Managed Care has a conversation with Molly Coye about the progress in automating and infomating the health care system. You’d think she’d be a pessimist after all these years. But she’s not really! Well worth a read.
TECH/POLICY: A prime example of how health care works, sort of.
The continuing fuss about the Cutler article rumbles on. Here’s the Scientific American article that I’m quoted in. You’ll note that I may seem a little extreme (“rubbish”) but I was interviewed before I’d seen the article (or even knew that it was coming out!) and the reporter told me that the number for a year of life was between $100,000 and $200,000. But the question is still “worth it compared to spending the money on what else?”
Meanwhile the answer from David Henderson at Hoover (the guy I challenged on the local NPR call in show —on the MP3, my piece is cut out totally! The response is at 44.14) remains “we’ve picked the low hanging fruit, so it will be more expensive to move the needle as the years go by.” I wasn’t given the chance to say a) the industry has co-opted the government so it’s not like there’s a real “choice” in how we spend the money, and b) perhaps we’d get better value for money picking low hanging fruit in some other area of our society. In other words there are diminishing marginal returns from the flat of the curve medicine—so perhaps we should think of spending the money elsewhere? Meanwhile a few others have picked up on that. In the Huffington Post, Merrill Goonzer (yes that’s really a name!) from the Center for Science in the Public Interest points out the other part of the problem—“we may be paying for an Aston Martin but we’re getting a Ford”.
And when the status quo proponents say “costs are going up in other countries too” you can note that in 1970, health care costs in Canada and the US were the same as a share of GDP—and they’re not now! And in the 1990s both Japan and Canada reduced health care costs as a share of GDP. So societies can make choices about this, even if ours politically won’t. In fact in the last decade the Brits made a conscious choice to increase the amount of money they spend on health care—with some interesting consequences.
Of course the whole thing is totally bogus, as no one thinks of these things other than as ex-post facto justifications, and pretty weak ones at that. There’s a perfect example in the NY Times this morning. It says that Cardiologists Question the Risks in Using Drug-Coated Stents, a story that’s been reported on for a while, and includes a new Swiss study that says that only one in three cases is the use of the drug eluting stent correctly indicated.
Of course three years ago a Stanford health services research group suggested that stents as a whole weren’t worth it on a cost-benefit level, and got totally ignored other than on this blog! So there’s a chance (and it’s a slight chance) that medical counter indications might, just might, slow the spread of a technology that is basically unproven. There’s no chance that saying it’s not cost-effective will slow it at all.
Which kind of proves that arguing about the Cutler article is a waste of time!
TECH: Perot wins another big outsourcing contract
Catholic Healthcare Partners to outsource tech operations to Perot. Healthcare providers have been slow to outsource their tech operations, but Perot especially has been making some gains in recent years (while a few others have been stumbling).
QUALITY/TECH: Book reviews on quality and technology strategy
So it’s time for book reviews on THCB. The first book I will talk about is an excellent business written by — full disclosure — my good friend Tony Seba. For several years now Tony has been teaching a course on high-tech marketing strategy. I used to think this was just a chance for him to hang out at Stanford and spend some time in New Zealand, but in fact the course he has developed combines interesting and relevant business cases with general marketing lessons, and most importantly practical explanations of what to do about it if you are creating a business.Now Tony has put his course into a book, so you can get the benefit of his wisdom, without having to go to class. The book is called Winners Take All – The 9 Fundamental Rules of High Tech Strategy. I was really very surprised when I read it because the articles and examples that Tony brings up are things that may appear obvious. But from my time working in even small corporations, I know how hard it is for people to organize and coalesce around getting those things done. Tony’s basic thesis is that for most high-technology markets, one corporation tends to dominate an entire product line. Of course that is not a new theory, but what Tony has successfully done is to identify nine rules that allow companies and products which are in different parts of their life cycle to effectively dominate their markets.
What is particularly useful about the book, beyond the interesting stories and insight you will gain from reading it, is that there are practical ways in which you can put your own project. product or company within the context of the rules. Although Tony is concentrating on high-tech marketing, I think this has many applications for projects and products within the world of healthcare and healthcare technology. And of course any of those of you reading this who are thinking about developing new products for sale to the healthcare industry will have to take the marketing rules deeply to heart.
Interestingly enough, even though I’m pretty sure Tony could have got a standard publishing contract for his work, he decided to publish it at Lulu.com in what he calls a beta version. His argument is that it’s better to get the book out now and to get feedback and incorporate it into the rest of his course and his work, then to take on the traditional 18 months publishing process. But if you go and buy the book at Lulu, which I highly encourage, you won’t be able to tell any difference from a book you’d get in regular store (unless of course you choose to download the PDF version). So not only are you looking at the future of high-tech strategy, you are also looking at the future of publishing. Given that one of the industry’s that has been revolutionized by on demand online access to their product is low recording business, and it’s one that Tony featured in the book, I suspect that the publishing industry should be similarly concerned.
The other book I am reviewing is of a somewhat different flavor. It is one that has been advertising on THCB for the past couple of months, so I felt honor bound to take a quick read. The book is called On Track to Quality, written by James Todd, a professor of pediatrics at Denver Children’s Hospital. Essentially James has developed ten major rules around quality, many of which will be familiar to those of us who have tracked the quality movement in healthcare and outside in the past two decades. I was glad to see the pretty early on in the book he gone in favorable mentions to the greatest book about quality of all time, Robert Pirsig’s Zen and the Art of Motorcycle Maintenance, and in fact the style of Todd’s book reflects some of the qualities of that hippy classic. In the case of On Track to Quality instead of it largely being a discussion between a man, his alter ego and his son on a motorcycle journey, it is a discussion between a group of unlikely passengers on a snowbound train heading across the Rockies. However the passages include enough characters that one suspects that Todd has had some interesting beyond those one would normally associate with an academic pediatrician!
