The prospect of Revolution Health’s official launch (it’s actually up already but is relaunching this Thursday) has generated favorable press in the NY Times for Steve Case and crew. Milt Freudenheim’s done his homework, mostly. He essentially says that the pack of contenders includes Revolution, WebMD, Google (although nothing official announced from them yet–stay tuned), Yahoo, About.com (a sop I think to the NYTimes corporate sister) and the big health plans. He talks a bit about the limited use thus far of PHRs (no surprise there other than not mentioning why they might grow). The only surprising thing is that there’s another potential competitor of Google, Revolution et al that has plenty of money, a decent track record in software, a significant online network, and has just bought a health care search engine—But Milt never mentions the boys (and girls) from Redmond. Methinks that there’ll be some shouting from them before the large lady chants.

My only complaint is that Revolution’s board is made up of a bunch of rich people who haven’t exactly covered themselves in glory in their recent business (or political) ventures including it must be said Steve Case himself—(other than the brilliant move of selling AOL at a hugely inflated price to the buffoons at Time Warner). But it doesn’t mention their management team which is pretty steeped in health care and technology and pretty smart. If I was interested in gauging Revolution’s success I’d think that they’re more important than what, say, Carly Fiorina thinks. But she’s got $21m more than most of us…

I’m at Digital Healthcare & Productivity talking about the real progress being made (or not) in fixing the infrastructure needed for ePrescribing. It’s called Getting the eRx Plumbing Right Is Hard Work.

This is why no one understands technology. I’ve interviewed the CEO of Click4Care Dave Blauer a while back and he managed to explain his business well enough. But honestly–read this press release and try to figure out who between these three software companies is doing what to whom!

CareGuide Selects HealthEdge^™ for Next Generation Integrated Health Management Solution

HealthEdge’s HealthRules^™ Provides Care/Disease Management Innovator Unprecedented Agility

BURLINGTON, Mass.–(BUSINESS WIRE)–HealthEdge, a pioneering healthcare software company, today announced that CareGuide, a leading innovator in population health management services, has purchased HealthRules™. HealthRules is HealthEdge’s revolutionary platform for health payors designed to deliver unprecedented levels of flexibility, scalability and ease-of-use in lowering costs while delivering better-quality, more-personalized healthcare.

CareGuide will use the entire HealthRules suite, including HealthRules Payor™ and HealthRules CareManager™, powered by Click4Care. CareManager is an intuitive medical management application that supports the entire care continuum by providing care managers with a patient-centric data repository to help them manage member populations more efficiently.

“CareGuide is directly focused on building a model for health management that will allow our customers to provide for their members the kind of smart, integrated and personalized care they deserve, and set the standard for the next generation of disease and care management services,” said Chris E. Paterson, president and chief executive officer of CareGuide. “HealthEdge shares our vision for bringing 21^st century technology and business practices to a healthcare system that is, in many ways, bogged down in decades-old approaches to managing care. Together, we will demonstrate that the future has already arrived for health plans that are ready to seize the initiative and start providing the kind of services that will be tomorrow’s norm.”

CareGuide will implement HealthRules enterprise-wide on an application service provider (ASP) basis and will deploy the complete HealthRules suite, supporting a wide range of critical functions, including claims processing, care management, business intelligence, benefit design and provider contract management.

“At HealthEdge, our mission is to bring an innovative, best-of-breed approach to care and benefit management and help payors deliver better quality care while effectively reducing costs,” said Rob Gillette, chief executive officer of HealthEdge. “The CareGuide relationship is exciting for us because we share a common vision and are eager to work together to bring innovation to the forefront of the healthcare system. Using HealthRules, CareGuide will be able to operate with a level of agility and flexibility the industry has never seen, allowing it to continue to raise the bar for care and disease management.”

HealthRules is a multi-module platform designed to allow flexible and scalable administration of health plan operations, from care management to analytics to contract and claims management. Based on a service-oriented architecture (SOA) that provides unprecedented levels of automation and seamless transactions between payors and their provider and member constituencies, HealthRules is the result of a six-year, $100 million state-of-the-art development effort. The platform offers a unique combination of enterprise-class scalability and reliability with the flexibility and functionality to support payors of all sizes as they deploy new business models in the increasingly consumer-driven healthcare industry. The system fully integrates care and disease management, benefit and provider contract design, and claims processing, enabling payors to meet the widest range of market requirements.

I hope you got that because I sure as heck didn’t. And they wonder why health care companies don’t understand what their products (or is it services) do!

At EMRUpdate there’s an interesting interview with Fred Trotter, a leading GPL/open source medical software/software freedom evangelist. Fred has made several appearances over here at THCB but this interview gives a very clear explanation of what GPL/open source software could mean for healthcare.

