Tag: EHR

Hello Health open for business

Aug 25, 2008• 13

By Matthew Holt

Hello Health, the clinic that Jay Parkinson has been promoting for a while, is open for business. If all the patients are as happy as the first patient, success is assured!

The deal is that they’ve gone with mid-range concierge fee ($35 a month—around the cost of a low cost cell phone plan or high-end Netflix?) for patients to get access/membership and then have fixed charges thereafter. That amount is about three times what I pay for very basic low-end concierge services (basically email) at Tom Lee’s Metropolitan Medical Group in San Francisco, but way less than the typical $150–200 a month fee for high-end concierge practices.

What remains to me the tricky factor in their vision is how they’ll make this work with the bureaucracy & accounting behind high deductible plans (without taking on a ton of staff). But however that piece works out, someone needs to shake up primary care. Jay and his 2 colleagues are young entrepreneurial docs giving it a shake.

Health 2.0 had a film crew there with David Kibbe acting as roving reporter at the launch party. Much more on both these topics to come, but remember that Hello Health is also working with MyCa on a very interesting new interface to the EMR and much more.

Yes, you’ll see much more about the Health 2.0 Across America video starring David Kibbe and the MyCa interface at the Health 2.0 Conference.

Health IT policy: the fur is flying

Aug 19, 2008• 11

By Matthew Holt

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

The call for government EHR unification

Aug 14, 2008• 2

By Scott Shreeve

While on my VistA kick (here and here), I need to respond to several important errors of understanding in the recent press release hailed with a “Bravo!” from Fred Trotter. I also wanted to take the opportunity to mention a significantly broader and more meaningful opportunity that the open source community should be rallying around.

First, so people are clear – the Department of Defense does NOT currently use VistA. They haven’t since their 1988 decision to have SAIC fork the code. The only reason that VistA is mentioned as part of the DoD’s selection process is that their own physicians are clamoring to throw away the current system in favor of VistA. While the DoD is correct in identifying some of the weakness of VistA, they also appear to recognize many of its outstanding clinical attributes.

Comments from a July 21 letter from Principal Deputy Assistant Secretary of Defense for Health Affairs Stephen Jones seem to indicate a ray of hope for a VistA compromise: “There is a strong feeling here and at the VA that the best approach is a convergent evolution of the two systems. This approach optimizes the strengths of both systems while creating interoperability that will drive more universal information exchange.“

Omnimedix still fighting Dossia owners

Aug 13, 2008• 1

By Matthew Holt

Kleinke JD Kleinke and Omnimedix are still in business and still fighting a pretty serious lawsuit
about the Dossia breakup. I talked with JD yesterday. The team is working on several super secret client projects, but it’s tough to run a small consulting shop and keep a protracted lawsuit open, so they’re passing the hat! Why keep the lawsuit going?

Well, there’s obviously stuff that JD couldn’t tell me, so this is speculation but it’s clear that this is much more than an a “vendor didn’t deliver/client didn’t pay” dispute. JD was always very vocal about an open nonprofit being the protector of the Dossia members’ employees’ data, so I surmise that contractual disputes about who got access to what data are at the root of this. It would be interesting (if practicably impossible) to compare Dossia’s contact with Omnimedix in their contract with Indivo.

More generally, JD and I talked about whether there’s a need for a Dossia-type entity when there’s Google Health and HealthVault. Here’s what JD said about Microsoft and Google’s privacy stance.

“In both cases they’ve violated their own operating principles as businesses to do the right thing.”

MedSphere CEO talks about big goals

Jul 28, 2008

By John Halamka

I had lunch recently with the CEO of MedSphere, Mike Doyle, to learn about the
company’s plans for OpenVista. The idea is simple — take the the publicly available code from the Veterans Administration clinical information system, add new modules such as revenue cycle interfaces that are needed in practices outside the VA system and include support/implementation services. In effect, you’ll have the "Red Hat Linux" of the electronic health record world. Medsphere

Medsphere has chosen to package Vista in two forms – Enterprise for large hospitals/integrated delivery systems needing departmental system and Clinic for small offices/multi-specialty clinics needing strong outpatient functionality.

Hospital rankings for positive press or for real?

Jul 17, 2008• 2

By Sarah Arnquist Wirehospitals

Hospital & Health Networks magazine announced America’s "100 Most Wired" hospitals for 2008 this week.

You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report.

Hospital & Health Networks created the "most wired" ranking a decade ago. This issue’s cover story says that wired hospitals have happier patients and higher quality measures than their less technologically advanced peers.

"Taken together, the patient satisfaction and quality indicator analyses
provide the strongest evidence in the 10-year history of the Most Wired
Survey and Benchmarking Study that information technology makes a
difference in both the patient experience and the quality of care."

Mr. HISTalk has a more cynical take on the ranking.

Health IT supporting our troops

Jul 16, 2008

By John Halamka Coin

I spent yesterday in Washington with Major General Elder Granger, Deputy Director in the Office of the Assistant Secretary of Defense for Health Affairs.

We discussed electronic health records, personal health records, decision support, and interoperability. Here’s a brief overview of the electronic systems supporting our troops. Go here for additional details.

