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Tag: HIT

mHealth: Seemingly Stuck in Neutral

As many readers know, Chilmark Research has been a strong proponent of mHealth for several years. Despite this enthusiasm, we sometimes come away from a conference, such as this week’s mHealth Summit, with the feeling that the only ones making a living with mHealth are conference organizers. Maybe it was the format of this particular conference – too many presentations that were not well vetted for relevance and content. Maybe it was the lack of exhibitors – where is the rest of the legacy HIT market who are all claiming to be bringing mHealth solutions to market? Maybe it was hearing too many mHealth vendors with weak value propositions asking the Feds to step in and jump start this market. Or maybe it was the over reliance on government presentations and an ill-fated alliance with HIMSS, who sponsored less than visionary sessions. Hard to point to any single thing that contributed to this ho hum feeling, so let’s just chalk it up to all the above.

That being said, however, the mHealth Summit, now in its third year, is the best conference one can attend in the US if one wants to get the global pulse on all things mHealth.

From its humble beginnings where the first conference was quickly over-subscribed and held in a small DC amphitheater, this year’s event drew over 3,000 attendees to the massive Gaylord Resort outside of Washington DC for three days of countless sessions running concurrently covering every aspect of mHealth one could imagine. While most sessions were structured as panels with several short presentations, one was thankful that presentations were indeed short for few had substance. But nearly every session had one stellar presentation that kept one hopeful. Those were the gems of this event and like any event, the networking that occurs in the halls.

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Obituary: RIP to the EHR

I just received another email from another EHR Vendor pandering to physicians to implement their technology so that the physician so they can access some usability incentive to use technology that they should already be using. Here is the offending language:

State Medicaid providers across the country have an unprecedented opportunity to collect over $21,000 in EHR incentives in the last few weeks of 2011. If you’re already using Xxxxxxxx Xxxxxx, there are a few easy steps you can take to earn your incentive.

This is just so wrong on so many levels to me. First, I find it completely incongruous that we have to incent physicians to use a simple tool that is designed to make their life easier, their practice more efficient, and their care more effective. I can’t recall, but I didn’t see the need to incent the stethoscope, antibiotics, or any other health innovations.

Second, the offer itself is just dripping with the grease and slime of “taking” something “while the getting is good”. Does anyone care that this “stimulus” money is subject to the grossest abuses? That it will be misapplied? That most of it is being doled out to people who have already implemented these technologies and now are getting a little gloss on top? Does anyone care that our country is broke and this is just another program that is unsustainable, unnecessary, and incapable of producing its intended results. Is there any evidence that this is having an impact?Continue reading…

Joint Commission Says Texting Orders Is a No-No, but Maybe Docs Are on to Something

The Joint Commission has issued a statement indicating that health care professionals should not text patient orders. It reads:

“It is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.”

I was alerted to this statement by an iHealthBeat article on the topic, which quotes a couple of experts who note that texting has security, privacy and reliability problems that make it unsuitable for critical issues.

I understand the downsides but I’d be interested to learn more about what’s driving the use of texting for orders — if there is in fact such a trend. My guess is that younger physicians in particular are used to texting in their personal lives, finding it convenient, immediate, reliable, concise and likely to be read, acknowledged and acted on quickly. Add to that the fact that texting can easily be done from personal mobile devices and the appeal becomes pretty clear.

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Mr. Bush Goes to Washington

You can’t believe the play that little athenahealth gets in Washington, DC… and thank goodness for it because no one has a clue about HIT.

How could they really?

I mean, there are 535 people in our federal legislature (give or take) and there are like a million different market spaces in the nation. This is why I have such a hard time with federal control of things. It’s impossible for them to  know what’s going on…there are just not enough hours in the year.

As I’ve been thinking about care coordination and the complete lack of sustainable models or entrepreneurship in that space, it occurred to me that it’s currently not clear that it is legal for RECEIVERS of electronic health information to pay senders for the value of that health information. This means that the sender has no real motivation to send useful, relevant data in a timely manner (I know I’d pay the doc who sent me exactly what I needed about a patient more than I’d pay the doc who sends over a 30-page PDF) and that our industry will take a long time to understand the true health information exchange needs of providers.

