Tag: Startups

Podcast with Silverlink and IncentOne

May 13, 2008

By Matthew Holt

Those of you regular THCBers are by now probably bored with me going on about the problems (and opportunities) with incentivizing people in health care to do the right thing. So today Silverlink which does automated voice recognition inbound and outbound calling (FD–they’re a THCB advertiser/sponsor) announced a deal with IncentOne, which, surprise surprise, runs incentive programs.

That was interesting enough to get me to bite, so I got Stan Nowak, CEO Silverlink & Michael Dermer, CEO IncentOne, on the phone for a quick podcast interview to explain what they’re going to do together.

Interview with CEO of Limeade, Henry Albrecht

May 8, 2008• 1

By Jen McCabe Gorman Imageprovider

Henry Albrecht, CEO of Limeade online employee wellness firm, was nice enough to talk with me on his cell phone in the evening (after 5 p.m. West Coast, 2 a.m. Amsterdam time).

Both of us were banging pots and pans, cooking dinner (him), making coffee (me).There’s something comforting about speaking with a high-tech health care executive in such an old-fashioned, "conversational" way.

Thanks again Henry – pleasure to meet you and Limeade.

Interview with Joseph Kvedar, Partners Center for Connected Health

May 7, 2008• 2

By Matthew Holt

Joseph Kvedar is the director of Center for Connected Health, which is part of the Partners HealthCare System’s empire in Boston (that’s Mass General and the Brigham for you old-schoolers). Joe emceed the conference I spoke at yesterday, and I stopped in for a quick chat with him this morning to get an update on the Center’s progress.

If you need an introduction to the Center, its web site is here, a piece Joe wrote for THCB last year is here and the transcript of a longer interview I did with Joe is here.

Today we had time for a quick catch-up, in which he touches on the state of the EMR initiative at Partners, the wider role of Connected Health within Partners, and the state of their current pilots. Here’s the interview (The first minute is a little quiet. My apologies.)

You can also see the details about the Center’s symposium (27-28 October). There, you can find out more about Connected Health than you can imagine, and you’ll probably see a little flavor of Health 2.0 there, too. We hope to bring a little flavor of the community aspect of Connected Health to the Health 2.0 Conference (October 22-23). Yes, we know they’re close together … but speaking as someone who’s been to both, I recommend both highly!

Should Hospitals Install Bar Coding or CPOE First?

May 5, 2008• 10

By Bob Wachter

Robert Wachter is widely regarded as a leading figure in the modern
patient safety
movement. Together with Dr. Lee Goldman, he coined the
term "hospitalist" in an influential 1996 essay in The New England
Journal of Medicine. His most recent book, Understanding Patient
Safety, (McGraw-Hill, 2008) examines the factors that have contributed
to what is often described as "an epidemic" facing American hospitals.
His posts appear semi-regularly on THCB and on his own blog "Wachter’s World

This is one of the most commonly asked questions in IT World, and my
answer has always been “CPOE first” – largely because that has always
been David Bates’s (the world’s leading IT/safety researcher) answer. But I’ve changed my mind. Here’s why.

Before I start, I promised
that I’d let you know if I ever blogged on a topic in which I have a
financial conflict of interest. On this, I do: I serve as a paid member
of the Scientific Advisory Board of IntelliDOT, a company that makes a
stand-alone bar coding system. If that freaks you out, stop reading.
But recognize that if you had asked me the “bar coding or computerized
provider order entry?” question last week, I would have answered “CPOE”.

The 2nd Annual DiabetesMine Design Contest

Apr 30, 2008

Over at DiabetesMine #1 blogger Amy Tenderich and her buds at Medgadget have got this years DiabetesMine Design Contest up. The winner gets to go to (and probably demo at) this years Health 2.0 contest—as if you needed more incentive!

Millennial Health Care Delivery

Apr 17, 2008• 5

By Scott Shreeve

Millennial (adj.)