Over at Digital Healthcare and Productivity I have an article about the latest merger in the asset tracking world. It’s called Pango-InnerWireless Merger Raises Hopes and Questions. I was relatively optimistic about it when I spoke to Pango’s (now InnerWireless VP) Michael Campbell, but another conversation with Tim Gee threw a bucket of cold water on that optimism! I hope the article comes out relatively balanced!

Health Affairs has a study from HSC about ePrescribing. here’s the press release. The team interviewed a bunch of practices using eRx and some not. About 2/3 were using it as part of an EMR, the rest were using a standalone eRx system. It’s not an encouraging study. The main problems identified:

1) Challenges to maintaining complete patient medication lists. Most physicians were able to use e-prescribing systems to access prescriptions written by other physicians in their practice. But none were able to access comprehensive lists of patients’ medications prescribed outside their practices. As a result, physicians continued to rely on patients as the main source of information to complete medication lists.2) Difficulty obtaining accurate patient-specific formulary information. Physicians in slightly more than half of the practices did not have access to formulary data electronically, because either the systems did not have the feature or the practice had chosen not to enable it. In the practices where physicians had access to formulary information, respondents pointed out information was available for only a subset of patients, with estimates ranging from 25 percent to 90 percent. Even when information was available, practices often questioned the data’s reliability. Physicians’ views varied on the value of the formulary information, and in many practices, physicians routinely ignored it.

If the RxHUB vision is working the information about both current medications and formulary information should be available for a substantial share of patients in the eRx application. 90% sounds a little optimistic, but 25% doesn’t sound at all good, considering that the 3 big PBMs who own RxHub allegedly account for more than 90% of commercial lives. It appears tha accurate patient identification is a problem within RxHUB. Given that we’re not getting a patient identifier anytime soon, that’s also not good news..

3) Limited connectivity with pharmacies and mail-order PBMs. Only the practices with stand-alone e-prescribing systems were using electronic data interchange (EDI) that allows electronic transmission between computers in the physician practice and those in the pharmacy or PBM. Local pharmacies’ lack of readiness was cited as a barrier to full electronic transmission. Most practices using electronic fax or EDI reported spending substantial time educating local pharmacies about e-prescribing. It took a couple of months of daily communications about individual patients for pharmacies to be able to treat electronic transmissions as routine.

That tells me that neither of the Surescripts and RxHub visions are yet working in practice. By this stage most pharmacies should be getting the eRx direct into their pharmacy system. If it’s a Surescripts certified vendor (which mot standalones and many EMRs are), then there shouldn’t be a need to rekey in the information at the pharmacy. In fact this line from the actual report “For example, a physician in Syracuse reported that despite the presence of national chains reportedly capable of electronic transmissions, pharmacies in the area were not yet even "fax-friendly." is pretty frightening and suggests that Surescripts has much more work to do amongst its owners!

4) Challenges continue after initial implementation. Practices were not prepared for the amount of interaction needed with outside parties, such as vendors, state regulators, and local pharmacies, to implement and maintain the system. Practices continued to devote staff resources for maintenance well after e-prescribing products were in use.

Hmmm….also not good. The idea is that this is supposed to save staff time.

5) Limited use of clinical decision support. All but one of the practices’ e-prescribing systems offered some clinical decision support (CDS) in the form of drug-drug interaction alerts. However, access to more advanced CDS was limited; about half of practices reported being able to check for drug-allergy interactions, and only 20 percent for drug-condition contraindications. There was general agreement that pop-up alerts were triggered too easily. As a result, physicians typically overrode them.

Alert fatigue is commonly talked about by the vendors of these systems—it’s a problem that will take some intelligence to overcome. But I’m not so sure that this is a gamebreaker. The previous four may be.

There is though some hope:

Practice efficiency. Most physicians agreed that writing new prescriptions electronically took about the same amount of time as writing them on paper once they became familiar with the system and had created a "favorites" list. For those practices that sent new prescriptions electronically, e-prescribing systems eliminated much of the staff time spent printing, faxing, and calling in prescriptions.Legible prescriptions also meant many fewer callbacks for clarification. But respondents believed that the greatest time savings came from streamlining management of renewals, particularly for patients with multiple medications.

Only one practice could quantify savings from e-prescribing. Most of the others provided examples of how it had freed up support staff to do other tasks, although they could not point to staff cuts exclusively from e-prescribing. Several respondents felt that there were no substantial savings because any efficiency gains needed to be balanced against the up-front and ongoing costs of implementing the system and the additional effort invested in tasks that had not been done routinely–for example, collecting information on outside prescriptions. Their perspective was that e-prescribing produces better outcomes for a comparable effort.

Furthermore the data in the study is more than a year old now—so we have to hope that things are getting better. But clearly more work on the plumbing is needed.