I wanted to bring the concept with me to the Hill that Meaningful Use, in my opinion, is use that is meaningful to a medical care provider in the actual doing of business. In a space with such clear demand, we’ve got to let innovators develop a way to supply information that the market (providers of care) needs, if we want to improve outcomes and reduce costs.

So I flew down to Washington and it was tons of fun… me and Lauren Fifield and the lobbyist and a full dance card on Capitol Hill.

First, we met with Sally Canfield, policy director for Sen. Marco Rubio, R-Fla.

She’s a true health policy veteran who likes getting—and will give you—the straight story. She’s also one of the only people on the Hill with whom I could speak at my normal (lightning) pace and know she can keep up. We talked about everything from the potential fall of hospitals (Need a hospital?  Just scan the horizon for a construction crane)…to the alarming rate of physician employment…to making Meaningful Use really meaningful…to encouraging care coordination…to life in the cloud.

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Dr. Watson I Presume

Little over a month ago, IBM and WellPoint announced an agreement wherein WellPoint will deploy IBM’s latest and greatest super computer and artificial intelligence mega-mind Watson. Watson’s claim to fame was its ability to beat the human Jeopardy champions much like Big Blue beat reigning chess champion Garry Kasparov in 1997. Since that Jeopardy match, IBM has been quite vocal about its desire to apply Watson in the medical arena, we’ve been buried in press releases and briefings, but the WellPoint announcement is the first one of any real consequence. Having interviewed both IBM and WellPoint, following is our review and assessment.

Background:
Watson is a relatively new form of artificial intelligence, based to some extent on neural networks. What is unique about Watson is that it has been developed (trained) to understand the nuances of language. It is a question & answer system that uses among other techniques, natural language processing, to extract meaning out of unstructured data. In developing Watson for the Jeopardy challenge, one of the key design parameters was for Watson to answer a question in under three seconds – plenty fast enough in a diagnosis/treatment decision scenario. This is a key reason why Watson may have enormous utility in the healthcare sector where so much data is unstructured, the pace of change is so high and the ability to chose the optimum treatment patient plan for a given diagnosis is less than ideal today.

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Who will be the Salesforce.com of Healthcare IT?


Last week was the massive Salesforce.com user conference Dreamforce (massive in that there were more attendees at Dreamforce then this year’s HIMSS!). We’ve been reviewing more than a few articles and writings written by those who attended the event. In the few short years of its existence (~13yrs) Salesforce.com has become one of the leading Customer Relationship Management (CRM) vendors in the market and basically pushed the previous leader Siebel to the brink and into the arms of Oracle. Salesforce is arguably the leader in the Software as a Service (SaaS) market and thus someone to pay close attention to on all things “Cloud Computing.”

So what makes Salesforce.com so compelling and what are some parallels to the healthcare sector?

Similar Market Demographics: From the beginning Salesforce has always been structured as a SaaS and targeted the hard to reach and highly distributed sales forces of companies of all sizes. Actually, they first targeted the small to medium business (SMB) market and once successful there, went after Siebel in big enterprises. In healthcare, the vast majority of care is provided by small, 1-3 physician practices that are highly distributed across the country – perfect target for a hosted SaaS offering.

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Decision Fatigue

We’re all suffering from information overload.  More projects with fewer staff on shorter timeframes mean more email, texts, blogs, online meetings, and phone calls.

We make more decisions and have more accountability than ever before.  Regulatory complexity and the need for risk management has increased.  We’re pressured to make decisions faster and there is less tolerance for mistakes.   Making all those decisions in a high stakes environment like healthcare leads to decision fatigue,  that numbness you feel at the end of an overloaded day when you decided what to spend, who to hire, and what to do, hundreds of times.