However when one strips away the somewhat stylized way that the material is presented, again in a fairly brief book — it’s just over a hundred pages -there is very useful information about what the quality movement is all about, and a holistic view of how it might be applied to medicine and healthcare. I particularly liked the way each chapter ends with a summary of the rule, and that you could build out the 10 rules and make them relevant to your own situation.
TECH: Dragon NaturallySpeaking first review
So I was so fed up with the common tunnel syndrome article from my last big project that I went out on board Dragon NaturallySpeaking 9. Now I am a hell of a challenge for any dictation system because as any of you have met me and spoke been no I mumble my words, and of course I have a funny British accent that doesn’t match the mutual trans-Atlantic term to Dragon NaturallySpeaking was trained in.The first two paragraphs here the first first two things I have written for the tutorial. It’s a little disconcerting because learned you have to still speak slowly and much more clearly than you usually would and the mother trendy headset digs into my skills with it more than I would like. In addition the words and I in a yellow box at the top of the screen and although I guess you can wait some time while you’re dictating a way for it to continue to think, it’s a little disconcerting to accumulate into it and saying nothing appearing on the screen. In fact some 10 years ago we tried out an e-mail program that IFTF that was supposed to be the greatest new thing but when you typed on the screen nothing appeared for several seconds. This is a little bit like that but as I continue to talk it does seem to be doing a little data, or maybe I am doing a little better for it. Now I’m going to leave those two paragraphs, corporate and below and correct them
——
While doing this I discovered that you cannot copy and paste a huge section 🙂 I’ve spent some time fixing the next section so you can see what it should have been.So I was so fed up with the carpal tunnel syndrome from my last big project that I went out and bought Dragon NaturallySpeaking 9. Now I am a hell of a challenge for any dictation system because as any of you who have met me or spoken to me know, I mumble my words, and of course I have a funny British accent that doesn’t match the neutral trans-Atlantic tone Dragon NaturallySpeaking was trained in.The first two paragraphs here the first first two things I have written after the tutorial. It’s a little disconcerting because you have to still speak slowly and much more clearly than you usually would and the rather trendy headset digs into my skull with more force than I would like. In addition the words appear in a yellow box at the top of the screen and although I guess you can wait some time while you’re dictating away for it to continue to think, it’s a little disconcerting to dissemble into it and have nothing appear on the screen. In fact some 10 years ago we tried out an e-mail program at IFTF that was supposed to be the greatest new thing but when you typed on the screen nothing appeared for several seconds. This is a little bit like that but as I continue to talk it does seem to be doing a little better, or maybe I am doing a little better for it. Now I’m going to leave those two paragraphs, copy them below and correct them
——Well, it look longer to correct what I just said that to say it in the first place. On the other hand, I guess the words that it cannot get the first time are going to be the ones it is going to continue to have trouble getting when you try to correct it. It’s a little difficult because the manual says that you when you try to use the voice command for "select", it will actually training the software to recognize your voice and you want to try to recognize the words it has the most problem understanding. On the other hand is a damn sight quicker to just use the mouse to select those words.Anyway it’s still a gazillion miles away from the 95% accuracy that talks about in its publicity, but it’s pretty damn clever nonetheless. Given that the reason I bought it, was because my wrists were hosting not because I type slowly, it’s probably a good thing that I start trying to use it, at least when I’m writing lengthy pieces that require a lot of correction — and even as I keep talking now, it seems to be getting better.
The weirdest thing off all, and I suspect many of you had the same thing going on, is that I don’t consciously verbalize what I write when I’m typing. None of your wisecracks please about the fact that I may not read what I have typed after I have typed it, although that may be true from time to time. In some ways it’s like the old joke about the English majors in college, we used to say that if you look very closely you can see their lips moving. While I guess I’m one of them now.
TECH: EMR meant savings, says Pa. doc
TECH: JSK tries to sort out the “Chaos and Creation in the Health IT Market”
Jane Sarasohn Kahn tries to sort out chaos and creation in the Health IT Market. JSK “remains hopeful” that the market will sort it all out. I’d say she was from the Planet Pluto, but it’s not one anymore. (Ho, Ho) Seriously, she lays out a whole host of reasons why the government “push” for IT has perhaps been overstated by the analysts as a factor for market growth, and knowing JSK as I do, reading between her lines, she’s quietly crying bullshit. On the other hand, I do think that the automation of the smaller hospitals due to the labor shortage is a bigger factor than the mainstream analysts seem to think. So there will be some creation, but still lots and lots of chaos.
PHYSICIANS/TECH: Technology won’t replace doctors — and it won’t cut costs, at least so says a doctor
Kessler’s book on how doctors will get replaced by technology is dissed by a doctor who points out that he had to go to medical school and learn stuff that you could never teach a CT Scanner, dammit! And those bastard venture capitalists next door earn far more money! I suspect steel workers in the 1960s said the same thing. I’m not exactly sympathetic to Kessler’s argument, but with defenses of the status quo like this…..
TECH/HOPSITALS: IBM Consulting’s view of the full employment future
Up over at Health IT World, there’s an interview I did with Ivo Nelson, the Healthcare Industry Leader of IBM Global Business Services. Suffice it to say that Ivo doesn’t think we’re very far along in the transformation of clinical practice, even on the hospital side. He thinks his shop will be plenty busy for the long-term, and he’s almost certainly right!
TECH: The real news
MrHISTalk channels The Onion. I get the impression he’s having way too much fun.
