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And the Voters Demand. . . Electronic Medical Records?

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By CRAIG STOLTZ

Over half of Americans think the next U.S. President should support. . .access to electronic medical records.

Compared to gas prices, the economy and the war in Iraq, this is, needless to say, a fairly minor issue. Even within the issue of healthcare reform, access to EMRs, as digital medical records are known, it’s small potatoes.

Yet a survey released by Kaiser-Permanente at the Information Therapy Conference in Washington shows that a majority of Americans agreed that providing people with online access to their own medical records should be a "top priority" for the next US President.

It’s tough to say what this data point really might mean. But my guess is it suggests people are frustrated by the mess of papers and records that make patienthood so difficult these days. Whether federal support for a nationwide program is the only or wisest solution to this problem is another question, of course. 

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Kaiser, Blues of Mass….health plans & consumers online

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Kaiser Permanente put out a new survey updating one they did last year which says that more and more people are going online, and now a sizable minority had a preference for doctors using an EMR. (It’s not clear whether they’ll yet change a doctor based on that). It does seem that they’re more likely to expect it and want it from their health plan — 61% wanted EHR’s to come from their health plan. (Here’s the PDF of  of the survey, which has lots of extra information for you nerds). But here’s probably the key results

Q. If two doctors had exactly the same qualifications, but one used an electronic record system and the other did not, which ONE would you choose? (ROTATE) The doctor using an electronic record system 47%The doctor NOT using an electronic record system 29%Don’t know/Unsure (Volunteered) 22% Q If two health insurance companies had exactly the same qualifications, but one provided their members with access to an electronic record system and the other did not, which ONE would you choose? (ROTATE)

The one using an electronic record system 60%The one NOT using an electronic record system 25% Don’t know/Unsure (Volunteered) 14%

So Kaiser Permanente has not only created its own health record via its big Epic project, but it’s decided to at least pilot with Microsoft HealthVault. (See a little more and some controversy about that here). And some other health plans are starting to notice.

Today, the big news is that BCBS Massachusetts has decided that it too needs to dive into this. They’ve decided to make their consumers records interoperable with Google Health by the end of the year.

So are Kaiser and BCBS Mass outliers, or are they first trickle of a torrent?

Paul Wallace–Get the patients brain in the game

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By Matthew Holt

Paul Wallace, Kaiser@Wired 002

Paul Wallace, who is both Senior Medical Director at Kaiser Permanente and Chair of the Center for Information Therapy, has some sensible things to say about the transition from Health 0.0 to 1.0 and then includes some of the lessons of Health 2.0. He also wanted us to think about the links to the big building behind him in this picture.

Kaiser now has the EMR up everywhere — that’s 1.0 in his terms—information flow. The workflow change is a big deal and we have to think about it. Paul used to wait a few days before dictating notes. No more. That information is needed immediately, and his colleagues let him know about it!

Wallace on the deal with HealthVault—we now have the opportunity to “understand the operational implications of such an endeavor”. Ho, Ho. What does portability really mean? He can see his medical record in Berlin. How does that change care?

The Advisory Board’s David Bradley had earlier told a story earlier of tapping into early wisdom of the crowd to discover that he had shingles.  An instructive story of 2.0–-sharing health information and discovering more than is known by the system.

What about engaging the employer. You spend 2000 hours at work each year and probably 1/100th of that with a doctor. Where can we have a bigger impact?

The 2.0 issue is to get the patients brain in the game….

He likes Susannah Fox’s phrase—"let’s design for what could be."

My Group Health and “Killer Apps”

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By Jen McCabe Gorman

Here at the Center for Information Therapy’s Ix Conference,
transparency is the name of the game. Transparency in information transfer, information therapy, also literal transparency – we’re surrounded by tons of
glass and steel here, late-morning light is streaming in, and attendees zone out to a sweet view of the Washington Monument.

James Hereford, executive VP of Strategic Services
and Quality for Group Health Cooperative (Seattle), has the smooth
charm that tells you he has a sales background. He’s taking us on a tour of Group Health’s portal – My Group Health.

