OK, the title is a take off on the Police song, but the subject has got a little more influence lately. A sometime THCB correspondent had these thoughts:

The December 11 edition of Health Affairs contains a very important article on “The State of Regional Health Information Organizations.”  At first glance, the article seems to pile on to the prevailing wisdom that RHIOs are a bad idea, because, of course, RHIOs are failing.

A more careful read, though, differentiates the issue of whether fully-functioning RHIOs (or clinical health information exchanges, more broadly) could provide value to a community and its (healthcare) stakeholders and the issue of whether the current model for funding RHIOs is sustainable – two very different issues.

The study takes no issue with the notion of the value of RHIOs: “Electronic clinical data exchange promises substantial financial and societal benefits…”

Continue reading…

One of my favorite ex-colleagues Phil Chuang got a nice bit of recognition last week being named as one of the ComputerWorld Top 100 CIOs for 2008. Note that this isn’t just health care CIOs, it’s among all CIOs!

Also note his quote about what his team did right

Making an aggressive go-live for an enterprise health care system in 100 days, 15% under budget — and still having everyone on the team like each other after the project.

Phil is very sharp and sensible, but always calm and good humored under pressure. We were working together in a not-too-calm start-up in 2000–2, and Phil’s team built a PHR which is still as good as many if not most on the market today—spending way way less money than most competitors.

He also kept a big score card on his cube wall on which he recorded how nasty I was being to the interns, who sat in the cubes next to us. For example if I bought cookies the score went down. After one particularly maladroit comment from me he had to add more paper above his cube to track my “nasty” quotient. Don’t worry, that intern still loves me and is inviting me over to dinner with her and her husband next week.

In any event, expect Phil to be a big star in health care IT in the future.

For many years it has been widely acknowledged that there are many benefits which could be realized by
healthcare through the creation of a system of unique individual healthcare identifiers. These identifiers could enable the creation of a comprehensive medical record for each participant and would virtually eliminate the risk of inappropriate merging of some other individual’s information into a medical record. In addition, these identifiers have the potential to play a significant role in enhancing the privacy and security of medical information.

Unfortunately, a well entrenched set of barriers and objections have prevented the creation of any such system: 1) there are many technical issues to be resolved, 2) the cost of any such system has been estimated to be significantly greater than $1 billion, 3) there has been a lack of a national consensus on how to create such a system, 4) the federal government has specifically prohibited funding for such an effort, 5) there are serious (and well-founded) privacy concerns about the risks associated with the creation of a national healthcare database, and 6) it is not clear how one could pull off the “Big Bang” implementation of such a system

Continue reading…

An old colleague writes to me from the land of multiple project coordination hell.

We’re managing about 60 concurrent projects in just one of our teams, and dozens of other concurrent projects with other teams.  We’re rapidly becoming victims of our own success as we receive funding for more and more concurrent projects. We’re looking for better options for visualization software for how to provide quick, useful views of multiple dimensions of each project both for our program management perspective, as well as from the perspective of packaging information for our executives.  In the past, you have reviewed this space, and I just wondered if you could recommend a few products that might help us manage this space.  thanks for any help on this topic.

I haven’t looked at this space in some time, but if you have any suggestions please put them in the comments!

Apparently Health IT is feeling left out and needs a CEO forum-type conference. The people at CCS are trying to create it at a flash hotel in Bel-Air no less. For a pretty humorous run down take a look at the The HIT Transition Weblog’s write up.

So on Weds night I met longtime THCB commenter (and old world pension fund manager) Barry Carrol. He told me that he also reads the Harvard Pilgrim blog. I didn’t even know they had one.

Thursday morning, Tom Donald at Bazian emailed me a link to a post there…so I know now that Charlie Baker—who runs the artist once known as the Harvard Community Health Plan and now called Harvard Pilgrim—has his own blog (and has had for most of 2007!). This makes him the second major Boston health care CEO to have one, even if he can’t quite match Paul Levy for his frequency of delivery, or Paul’s colleague the man in black superstar CIO John Halamka (who also has a new blog) for ubbergeekiness.

While we’re on the topic left-coast patient safety and hopsitalist guru Bob Wachter has a great new blog also.

…and you thought those four all had real jobs….(ho, ho)

There is a point to all this, really. It’s that dealing with process change in health care is deeply cultural and that you can’t just do it with technology alone. That is what Charlie is pointing out to Bill Gates. Read the post, it’s very worthwhile but it’s also worth remembering that culture gets calcified by incentives.

And something that all four of these relatively new and high powered bloggers all intuitively know, and something that makes health care reform quite tough.

Dr. Paul Grundy helped organize
the Patient-Centered Primary Care
Collaborative at IBM and serves at its Chair. IBM spends about $1.7 billion a year on
healthcare for its employees and families, providing coverage for half a million people. The company is working to improve their
healthcare quality, while lowering costs through wellness programs, but believes that more could be accomplished if a critical mass of key
healthcare participants work together to drive even more significant change. Executives believe the Patient-Centered Primary Care Collaborative is a major step towards that goal.   