1. Of or pertaining to the millennium, or to a thousand years
2. Generation of Americans younger than 29 in 2007 with unique social, cultural, and market identity

The highlight of last month’s Health 2.0 conference was the segment in which three enterprising physicians discussed their next-generation practice models. We heard from Enoch Choi, MD at Palo Alto Clinic who has a traditional, but technology enabled practice; Jordan Shlain, MD of San Francisco On Call which provides a cash only mobile practice; and from Jay Parkinson, MD who has attained the most notoriety through his unique approach, clinical skill set, and artistic flair. These services are representative of a growing number of similar practices that serve as an example of another important concept to consider in preparing for next generation health care. Millenial patients will demand a new range of services, many of which currently do not exist within the current medico-industrial insurance construct. In fact, the provision of niche services which have traditionally fallen outside the concept of traditional health care may prove to be the biggest opportunity to impact care delivery.

This conceptual framework can be understood within the technology description of The Long Tail. First described in the popular press by Wired Magazine Editor Chris Anderson in 2004, it is basically descriptive of unique markets wherein distribution and storage costs approach zero and therefore the provision of small numbers of less popular items actually is more profitable than the provisions of large number of popular items. The math works out as such that the area under the “long tail” part of the curve is as big or bigger than the area under the curve to the left. This long tail represents all the niche, specialty offerings that can be purchased so that when aggregated, the niche market opportunity is bigger than the mainstream.

The anatomy of the long tail shows that most patients consume a relatively small number of core health care related services. These have been provided in a prescribed way for decades and have address most basic health care needs. However, as science and technology advance, there have been, and will continue to be new, more efficient, and hopefully effective treatment options. Over time these new therapeutic options themselves become more personalized and specialized in order to address the needs of niche target populations. The number of personalized services will ultimately outstrip the traditional health care service offerings.

But niche products are not for everyone. Most people have gotten and can continue to get traditional health care services. However, newer technologies that create new value propositions might fill an entire set of health care needs just as well, or perhaps even better. The personalization of medical services allows them to be consumed “wherever the consumer is” along the health care delivery continuum based on their unique value equation. So while not everyone will want to speak live with a physician for $1.99/minute, there are certainly some who will, and they can be recruiting into the next generation health care system via health care delivery offers that occurs within the long tail of healthcare.

Scott Shreeve is a physician and entrepeneur based in Laguna Beach, California. After a long career in medicine, Scott founded the open source electronic medical record company MedSphere. He currently serves as entrepreneur in residence at Lemhi Ventures. If you enjoyed this piece you may also enjoy his earlier piece examining the potential impact of Long Tail economic theory on the healthcare industry. Scott is a frequent contributor to both THCB and the Health 2.0 Blog.

Health 1.0h. . .Geez, This Is a Mess

Apr 10, 2008• 16

By Craig Stoltz

Stoltz

A family member just had surgery, but don’t worry, this isn’t about that.

I want to share just one observation from the experience: Between the decision to have surgery and the moment scalpel touched flesh, the patient’s medical history was taken four times. None of these documents contains identical information.

Medical History 1. At the specialist’s office, forms were filled out in the waiting room, then completed and annotated during the in-office consult. The primary care physician’s record was not provided or asked for. We didn’t have the records from previous episodes of the medical issue in question–this all came up suddenly, and. . .we couldn’t find them.

But the hospital said they’d faxed the latest ER report, didn’t they? Can’t find it here.

Medical History 2. The day before surgery, a hospital prep nurse
called and created a new medical history by phone. My wife was there,
so she was able to correct and change some details. One of these
details was. . .the correct name of the earlier diagnosis, at least as
far as my wife could remember. I had it wrong the first time. My bad.

The Security of Patient Data

Apr 8, 2008• 3

By Brian Klepper

EXCLUSIVE TO THCB: HIMSS Analytics, the research arm of the powerful, thoughtful and highly regarded Health Information Management Systems Society, has published a sobering study, Security of Patient Data – see here – that highlights the gap between hospital patient data security practices and the reality of impacts if a breach occurs. The report, commissioned by Kroll Fraud Solutions, should be a splash of cold water to health care executives in all settings with responsibility for patient data. A link to the Executive Summary has been placed at the bottom of this post.

In the wake of several recent incidents involving breaches of celebrity records, what’s fascinating about the study is that the executives interviewed claimed a very high familiarity with HIPAA rules; they averaged 6.53 (on a 7 point scale) and 75 percent of those interviewed gave themselves a 7. The report attributes the high sense of HIPAA knowledge with the current rounds of HIPAA compliance audits and the penalties for non-compliance that have resulted in some cases.

