I greeted with glee an email from Modern Healthcare suggesting that there was some seedy goings on in the RHIO world. That article is called Conflict-of-interest questions arise over RHIOs. I was looking forward to the expose of fraud, graft and corruption. Frankly the article is pathetic, and an embarrassing attack on totally the wrong targets.

Essentially the article says that Molly Coye was tangentially involved in the steering of consulting work from the Cal RHIO which she basically started out of HealthTech, which she did start, to a consulting company called Health Alliant of which she was an unpaid Board Chair/Adviser. The article does note that Molly never got paid anything by Health Alliant and recused herself from the negotiations between Cal RHIO and Health Alliant. Meanwhile Blackford Middleton is also on the board of Health Alliant, as is Scott Wallace and apparently they at least approve and are damned by association.

Full disclosure; I know Molly and Blackford quite well, and am in general fans of theirs, so take what I say in that context. But frankly this article is clutching at straws.

Yes, Molly is influential in the whole RHIO movement. She put together the energy with David Brailer to start the whole national health IT initiative, and you can argue that much of the concept of small Federal money to kick-start the private sector came from her 2003 Health Affairs paper. Yes, Health Tech was funded primarily by big providers, and Molly used her contacts and influence to get them to pay to fund it—but I might modestly suggest that if they provided nothing in return, HealthTech’s membership would not have come back for year 2. Yet several years later they’re still there. Yes, given that HealthTech exists it was a natural venue for RHIO discussions in California. Yes, HealthTech (and CalRHIO, and, on a sadly much more modest scale, I) receive money from the California Health Care Foundation, but that’s to support work that is important to CHCF’s charter. And the article managed to miss the juiciest ridiculousity of all in that CHCF’s President is Molly’s ex-husband! Surely they could have made some hay there!

Health Alliant, which is largely run by Jeff Rose who’s been in the health IT game for a while, is making a little business out of helping fledgling RHIOs with strategic planning. But it is a little business, at most $4m this year—and given the low margins on that type of work I bet their profit is puny compared to just the overspend on expenses at King/Drew in Los Angeles, or what Deloitte billed at UC Davis. And it’s nothing compared to the mega-millions Blues of Tennessee and Blues of Florida spent  in the 1990s with Andersen Consulting developing software that never worked.

And most importantly, Molly bent over backwards to get out of the appearance of conflict of interest. I’m sure if she was raking it in somehow, we’d all be invited to spend time on her yacht.

Many among us may have doubts as to whether RHIOs will succeed, and whether this is all a waste of Foundation and taxpayer money. But that’s the way progress (such as it is) in American health care IT is made. The goals of the the RHIO movement are extremely laudable. That it exists at all is in no small part due to Molly (and Blackford and Scott Wallace). There were I assure you plenty of things they could have been doing in the last few years to get much richer if they’d chosen. But instead they spent their time in getting us some of the way towards those goals. How does that justify running a long story about a non-existent conflict of interest that made them no money (and probably had a negative opportunity cost)?

If they want to dig into Molly, perhaps they should look into her appointment to the Board of Aetna. Although one only needed to look at their 10K to find out about that. Sadly for her she doesn’t appear yet to have the $400K in Aetna stock that the Directors need to own (and persumably not sell when they’re still directors) according to Aetna’s by-laws. They gave her a bunch of options for being on the board. I’m not exactly sure from my reading of the document whether it was a gift rather than she had to buy in. Perhaps Jack Rowe can lend her some cash if she’s short.

But even that seems very minor compared to just some of the Board appointments in health care. Don’t you think she could have got herself on the board of any and every health IT company in the nation if she’d really wanted to cash in?

There are plenty of potential conflicts of interest with board appointments in health care. Roy Poses doesn’t have Modern Healthcare’s resources, but  he manages to snare one or more from time to time including having a go at some clear board gadlfy’s like Uwe Reinhardt.

As for real malfeasance in health care? It’s just hard to imagine that Modern Healthcare couldn’t find somewhere better to look.

From Tom Foremski at Silicon Valley Watcher, Net neutrality has already left the building. You can subtley divert lots of content and commerce if you own the ISP and the pipes…

The conventional wisdom among the three of us who care is that physician clinical IT use is climbing among docs in big groups (really taking off 2003 onwards), but at a slower rate amongst other docs. A new survey from HSC that looks at physician IT use in another way seems to confirm that. But frankly it’s written in a way that makes it a little confusing, and I suspect that the key question about “Accessing patient notes, medication lists or problem lists” means that physicians can be doing that in a hospital, which is why it’s at 50%, but they probably aren’t using a computer to generate notes or orders.

The availability of ePrescribing is at 20%….given that these numbers are about “availability in the practice” not about actual use, it’s fair to assume that the 15% number I’ve been using for eRx is still about right.

But the conclusion makes sense.

On an annual basis, the proportion of physicians with IT for the various clinical activities examined increased an average of between 1 and 4 percentage points a year. The fairly slow average year-to-year growth and the significant proportion of physicians that continue to have only limited access to clinical IT suggest that physicians as a group have not yet reached a tipping point in the adoption of IT for most clinical activities.

I have an article up at Health-IT World which is about the evolution of PACS — largely based on a long interview I did recently with Oran Muduroglu, a founder of Stentor which Philips bought last year. I found it pretty tough to squeeze this one into the few words allotted, as it’s largely about a market and tech evolution that’s pretty messy! Again feel free to come back here and comment.

If you really have nothing better to do over the holiday weekend, take a quick look at where Cerner claim that they’re going to make their money in the future. I’ll be back Tuesday to comment.

I’m up at Health-IT World talking about interoperability. I interviewed the Sun guys and TeraMedica for this brief article, and will have something else on the topic out later this week. I hope that I made it understandable….it’s the kind of buzzword-full topic that makes your head spin. Please let come back and let me know what you think after you’ve read it.

Also at the TEPR Conference, Phil Sissions, who recently left working for the UK’s NHS’ National Program for Information Technology (NPfIT), gave a pretty critical account of the progress to date for the single largest program in health care IT. The only real successes were getting broadband into the various hospitals and practices, and getting some PACS systems up. Getting doctors their own email address was somewhat mocking called the biggest achievement. Sessions said that many of the other programs, including the Choose and Book appointment system are barely being used, and that GPs have revolted when being told that they had to change out their practice management systems. So far the project has spent hardly any of the money allocated to it (approx. 650m GBP each year) because most of the contracted software hasn’t been delivered. Meanwhile, local hospitals and physician authorities have little money for process change, and have stopped much IT development progress waiting for the central program to provide for them. Sissions didn’t give the attendees much cause for optimism, and indicated that there was a heightening level of hostility between the vendors and NPfIT head Richard Granger.

More later….