Little did I know three years ago when I started this blog, that I might venture down the path of actually becoming a journalist. Well here I am, with my own by-line on a story at Health-IT World. It’s called Location Tracking Magic and the Aircraft Black Box: Coming to a Hospital Near You
Of course, now I know what freelance journos make, I’m not exactly thinking that this is such a great career move!
Meanwhile, Shahid Shah has a pretty interesting article about RSS in the same issue.
Over at HealthNex, the IBM health care blog; Blogposium is a Go: April 18-19. I will not be taking part in this one, because of something I’ll tell you about later. But it looks pretty interesting. Lots of different bloggers all working on different aspects of a clinical wiki.
So here’s what’s going on: Here’s Jack Mason’s guide.
The Objective: To help flesh out The Clinical
Informatics Wiki with a dozen or more new entries, so that this
wikipedia-like resource will become more useful for all. The
Work: In the next few weeks, each participating blogger will choose a
topic related to healthcare IT (I’ll take on Biobanking, for
example) research it, and prepare a first draft for an entry in the ClinfoWiki.
Entries should include basic definitions, links to supporting material, etc.
April 18: Bloggers will post their first drafts on and all
of us, as well as all our readers, will provide comments, suggests and edits on
each other’s work. Everyone should include links at the bottom of their draft to
the preliminary drafts of fellow Blogposium participants, so that we will pass
traffic and editorial eyeballs around.April 19: Readers and other Blogposium participants will
continue to provide input, and topic authors will work toward second drafts
based on comments.April 20: Blogposium participants
post their revised Second Drafts, for
inclusion in the wiki and point our collective readership to it for continuing
evolution.
Medical Economics, a magazine doctors actually read, probably just set back the cause of getting EMRs into small practices about 10 years with this article called: Why EHRs falter (Hat-tip to KevinMD)
My take is that this needs to be an ASP business wrapped into the billing service. I think that it’s nuts for a small practice to take on the responsibility of integrating an EMR with their billing system, and even crazier for them to buy and manage software and hardware. They’re already paying somewhere between 6% and 12% of revenue for billing services, and they should be making their billing services provide them with an ASP based EMR. And quite a few out there will do that.
And think about this. My friend who is a physical therapist at Kaiser tells me that she is going to halve the number of patients she sees for six weeks and have a full-time consultant helping her individually when she gets put on the HealthConnect/Epic system. And that’s probably the right approach. How many small practices can genuinely take that time or make that investment?
(If you’re not a Noel Coward fan and don’t understand the title reference, look here)
The ever wonderful Jane Sarasohn Kahn has written a pretty definitive piece on physician PDA use at iHealthbeat. (Yes, Jane is a co-author and long time friend, so I’m biased, but she is wonderful). It’s called PDAs Reach the Tipping Point . The point is that somewhere between 50% and 60% of doctors and plenty of other clinicians are using PDAs for reference use.
Epocrates is a big reason why. I met with Epocrates’ Michele Snyder briefly at HIMSS. Epocrates has now some 135 people and hasn’t taken any more cash since the dotcom days when it took in $35m. It still gives away its drug databases for free to any PDA user, including a scad of formularies—some 400. It’s got around 500K active subscribers (updated in 6 months) — including 200K physicians in the US alone. The struggle is of course to make money off that database.
They do that by charging for a symptom and diagnosis checker ($60 a year each or $149 for the lot) and by charging health plans and PBMs to show their formularies. In addition they have 130K physicians in a market research panel which you can ask questions of, for a fee of course! Doctors can even do CME short credit courses on the device. And one of five of their alert messages are sponsored, so there is a little advertising, but less than on a prescription pad. And apparently using the database is worth it for doctors
Let’s use one of Epocrates’ findings from the Brigham and Women’s study to calculate potential revenue savings generated by using a PDA for drug reference information alone. The study found that 35% of Epocrates physicians saved at least 30 minutes per day. Assuming the average physician generated $1.26 a minute (according to the MGMA’s 2004 physician compensation survey), using a PDA for drug reference could produce about $10,000 a year saved for a single physician. Now, consider additional applications for the PDA and what they could generate in productivity savings (and thus income enhancement). Epocrates’ recent survey on Medicare Part D offers another factoid to consider: 70% of physicians surveyed believe accessing Medicare Part D formularies via Epocrates software will help them save at least an hour per week. These time savings would be in addition to the drug reference savings already calculated.
Of course the key question is whether the PDA as a platform becomes a transaction tool rather than just a reference tool. Palm, whom I met with last week, of course hopes so, and has recently brought out a Windows mobile version of its Treo to increase its range in health care—as well as other industries. (Epocrates already ran on both systems, but some ePrescribing tools like Zix were Windows only). It’s also worth noticing that cell phone penetration amongst docs is in the 90% range, and that the integration of PDA capability into the smart phone makes it easier to get transactions into the work-flow. When everyone’s used to getting email on their smartphone, eRx will fit right in.
In fact JSK has a list in her article of PDA applications in health care. Several (like PatientKeeper) are looks into larger health care IT systems, and Allscripts’ Touchscript is probably the leading eRx application—a transactional system. So this is coming together. And as we told you in our recent piece, the infrastructure is being laid so that the eRx applications can get to the pharmacy work-flow and improve efficiency in the pharmacy and the physician’s office.