HEALTH 2.0: Getting the PHR, Privacy and Deborah Peel issue off my chest

Mar 13, 2008• 14

By Matthew Holt

I’m a card carrying member of the ACLU. I oppose the Patriot Act. And I absolutely oppose the current Administration’s decision to ignore the FISA law that already bends over backwards to help the government spy on Americans whom it suspects of criminal activity. I’m also appalled when I read stories like this one—in which the FBI has been illegally abusing its power by issuing “National Security letters” willy nilly.

I say all this because it’s now a couple of weeks since Google announced it’s health initiative and during that time we held the second Health 2.0 conference. And all the mainstream press can write about is the potential for privacy violations in online health sites, and PHRs, whether it’s been in the San Diego Union Tribune, ZDNET, USA Today or Modern Healthcare.

So even this balanced article in the Washington Post leads with Deborah Peel from Patient Privacy Rights and you have to wade through her incendiary rhetoric before you get to some sense from John Rother, while David Kibbe’s rational applauding of electronic health records only appears towards the end. Here’s what Peel says:

Many online PHR firms share information with data-mining companies, which then sell it to insurers and other interested parties, Peel said.

Well I’m still waiting to see the proof about this. Essentially she’s saying that consumers’ identifiable data is being sold and used against them, and so PHRs are bad.

Much data is of course sold in health care, but as far as I’m aware it’s all de-idenitifed. Whether PHR companies are systematically selling data is unclear. Whether they are selling identifiable data (the thing HIPAA bans and everyone agrees is a bad idea) I severely doubt.

And the problem is that this type of allegation gets the conversation completely off track. The biggest problem with the US health care system and its use of technology is not privacy violations. It’s inefficient use of data causing harm (and costs and poor quality care).

I am getting more than a little annoyed with this focus on the wrong thing. As my commenter JD paraphrased in my earlier piece on the topic (5^th comment down here), do the Deborah Peels of the world not use bank accounts or credit cards? Do they not buy houses or have credit scores? Do they not know about what is already known about them in the real world? People understand this data flow and they accept it because it brings them a return that they value. And the same will be true for health information—if health information technology produces valuable results

So what are the nay-sayers going on about? Well I actually suffered and read the World Privacy Forum report on PHRs by Robert Gellman. It’s a hash of conjecture with its main complaint being that HIPAA doesn’t explicitly cover PHRs. Well, no shit Sherlock. HIPAA passed in 1996. It was actually was prepared years earlier and it’s about the automated transactions that existed then. No one had heard of a PHR in 1995, so why should the law cover them? What will happen is that PHRs will start being provided by covered entities and will be under the aegis of HIPAA (in this country at least—it’s called the “World” privacy forum but in reading the report Gellman only has heard of one country apparently).

But even if PHRs are not covered by HIPAA, what are the terrible consequences? Well let’s see. I’ve taken a few excerpts from the report. In the first Gellman says:

Regardless of the PHR’s policy on marketing disclosures, advertising can provide a method for a consumer’s health information to escape into marketing files. Marketers already have millions of names of consumers categorized by specific diseases and diagnoses. Most of the information comes from consumers who provided it in response to “consumer surveys” or through other stealthy methods for collecting health information for marketing use. Health records maintained by health care providers have been unavailable to marketers directly, but commercial PHRs operated outside of HIPAA offer marketers the promise of more and better health information from consumers.

So the problem is not PHRs. It’s consumer surveys taken over the years by marketers. But let’s blame PHRs because they might potentially be used for the same thing.

But hang on, if I’m a transparent PHR vendor won’t I drive out the scummy guys who are secretly selling data which will be used to harm their customers? And aren’t Microsoft and Google and many others being transparent about that? Yes they are, and why won’t consumers vote with their data?

HEALTH 2.0: Healthline personalizes Aetna (and more)

Mar 12, 2008• 14

By Matthew Holt

Healthline Networks is pursuing a really interesting strategy as it attempts to "dance with the elephants" in vertical search in health care. Today, it’s announcing a number of new partnerships and perhaps most interestingly a deal with Aetna, where the information in the members’ PHR will personalize their online experience. I sat down with Chairman and CEO West Shell yesterday to talk about what it means for the industry, for health plans and where he sees Healthline going.

Listen to the podcast