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TECH: More wingeing Brits complaining about IT

• 3

Those damn Brits are whining about their shiny new technology again

As revealed in a joint investigation last week by Computer Weekly and Channel 4 News, after Newham Primary Care Trust in East London and Nuffield Orthopaedic Centre at Oxford implemented a system from US supplier Cerner, some patients did not receive a timely appointment with a specialist because of IT-related problems. An enhanced version of this same Cerner system is due to be implemented across England as part of the NPfIT. John Bourn, head of the National Audit Office which investigated a report of a serious untoward incident after the go-live at Nuffield, said in a letter to MP Richard Bacon, "The [Cerner] system reported that it was printing letters inviting patients to clinics, and yet it soon became clear that far fewer people were turning up to clinics than expected as they had not received any notification to do so. "Conversely, other patients were turning up for clinics that they were not recorded as having been invited to. The impact of this was inconvenience to patients, wasting of doctor and staff time and a need to reschedule appointments. The missed appointments then resulted in a backlog of outpatient appointments building up." After a go-live at Newham hospital, details on patient appointments were lost – more than 110 of them for children. The problem was spotted in October 2004, but it was six months before health staff tried to contact parents of the children, and 30 were never tracked down. The incidents at Newham and Nuffield were not specifically the fault of the supplier or the trust, but happened for a variety of reasons.

Why they can’t just order in more pizza and fix it themselves, I (and Neal ) just don’t know. And while I’ve scooped MrHISTlk on this piece of tech news, (and that doesn’t happen often!) he’s clearly in the top 3 health care bloggers, whatever Fared says, and the link to the Patterson (Cerner) Pizza Memo comes via him.

On a more serious note, the UK problem sounds relatively trivial, but it appears that no one followed up to fix it. Given that Nuffield was one of the first to go live with Cerner and both London and the South are following (now that they’ve changed in IDX for Cerner) and with who knows what happening in iSoft land in the North West this problem needs to be jumped on pretty quick. The Brits are very attached to their health care system, but not so to major government IT initiatives. I still remember people telling stories about the ill-fated initial computerization of the DVLC (national car and driver registry) in the 1970s, particularly the mistaken registering by the new computer of a scooter as a “2 wheel fire engine” being featured on That’s Life (a consumer tales of woe show which was a British national institution). The UK is not like the US where a big governmental agency IT screw up won’t matter politically, and the NHS NPfIT is a) way behind where it should be, and b) losing the support of the doctors and the public.

It doesn’t do any of us any good (other than the total luddites) to see the major IT project in world health care go down in flames, especially as the vendors are the same ones as are working over here…

HEALTH PLANS/TECH: PHRs–Can this woman ever tell the truth?

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Time for the Karen Ignagni lie of the day.

It comes in a session during which AHIP and the Blues talk about their sponsorship of a common model for PHRs (or at least for payer-based PHRs). It’s hard to know how she manages to slip in a whopper during a session that’s relatively non-controversial—or at least one supporting an initiative that most of us think is a good idea. (Even if there are grave doubts as to whether health plans really believe in portable health data or records that can be moved from plan to plan, or even could put it together if they did believe it—it’s clear that Kaiser, which is way, way ahead of these guys, has no idea about portability).

Here’s the lie. She says that there are 70m people using online PHRs now. When called on it, she doesn’t bother to justify her numbers. She then says that soon 100m will have access to these from health plans. That number is so wrong, it’s just amazing. Harris and Forrester both think that much fewer than 5% of the population (e.g. less than 15 million) have got PHRs, and Markle and Manhattan disagree but both say that the potential market is between 20m and 60m. So how does she come up with 70m people having one already? Who the hell knows? It must be a derivative of the number of members for whom their plan has a web site they can create an account on (most of those Wellpoint members with WebMD, by the way). I’m prepared to bet her annual salary that the total number of people who have ever actually visited a health plan web site is less than 70 million. After all that would constitute more than 50% of all Internet users.

And would it really hurt her to tell the truth? Which is that health plans have been really weak about creating PHRs and could have done it 5 years ago and chose not to! (Yes, I know I’m bitter). Is their record thus far really that embarrassing? (It is, actually, but no where near as embarrassing as the rest of the industry’s performance in the last 5 years!) What’s changed is that now they realize the time has come to do something before it gets done too them, and now they say they will get us to the PHR land there very quickly. I happen to think that they have a good shot, but can’t for once Ignagni just tell the truth about the progress so far? I guess we know the answer.

(Note: slight edits to end para made 12/15 when I noticed it didnt make sense!)