AHLTA-T is a PDA version of the Department of Defense Health Record running on Windows CE devices. The DOD tests all of its battlefield technology at Fort Detrick for ruggedness in battlefield conditions — heat, sand, ice, water, and physical abuse. A shock resistant enclosure keeps the PDAs safe. The AHLTA-T record itself has an iPhone-like interface with radio buttons and touchable graphics to rapidly record a battlefield assessment. It generates a structured history and physical, then creates a care plan based on triage rules and best practice protocols. The user interface is designed to be easy to navigate in high stress conditions. Given the lack of WiFi and reliable cellular in battlefield conditions, cradle sync is used to transfer all the medical records to AHLTA system.

Once in AHLTA, battlefield data joins the patient’s lifetime health record and is available worldwide for clinical care. Patients may be evacuated to Germany and upon arrival, their entire updated record is available to the care team.

AHLTA data is transferred to a Clinical Data Repository where it is available for institutional review board approved clinical research, surveillance, and quality reporting. DOD leadership has real-time dashboards showing injury, biosurveillance, and medical supply data.

The DOD also has an integrated pharmaceutical repository with over 1 billion records from pharmacies and pharmacy benefit managers which dispense medications to the armed forces and their families.

When a patient leaves the armed forces and becomes a Veteran, their lifetime medical record is available in the Veteran’s Administration VISTA system via the Bidirectional Health Information Exchange (BHIE) built to connect the DOD and VA systems.

It’s an impressive system, incorporating national standards, serving our troops throughout their lifetime.

As I left, General Granger shook my hand and passed along his personal coin (photo above), just as Dr. Koop had done with me a few months ago.

I look forward to a productive collaboration between the DOD and the non-profit health care world I live in everyday. I’m confident there are decision support alerts/reminders, mobile device implementations, and data exchange experiences that we’ll be able to share for our mutual benefit.

Untangling the electronic health date exchange

Jun 23, 2008• 12

By David Kibbe Kibbe

The purpose of this post is to help a non-technical audience untangle some of the confusion regarding health data exchange standards, and particularly come to a better understanding of the similarities and differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document
(CCD). But what I’m most interested in is getting beyond the technical, political, or economic positions and interests of the proponents of any particular standard to arrive at some principles that demonstrate in plain language what we are trying to achieve by using such standards in the first place.

Frankly, I don’t give a hoot about what standardized XML format for
capturing clinical data and information about a person becomes the norm
in the health care industry over the next several years. I do care
that the decision is made by the people, institutions, and companies
who use the standards, and not made by a quasi-governmental panel or a
group of "industry experts" whose economic or political interests are
served by the outcome, and dominated by a particular standards
development organization with whom they are very cozy.

In other words,
I do want free and open market forces to be able to operate freely and
openly as health information exchange evolves, in part because I
believe market forces will work in the direction of continuously
improving health IT, whereas in my experience top-down efforts are
often protective of established interests and discouraging to
innovation.

Editor’s note: When republishing Kibbe’s post today, we accidentally deleted the great conversation going on in the comments section. If your comment was deleted, we encourage you to submit again.

Kaiser tiptoes into HealthVault & tells THCB about it, with UPDATE

Jun 9, 2008• 11

By Matthew Holt

Kaiser Permanente signed on this morning for a pretty extensive pilot with Microsoft,
allowing its 159,000 employees to copy their online health records into HealthVault. This is a big coup for Microsoft and a fairly ambitious move for KP which to this point hasn’t said much publicly about the data transferability it was going to provide for its members. This is a clear signal.

Assuming that the pilot is a success, presumably all Kaiser members using My Health Manager (over 2 million now and heading to 3 million at years end) will soon be able to move their data to HealthVault. We are potentially seeing the first real example of mass scale data interoperability onto a platform not connected to a health care organization. And obviously, Google is playing in this same space too.

Once the data is collected in HealthVault, there are lots of possibilities for what can be done with that data, and what services can be offered.

Back in the days when Justen Deal was causing havoc with HealthConnect, I had a somewhat unorthodox interview with Permanente’s Andy Wiesenthal — in which (without KP’s PR folks knowing) I called him in a taxi on a cell phone late on a Friday night. Perhaps it’s a mark of how far THCB has come (you decide if it’s good or bad) that in regular business hours on Friday, KP’s publicity machine lined me up for a pre-release interview with Peter Neupert, Corporate VP of Microsoft Health Solutions Group and Anne-Lisa Silvestre, VP of Online Services at KP.

Readers respond to Google Health launch

Jun 2, 2008

By THCB StaffGoogle’s recent launch of its Health Beta personalized health records provoked great commentary from THCB’s expert contributors and thoughtful comments from readers. Generally, readers acknowledge Google’s system is not flawless, they are enthusiastic something tangible finally exists.

But the privacy concerns persist.

In response to Matthew’s "Serious test drive," E-patient Dave wrote,"The privacy issue is simply huge. I don’t know why the advocates don’t get it. The lay people I talk to *all* express concern about it; some flat-out say "No WAY I’m giving them my data."

He continued,"I’d feel a lot better if all the enterprises that want to get into this great opportunity (and it is one) would work to get HIPAA updated to cover their case."

Keith Schorsch’s post on whether consumers care about Google Health also generated a lot of comments — mostly from people who shared his skepticism.

"While I agree that there certainly is and can be value in a PHR for
consumers, I think this is the right discussion. Do consumers even know
what a PHR is and that it is an option for them? I think Forrester’s
data shows that something like 75% of consumers don’t," George Van Antwerp wrote