Now we just have to beat the clinicians to the point of pain to make them use it!
The S.F. Chron has an article about local boy made good David Brailer and his attempt to persuade American health care to inter-operate, or whatever it’s supposed to be doing in the absence of a mandate or any money! Brailer lives in San Francisco and truies hard to be in California on the weekends. It’s a good article complete with actual photos of actual doctors in a real life-hospital trying to use an EMR. And there were people who scoffed that it would never happen!
Meanwhile, the profile tells us something I never knew, not that it’s relevant to his gig or his career or in the least unusual in our fair city; Brailer is gay. He frequently mentions his kid in his speeches, and I just assumed and assumed wrongly. So given that my immediately previous article in THCB was about another Bush appointee who thinks that Brailer and his ilk will rot in hell, it’s good to see that the Adminstration for once ignored its maniac Christian right in a relatively non-political appointment. Or given that a quick google search shows up nothing on the topic, perhaps Rove at al were as political as usual but their background searches were as competent as their war-planning and hurricane relief efforts.
A while back there was a boring argument interesting exchange in THCB on whether the options awards to a certain health plan CEO were really part of compensation or costs to the company (and hence to its shareholders and customers). I suggested that option grants that were “in the money” certainly were. Of course if you really want to play the option and stock trading game really well, you’re better off if you are transported back in a time machine and you could then place bets on a game of which you already knew the result. OK, if you haven’t mastered time-travel, you could just be allowed to backdate the timing of your option grants (and hence the strike price) to the lowest closing price of the year. And the WSJ has a rather interesting article showing that apparently both the certain health plan CEO and the CEO of the largest Medicaid technology outsourcing company did just that. Nice work if you can get it. But of course none of this is costing us —the suckers paying premiums and the taxpayer paying the tab for Medicaid—any money, is it?
Below the jump are the graphs about UnitedHealth’s McGuire and ACS’ Rich:
There’s a new crisis every day, and Friday’s was a terrible new affliction as reported in the New York Times caused by poorly used laproscopes which burn holes and cause bacterial infections because don’t have a special new feature that tells the surgeon when they’re leaking electricity. So I asked a rather experienced laproscopic gynecologist that I’ve known all my life (thanks, Dad!) what he thought about how real this problem was? Here are his comments.
It has not happened to me but obviously does. Like all safety precautions it is a question of balancing costs and returns. As well as the cost of the monitoring methods there is the staff time in using them and probably reduced OR activity due to delays when monitoring. As far as I can see from the article there are no definitive figures as to the incidence of leakage burns due to defective insulation. I would guess there are more complications from inadvertant and unrecognised perforation of bowel inserting trochars or unrecognised direct burns from the working tip of the instrument being accidentally activated. There is no completely safe surgery.
Sensible words indeed. But of course, there is a solution!
Of course not coincidentally the stock of the company that makes the solution, called active electrode monitoring technology, went up 35% on twenty times the normal volume on Friday. Pure coincidence of course!
I’d be prepared to dive in
myself, if the last company the NY Times hyped up that I did dive into
hadn’t had its stock go down 30% since the article came out!
If you bought ECI today I hope that surgeons and hospitals are more
pliant to the NYT’s advice than are the school kids who’ve failed to
buy the Fly Pentop Computer.
Newt is at it again. This is one speech for which I assume he didn’t get his $40K going rate as it was to the Florida House. As usual he said tech would solve all our problems— he should know enough to shut up about that line, or at least qualify it by now. My views on this are well known to THCB readers but suffice it to say it’s not an accident that health care doesn’t use IT the way Newt would like it to and his solutions appear to operate in a vacuum. Still if health care companies keep ponying up $200K a year for the right to listen to those brilliant statements (and not of course just to get close to a big Republican mover and shaker), who am I to judge? But in the middle he said this:
"Current federal law is stunningly stupid and destructive because it blocks hospitals from giving away electronic health records to doctors," he said.
Maybe I’m dumb but didn’t MMA explicitly say that this was OK? And hasn’t CMS and DOJ ruled that this is a safe harbor? And aren’t hospitals already doing this?
Then he said:
In many ways, he said, Florida is the nation’s most innovative state in health care.
I assume he was talking about innovation in spending three times as much as other states for the same results, and leading the league in health care fraud.
Meanwhile he’s speaking out about transparency in hospital supply pricing while my spies tell me that MedAssetts the GPO is a big backer. Although that’s not a bad thing given the opaqueness in traditional GPO business practices.
Zack Lynch has put together a conference called The Neurotech Industry Conference 2006. It looks pretty interesting for those of you who care about the various medical and pharmaceutical approaches to the development of new treatments and diagnostics for the brain and nervous system
And if the health care blogging world wasn’t specialized enough for you, here are two new ones taking deep dives into very specific subjects. One on the Ethics of Vaccines from the Bioethics guys at UPenn, and the other on bio-medical informatics called FutureHealthcareIT from uber-nerd Dale Hunscher at Univ Michigan.
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