TECH/PHYSICIANS/INDUSTRY: Communists in press stirring up trouble

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Cypho
So a disgruntled reporter is stirring up trouble by daring to question the way medical advances happen in this great nation. Apparently this Joel Rutchick character is suggesting that when respected surgeon Dr. Isador Lieberman and his organization the Cleveland Clinic began pushing a new type of back surgery, we are supposed to be surprised he didn’t plaster memos about his stock options and holdings in the company that made the device all over the foreheads of his patients.

Lieberman did not tell his patients about his financial conflict of interest unless asked, the Clinic acknowledged. According to Plain Dealer research, he also did not reveal his stock holdings in numerous articles he wrote about kyphoplasty.

Bunkum! Does every computer come with a message that you’re making Bill Gates richer every time you turn it on? Of course not.

And when he (Lieberman) testified to the treatment’s benefits at a government hearing last year, he did not divulge past stock interests in Kyphon Inc. and other device makers – even when explicitly asked to disclose such holdings.

Well he was correct. He had apparently sold the last of his stock a few months before the Congressional hearing. Like any good capitalist Dr Lieberman is onto the next pony. As he told the commie rag The Plain Dealer

"I strive to be transparent in my disclosures and believe that I have disclosed my interests within the guidelines and policies of the Cleveland Clinic," Lieberman said in a written statement. He declined to be interviewed.

Who needs an interview in the face of that transparency!

Didn’t Rutchick know that unlike a bum masquerading as a reporter Dr Lieberman had been to medical school and therefore knew all about ethics? And didn’t Rutchick also know for there to be great inventions like this it’s required that not just the inventor but anyone who uses it gets rich? Otherwise what incentive would physicians have to help patients and save lives! After all who except some communist would disapprove of such a system?

When Kyphon officials took their company public in May
2002, they disclosed in a filing with the Securities and
Exchange Commission that they had offered stock options to
the eight members of their advisory board. All took them
except Dr. Joseph Lane, a New York orthopedic surgeon who
teaches at the medical school affiliated with Cornell
University. "I felt it was very awkward for me to be honest about
these things if I owned stock in the company," Lane
said last week.

Yeah, and we know what color state this Dr. Lane character is from, don’t we?! Enough said on that topic. Honestly, virtually every great medical advance absolutely requires this kind of capitalist incentive for those using them. After all, most other medical advances come about the same way. The important thing is that there’s clear evidence of an improvement.

On the SpineUniverse Web site, Lieberman, Kyphon co-founder
Reiley and three other doctors published a four-paragraph
synopsis of their initial experiences with kyphoplasty
involving 26 patients. "These results support further
use of kyphoplasty," the March 2000 summary concluded.

What possible other evidence than this initial, non-per reviewed disinterested study could be needed? None, of course! The important thing is to get the new procedure into as general use as quickly as possible for the betterment of patient care and to save lives!

Before 2004, there had been only one reported death
associated with kyphoplasty and seven with vertebroplasty.
Since then, the numbers have changed dramatically. From 2004
through September, 16 deaths involving kyphoplasty were
reported to the FDA versus three vertebroplasty-related
fatalities. Experts agree that vertebroplasty is used more
frequently than kyphoplasty, although the gap has closed in
recent years. “These sorts of complications are extremely rare,” said
Julie Tracy, a Kyphon vice president. “These are procedures
that are very safe and do a lot of good for these patients.”

In a study published two years ago, researchers at the Johns
Hopkins Hospital in Baltimore also concluded that
kyphoplasty was more closely associated with serious
complications than vertebroplasty. Lieberman led the rebuttal for kyphoplasty proponents,
challenging the methodology of the study and completeness of
the data. However, those deaths and other complications underscore a
fundamental flaw of kyphoplasty: the risk of subjecting an
elderly patient to trauma and a general anesthetic, said Dr.
Kieran Murphy, one of the authors of the Hopkins study.
Murphy has disclosed that he receives royalties from one of
several manufacturers of the equipment used in
vertebroplasties.

Exactly, it’s clear that the naysayers are paid off by the communists. And at least we know that the insurance industry and the government are getting better value for money from the new procedure.

Murphy and other critics of kyphoplasty say hospitals need
the fees from general anesthesia and admission to recover
the costs of the equipment used in the procedure. That
equipment averages $3,500 to treat a single fracture,
according to Kyphon; vertebroplasty kits generally cost $500
to $600. Costs vary, but all told, vertebroplasty was found
to be $6,000 cheaper for each fracture treated, according to
a research report.

Well obviously those insurers must think it’s a better deal! Who could imagine insurers or Medicare just paying more for a new procedure without careful vetting it. After all they’re the end payer aren’t they? And they’re really strict about containing costs, as anyone paying insurance premiums knows! And if they weren’t so tough on containing costs for consumers and taxpayers, then why would we have a national clinical cost-benefit analysis center researching all these new treatments and being "transparent" about which ones cost what?

Answer me that, you Cleveland commie reporter, eh!