I believe decision fatigue is an escalating threat to our ability to manage the events of each day and keep balance in our lives.

When I think back on my early career as a leader, in the 1980’s, there was no email, no overnight shipping, and limited numbers of fax machines.

Issues were escalated by writing and mailing a letter.    The time it took to compose, type, mail, and deliver a letter meant that many problems solved themselves.  Since the effort to escalate was significant, many problems were never escalated.Continue reading…

Data to the User!


NEW YORK – Customer data is a concept that most companies, especially those involved with health and health care, see as a threat rather than an opportunity. Most companies associate consumer data with “privacy,” seeing only expensive disclosure requirements, constraints on their ability to collect information about their customers, and a potential source of legal trouble.

So they consult lawyers and IT risk specialists to consider their options. To protect against being sued, they write lengthy disclosure statements that cover every possible use of consumers’ data. They then hand these statements to their marketing departments, who hide them behind little windows in small type.

In general, these companies see consumer data as something that they can use to target ads or offers, or perhaps that they can sell to third parties, but not as something that consumers themselves might want. In fact, many so-called privacy advocates have the same constricted vision. Most pundits on either side don’t consider that  that rather than hiding from consumers or protecting them, companies should be bringing them into the game.

Over time, I’m convinced, successful companies will turn personal data into an asset by giving it back to their customers in an enhanced form – analyzed and visualized into something of value to the individuals themselves. I am not sure exactly how this will happen, but current players will either join this revolution or lose out.

Let’s start with the disclosure statement. Most disclosure statements are not designed to be read; they are designed to be consented to. But some companies actually want their customers to read and understand the statements. They don’t want customers who might sue, and, just in case, they want to be able to prove that the customers did understand the risks. A regretful customer is a vengeful one.  (The very best companies want this because they like their customers to understand what they’re getting.)

So the leaders in disclosure statements right now tend to be financial and health-care companies – as well as my favorites, space-travel and extreme-sports vendors. Right now,  some clinical trial operators and the “extreme” companies are doing the best job – perhaps in part because some of their customers actually appreciate the element of riskContinue reading…

HIT Trends Summary for July 2011

Specialty EMRs. There is a market for EMRs that specialize by practice type.  This month, the ophthalmologists tell us what’s required to help them.  They have specialized vital signs, testing and measurement devices.  It is likely all specialties would benefit if EMRs get more specialty-specific.  Some specialty EMR solutions have found a successful niche markets in cardiology, oncology and other segments.  This could be another.

Medscape reports that AAFP’s smaller practice members like EMRs that focus on them.  This report is focused on user satisfaction.  The combination of easy-to-use software and physician involvement is leading to high satisfaction with products from vendors focused on small practices.  And yet, we have also heard from prior KLAS reports that many practices (30%) are abandoning current vendors for market leaders.

A national study also reports that smaller practices are interested in new care models, but may lag implementation because they tend to underutilize needed technology.  The study included 1,344 practices with fewer than 20 physicians each.  The EMR is central to success of emerging collaborative and more accountable care models.  Using registries to help manage patient populations is a core element as is medication management through e-prescribing.   This study confirms that it will take a while for smaller practices to get the utilization required to be effective in the new model.

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WhiteGlove Health’s Growth Fueled by Technology


Bob Fabbio is a tech industry veteran most known for founding systems management company Tivoli which went public in 1995 and a year later sold to IBM for $743 million. He’s been a part of other successful exits such as selling Dazel Corp., which was acquired by HP in 1999. His latest venture is WhiteGlove Health’s which now has 500,000 members primarily in its home state of Texas.

An enterprise software veteran isn’t the obvious person to lead a healthcare provider. However, as outlined in Healthcare Disruption: Healthcare Providers Repeating Newspaper Industry Mistakes, it’s frequently not the obvious competitors that create the greatest disruption in the marketplace.

The legacy healthcare payment model for primary care is a Gordian Knot designed by Rube Goldberg. Consider the legacy model versus WhiteGlove’s model in the tables below.

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