His pitch – "My Group Health" is a combo of killer apps, including:

1. EMRs

2.
Secure messaging (between doc and patient)…Group Health has
received/sent these from all over the world, every continent, including
Antarctica

3.
Automated results sharing (lab results)

4. After visit summary

5. Integrated health profile

Hereford’s thesis on the main difficulty of HIT adoption – it’s "completely
psychological." Providers (1k in the Group Health network) didn’t believe the patient should
have ANY information before they did. There’s a shocker.

But as James points out – "You don’t have to be a brain
surgeon to look at your lab results and figure out if they’re outside the
normal range."

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The Health IT politics overview (more from Ix)

By Matthew Holt

Up next at Information Therapy was Claudia Williams from Markle introducing Kavita Patel, Ted Kennedy’s staffer from the Health (et al) Senate sub-committee, and Joel White, a former Republican staffer now running the Health IT Now coalition. There was far too much agreement between Kavita and Joel for my liking!

Essentially they both agreed that the Federal government should pay something for Health IT, and Joel said that actually HHS is piloting spending up to $56,000 per physician to buy medical records.

Joel seemed OK with this—and like Newt Gingrich—seems to be OK with socialist mandates as the way to provide IT (that is, the government paying). On the other hand, Kavita wasn’t sure that the Feds should pay for everything and maybe the states and even consumers should be paying something. So I for one now don’t understand where ideology has gone in health politics!

But they were both confident that bipartisan legislation will pass encouraging Health IT (such as ePrescribing) via Medicare and other programs in the next Congress (but not this one) but both were a little concerned about the incentives problem. As Claudia said, Health IT leads to better quality, but Health IT won’t be widespread without a change in incentives.

CODA: Meanwhile and somewhat off topic, at the end Joel, (who’s now a fellow at Galen with Grace Marie Turner to give you a hint), went off on a rant about what was wrong with comparative effectiveness research. He recited PhRMA’s lines pretty well, but ran away before the mass ranks of Kaiser attendees surrounded him and pecked him to death. If you want to see some of the controversy about who has what to say about comparative effectiveness, look at what Merrill Goozner said about it last year.

Information Therapy time (again)

By Matthew Holt

The Center for Information Therapy has—in a move aimed at upsetting me personally—moved its conference from Park City, Utah, to Washington DC. Today along with some other THCB regulars like star Health 2.0 Ranger Jen McCabe Gorman, and Craig Stoltz, I’m in the Newseum — the new Museum of news media and the First Amendment. Here the Center for Information Therapy is literally and figuratively moving the Information Therapy debate into the core of the Washington Policy process.

The Center’s President, Josh Seidman, drew parallels between the development of news media in the US and what we’re seeing in health care. Here compared the Royal Mail in the UK with the pony express, and noted that some American innovations were “so democratic as to be regarded as subversive.”

Me, Jen & maybe Craig will be back with more later. Here’s the agenda.

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

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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.Kp

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.

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Dispatch from India: Tyranny of the IIT

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By Jay Srinivasan

Can one institution hold the key to all innovation? Could it be that one very tiny minority is the brain trust of a whole nation, and the font of all knowledge, insight, wisdom, entrepreneurial energy, and superior practices?Iitlogo

If this sounds silly to you, that is what Indians promote and practice. As a culture, we are obsessed to wear the badge of such alma maters as the Indian Institutes of Technology or Indian Institute of Management on our sleeves. Those diplomas have become the yardstick by which we evaluate and weigh a person’s worth, personality, effectiveness, capabilities, capacity to achieve, and integrity.

I should acknowledge that I do not belong to that club — that elite band of super men and women, who have been annointed by the Western media as capable of the most incredible feats. Does it bother me? It used to, but no longer as I’ve grown more comfortable in my own skin. It has prompted me, though, to reflect on our middle-class need to identify with and project an exclusive membership.

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