The only slightly disquieting aspect of this whole article is that the procedure concerned was invented in France. I know it’s a free market and all that, next time I hope that a red-blooded American like Dr. Lieberman could have been a little more patriotic. We don’t want those people with nice new backs only able to run backwards, do we?

 

TECH: Brief musings on the PHR

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Some brief musings on the PHR…given that I gave a talk on it for HIMSS N. Cal yesterday

— Email is unreliable! Not a comment on the PHR but I sent the organizer my talk in both Powerpoint and PDF (one for the talk, one for the web so the secret stuff hidded in the PPT stays hidden). Most of the intellectual property is of course in the fancy “builds” I did in Powerpoint. When I started clicking into my presentation, it became apparent that only the PDF version had gotten tp him, and was the one loaded on the computer. I of course had a copy of the Powerpoint on my thumb drive and this could have been avoided. Motto—always check what’s on the computer you’re presenting from.

— Kaiser Permanente’s PHR is rolling out pretty well, and has decent usage so far. It’s relatively transparent in terms of the views it gives into the patient record (gives full lab results) and links well to Web 1.0 generation content/information therapy.

—One of the points Kate Christensen (from KP) made was that they felt PHRs should be portable. But thus far that means portable within the world of Kaiser. I asked  if a member using KP.org changing plans could move all their data to Palo Alto Medical Foundation (which uses the same basic Epic software and is therefore the easiest imaginable “move”). Kate said that a) no one had asked so far and they didn’t yet have a policy on that yet, b) the data structures were different so it was more complicated than I’d made it seem, and c) they had a technical team working on it, really! Take it as read that this is a major potential future stumbling block and  view all those slides about “portability” and “interoperability” with extremely jaundiced eyes.

—One word baby: Autopopulation

— I didn’t smell sulphur. In fact the entire HealthConnect EMR (clinician part) was basically unmentioned, other than by me saying I didn’t smell sulphur. I think that knocks the conspiracy theory on the head.

—This article finally confirms that the just announced Intel/Walmart/BP et al initiative will be using PHR’s developed by JD Kleinke’s Omnimedix Institute. He was keen to point out when I last talked with him that his was a data auto-population and storage, non-profit, trusted 3rd party model, which others could build applications on top of. (i.e. competition for WebMD/Intuit).

— Cleveland Clinic has rolled out its Epic System including the PHR, faster and harder (if that makes sense) than Kaiser. They also have a way that allows referring physicians to get access to their patient’s records when they’re at the Clinic’s hospitals. This is a model for how providers not integrated with insurers or using a “monogamous we hope” (to quote Kate) medical group can roll out EMR and PHR. However, it was very hard work. Holly Miller, the doc in charge of eClevelandClinic, had to buy a lot of pizza. She’s leaving next year to take up the CMIO role at University of Cleveland. I joked that this meant that the Clinic’s docs had succeeded in running her out of their organization, but not yet out of town! Rather more likely, the Univ. Hosp likes her pizza buying/persuasion skills and realizes that the quickest way to catch up with its major cross-town competitor is to steal the talent! (Isn’t that what the Dallas cowboys and the 49ers used to do to each other in the 1990s?)

—Cleveland Clinic is also doing virtual visits into Mexico and Arizona, separating the reading from the diagnosis, and they’re pushing second opinions online as a service. Clearly they see their brand as a major weapon in getting national and international market share. They may be early, but if enough records go online, why does your second opinion need to come from the same city or country? And more importantly why does the patient have to be in the same physical room, when a tech can move the stethoscope or instrument around the patient, and the doc can see it all on screen, or an entire team of experts can be assembled virtually online?

—One reason why is that state laws restrict practice across state lines, and in some states (Holly think Ohio, but it was certainly true till recently in Georgia) even a prescription has to be handwritten and signed by the doctor. So 200 years of trade protection will not go quietly into the night.

—Matthew Guidin from Frost & Sullivan has done some real research on PHRs, which may make my back of the envelope stuff obsolete (or more valuable?). He seems to think that the health plans are talking a good game about interoperability, but have little intention of doing much. He also thinks that CCR (the AAFP-based standard for moving data between EMRs) is being sabotaged by the IHE crowd before its really gets off the ground.

—Everyone I met at the meeting that used to be a client is now a consultant! Who’s doing the hiring these days?

—Whenever a new incredible “innovation”  on their PHR was shown by KP or Cleveland Clinic Phil Chuang (my ex-i-Beacon colleague) and I kept whispering to each other “Didn’t we build a better version than this in 2000?” And we did. Which goes to show that timing, politics and marketing are everything. And technology is largely irrelevant.

 

PODCAST/TECH: Health Communities 2dot0

This is the transcript from the recent Health 2.0 Communities podcast–original post here.