Many studies have shown that patients with a personal
physician who coordinates their comprehensive care have better outcomes
with lower costs.  We want to make this a reality for patients in the
US. So we joined with the four major primary care physicians’
professional societies, national employers and their associations, quality
advocacy groups, academic centers and consumer advocacy  groups to create the
Patient-Centered Primary Care
Collaborative. The Collaborative is
advancing a new primary-care-based healthcare model called the \u003cu\>Patient-Centered Medical Home \n(PCMH)\u003c/u\>\u003c/font\>\u003c/a\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>. We're also \nworking to \u003cbr\>restructure traditional reimbursement practices, which currently \nincent physician \u003cbr\>specialization. We want to support and reward the \ncomprehensive delivery of \u003cbr\>primary care and expand the role of primary care \nphysicians as patient care \u003cbr\>coordinators. \u003c/font\>\u003cfont size\u003d\”3\”\> \n\u003cbr\>\u003c/font\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>\u003cbr\>Last week, we added to our \nmomentum. Aetna, BCBS Association, CIGNA, \u003cbr\>Humana, MVP Health Care, \nUnitedHealthcare, and WellPoint \u003c/font\>\u003ca href\u003d\”http://newsroom.cigna.com/article_display.cfm?article_id\u003d791\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>\u003cfont face\u003d\”Times New Roman\” color\u003d\”blue\” size\u003d\”3\”\>\u003cu\>announced\u003c/u\>\u003c/font\>\u003c/a\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\> they \u003cbr\>will support Medical Home pilot \ndemonstrations. \u003c/font\>\u003cfont size\u003d\”3\”\>\u003cbr\>\u003c/font\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>\u003cbr\>Together, we want to start one or more pilots \nnext year. Stay tuned! \u003c/font\>\u003cfont size\u003d\”3\”\> \n\u003cbr\>\u003c/font\>\u003cfont face\u003d\”sans-serif\” size\u003d\”2\”\>\u003cbr\>\u003cbr\>Steve\u003cbr\>\u003cbr\>IBM Analyst & \nInfluencer Relations\u003cbr\>Phone 845-677-1017 t/l 320-8929\u003c/font\>\u003cfont size\u003d\”3\”\>\u003cbr\>\u003cbr\>\u003cbr\>\u003c/font\>\n\u003ctable width\u003d\”100%\”\>\n \u003ctbody\>\n \u003ctr valign\u003d\”top\”\>\n \u003ctd width\u003d\”45%\”\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>\u003cb\>"Matthew Holt" \n <\u003ca href\u003d\”mailto:ma*****@*********lt.net” data-original-string=”I0uoyXpUqTQN4z7u3eb3Xg==57drDUXiq7gDn6XmQM2jMaUCKu1qsI9MSlhcwR3DlyM9qU=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>ma*****@*********lt.net\u003c/a\>>\u003c/b\> \u003c/font\>\n \u003cp\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>10/19/2007 07:48 PM\u003c/font\>\u003cfont size\u003d\”3\”\> \n \u003c/font\>\u003cbr\>\n \u003ctable width\u003d\”100%\” border\u003d\”4\”\>\n \u003ctbody\>\n \u003ctr valign\u003d\”top\”\>\n \u003ctd width\u003d\”100%\” bgcolor\u003d\”white\”\>\n \u003cdiv align\u003d\”center\”\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>Please respond \n to\u003cbr\><\u003ca href\u003d\”mailto:ma*****@*********lt.net” data-original-string=”KrkLwzTCZuZdZqlX9bTmNg==57dXPM27pkljYtGZGjaGiAmN8ekzdJS9oUMkfciH5ZkjaE=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>”,1]
);
//–><span face="Times New Roman" Patient-Centered Medical Home
(PCMH)  We’re also
working to restructure traditional reimbursement practices, which currently
incent physician specialization.  We want to support and reward the
comprehensive delivery of primary care and expand the role of primary care
physicians as patient care  coordinators.   
Last week, we added to our
momentum.  Aetna, BCBS Association, CIGNA, Humana, MVP Health Care,
UnitedHealthcare, and WellPoint announced they will support Medical Home pilot
demonstrations.   Together, we want to start one or more pilots
next year.  Stay tuned!  

It’s official! The waiting is over. The follow-up to the first Health 2.0 conference has been scheduled.
"Health 2.0  Connecting Consumers and Providers" will be held on March 4th, 2008 at the Westin San Diego. For details, visit the Health 2.0 site. If you’re thinking of attending, you may want to act now and pre-register.  You’ll get a friendly email from us alerting you when passes go on sale. Doing this is probably a good idea as Health 2.0 User Generated Content sold out a month before before the conference. For email updates sign up for the THCB email list.

Meanwhile, the Health 2.0 media room is now open. If you’re interested in browsing recent articles on the Health 2.0 movement, this is a good starting point. If you know of a piece that we haven’t included, drop us a note. We’ll be adding more material soon, including links to blog commentary. Also coming soon: an updated Health 2.0 FAQ, pics from the September conference, user-generated content and more.