apr 1, 2009• 2

Health 2.0’s NYC chapter is having a meeting this Thursday 4/2–-around 50 people are due to attend and it’s set to be a great session.

There is one minor problem though. Due to a last minute cancellation by the existing conference room sponsor the meeting needs a new venue. Please contact eugeneATnyhto.org if you can fit ~40-50 people for tomorrow evening from 6.30pm on.

(Eugene does have a back up, but it’s not ideal! And no this is not an April Fool’s joke)

BIDMC, Google Health and the data transfer problem

Apr 1, 2009• 15

By Matthew Holt

e-Patient Dave on the real world issues of moving data around in health care. The punchline—claims-based data without dates is not very useful, which requires those using the aggregators (Google health et al) to do a whole lot more work.

A really, really important article. Go read.

Imagining the Possible

Mar 31, 2009• 18

By Bruce Pyenson, Sara Goldberg and Kate Fitch

The emperor we call American healthcare is wearing no clothes—or perhaps too many clothes. The United States spends too much on healthcare. More than 25% of our healthcare dollars are wasted on unnecessary utilization. With this in mind, we recently completed research that identifies where that waste resides. Our analysis offers a target for how far the country might go in weeding out waste. We used the top-performing health systems as a basis, employing actuarial models to extrapolate results for the entire country. Our “16 to 12” model is a standard you can use to measure healthcare reform proposals. It can help you quickly identify defenders of different pieces of the status quo—and defenders of the absurd. In the few weeks since “16 to 12” came out, we’ve heard an almost universal reaction: “Of course you’re right, but [fill in special interests] won’t let it happen.” That’s amazingly positive—maybe we can actually reach consensus on fixing the system.

Framing the vision

In 2006, approximately 16% of the gross domestic product was spent on healthcare. Even if the United States were to reduce its healthcare expenditures to 12% of GDP, we would still spend far more than any other country. Is this possible? Our reduction is less than many estimates of healthcare waste. It’s also more than the annual spending on motor vehicles—4% of GDP could power a new American century.

Numbers for a growing consensus

Opposition to waste seems universal, from President Obama to Senator Max Baucus. They join a chorus of other voices, from CEOs and medical trade organizations to employer groups. Let’s take them all up on this point by quantifying opportunities for reductions in waste.

The table below offers a detailed inventory of efficiencies by service category, for one year’s costs. For example, inpatient services in 2008 cost an estimated $500 billion. Our working efficiency model reduced that by 38% to $311 billion.

These reductions are based on evidence-based best practices, including reducing unnecessary imaging and surgeries, better managing inpatient admissions, increased reliance on generic drugs, embracing primary care and certain electronic transactions, and other 20th-century (not even 21st-century!) management practices.

We’re proposing that healthcare payers (governments, employers, and individuals) could reallocate more than half a trillion dollars each year to other priorities.

The saved money could be used in other sectors, such as increased wages and infrastructure investment initiatives, and possibly even toward deficit reduction, reduced taxes, funding Medicare, etc.

The money saved could also stimulate the economy. And even though we’re working with 12% as the target model, we think it can get even lower than that.

Economic stimulus programs will likely increase healthcare spending, especially by federal and state governments. The 12% target may have to fight that surge, but we’re not talking about speculative long-terms gains, such as getting all Americans to exercise and reach a healthy weight.

What will the new system look like?

Although the healthcare system is typically divided into three categories—physicians/healthcare professionals, hospitals, and prescription drugs—our vision directly benefits patients.

We point to patients consistently receiving attention and care, according to treatment plans based on evidence-based medicine. All patients’ interactions will be streamlined through administrative systems, along with expanded hours via e-mail and phone access. We also suggest that the average patient will be more informed about choosing the appropriate care due to the reduction in costs; in turn, fewer medical errors should occur.

Another big change in the desired model is the re-engineering of hospital care.

Hospitals would operate on a 12/7 (12 hours a day, seven days a week) or 24/7 basis. While many hospitals currently don’t provide diagnostic treatment services on weekends or after standard business hours, that would change under this vision.

We believe hospitals can do a much better job lowering their readmissions. A separate report estimates that 18% of Medicare hospitalizations result in readmission within 30 days. A majority of those are potentially avoidable.

Our report didn’t delve deep into prescription drugs, but we suggest that there are efficiencies to be found in improvements to the FDA approval process and in a more widespread embrace of generic drugs.

It’s important to point out that we can become even more efficient than this vision. For example, we can dramatically improve end-of-life care, fix medical malpractice, and reduce administrative costs on better than a pro-rata-with-claims basis—all things that could push healthcare spending below 12% and improve the patient experience.

Winners and losers

Given this demanding vision, hospitals and other providers who don’t adapt to an efficiency- and quality-driven system will lose out.

For the nation, this vision offers more winners than losers. Patients and consumers would be the biggest winner and the U.S. economy overall would benefit. Employers would minimize the yoke of expensive benefits that has made it difficult to compete with leaner companies in other countries.

Proposals for healthcare reform now have the glamour of springtime fashions. Our 16% to 12% vision measures what’s under these emperors’ new clothes.

Pyenson, Fitch, Goldberg, Imagining 16% to 12%. 2009. Available online at http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/imagining-16-12-RR02-01-09.pdf

Lead author Bruce Pyenson, FSA MAAA, is a Principal and Consulting Actuary with Milliman, an actuarial and consulting firm with offices worldwide. Kate Finch RN serves as a Principal and Management Consultant with Milliman. Sara Goldberg, FSA, MAAA serves as Consulting Actuary with the firm.