Sermo_logo


Matthew Holt: Welcome to another podcast here at the Health Care Blog. This is Matthew Holt, and with me today are two more leaders of what we’re starting to call the Health 2.0 Movement. They are Daniel Palestrand, founder and CEO of Sermo, a community-focused site that focuses on physicians, and Unity Stoakes, President & COO of Organized Wisdom, which is a community site focused on patients and consumers. Good afternoon, both of you.

Daniel Palestrand: Thank you very much. Nice to be here.

Unity Stoakes: Likewise, Matthew. Thank you for setting this up.

Matthew: Let’s start off by getting right into it. I suspect that a lot of people reading the blog haven’t heard of Sermo or Organized Wisdom, and you guys are on different sides of the same coin. This is all to do with the open health care issue, and the idea of getting many more voices online. Daniel, why don’t you start off? Tell us a bit about the core idea behind Sermo, what it does, and what kind of activities are going on on your side?

Daniel: Sure. Up until about fifteen months ago, I was a surgical resident at one of the hospitals here in Boston. I had done some startups in ’98 and ’99, but really had no near-term plans to go back to the business world.

I started seeing a trend more and more with my colleagues, where we would be talking about cases or recent news in the mainstream press — perhaps a new revelation about a new approach to treating a disease, or a problem with a drug or device, or a new resistant form of bacteria. What we were remarking on was that we had inklings of this — it had come up in conversation weeks or months ago — that there was an idea there. We realized that this wasn’t a fluke event. So often in the trenches of medicine, at the bedside, in grand rounds, physicians were talking about these phenomena long before it appeared in the conventional press. That set me about thinking: what would you have to do to capture these clinical insights and make them useful?

My starting point was coming up with a business model. I had done other startups that involved physicians and health care IT, and I knew that trying to get people to part with money is particularly difficult in health care IT. So from the start, we had a model where we would not have physicians paying for anything. We would look to get the parties who find value in the information to pay — to underwrite the business model.

My second thought was, assuming we could get physicians to make these insights, how would we distinguish the signal from the noise? I had had enough experience with my early work with the CDC and Device Registry to know that getting the initial observations isn’t the challenge. The real challenge is separating the signal from the noise in the background. What I wondered was, could you create a model whereby the valuable information would be determined by the users themselves — in other words, the people on the front line.

That was really when Sermo was born. In our model, we have a system where any licensed and credentialed physician can submit an observation, but what really distinguishes the value of that observation is the degree of corroboration that it gets from other physicians. It started out with a very simple, basic idea. We were thrilled to see that it was a very patentable and fundable idea, and has now turned out to be extremely scalable. We are seeing an incredible torrent of information coming out of our system.

We’re now a thriving young startup company, part of what we’ve realized is a much broader trend, variously called social media, Web 2.0, or prediction markets. We’re very excited to see other companies, like Organized Wisdom, tapping into the same trends.

Unity:  I’m actually the president and co-founder of Organized Wisdom. We’re a health-focused social networking site. The easy way to think about what we’re doing is that we’re a mash-up between WebMD and Myspace.com. We’re really focused on integrating expert content with user-generated content, and eventually flaring in industry content and research from health organizations as well.

We got started… actually, my partner Steven Krein and I have been in the online space for the last twelve years. We took a company called Promotions.com public in the late ’90s. It was an online marketing company that was later acquired by iVillage. So we spent many years seeing a lot of these community trends taking shape in other industries, but we didn’t see a lot of progress being made with online health. At the same time, over the last couple of years, we’ve seen eight out of ten people going online to search for health information. We’ve also seen a lot of research indicating that people are turning to their friends and family to get health information. So we got the idea to combine the two and really try to create a community for consumers, patient experts and leaders of health organizations to come together and share their wisdom and knowledge in an organized, structured way… to build a very useful, helpful knowledge base covering thousands of health topics, conditions and diseases, so that any consumer needing health information could easily come in and find the information that they need.

Continue reading…

POLITICS/TECH: Fame and fortune and everythingthat goes with it

Today, (Monday) I’ll be on local NPR in San Francisco talking about what the Democrats may (or more likely, may not) do about health care in the new Congress. It’s on the Your Call show on 91.7 KALW at 10am and yes it has the politics you’d expect of a San Francisco NPR station, so I’ll be the right winger on the show! You can tune in or listen here.

And on Tuesday I’ll be talking at the Northern California Chapter of HIMSS in San Ramon about the PHR. It’s a good line-up and I’ll be reporting back on the smell of sulphur!

TECH: HealthCamp

There’s a meeting called HealthCamp about Health2.0 in San Francisco on Saturday. Many of the usual suspects will be there, but I suspect there’s room for lots more. You can add yourself to the list at the wiki.

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