The ever wonderful Jane Sarasohn Kahn has a new commentary up at iHealthbeat on iPods and Health Care. It’s really more about how consumers are using new media in general in health care rather than podcasting per se, but it’s well worth a read.
TECH: More PHR struggles
I’m talking at a conference at the end of the week about consumer health records. Given that you all by now know the history of how the company I was with that sold consumer health records to health plans was ahead of its time didn’t survive, you won’t be surprised to know that I’ll be talking on a topic I’m calling An Archaeology of the Commercial PHR Movement.
Well today it looks like another start-up that announced with much fanfare a couple of years back is biting the dust, or at least going back to the machine shop for some serious work. RedMedic is sending out letters asking its subscribers to print out their records, and telling them to go to MedicAlert instead. Unfortunately when they contacted me a couple of years back, I told them that I thought they’d have a very tough road. Hopefully, they’ll come out of this somehow, but unfortunately they look like they’ll be another layer in the rubble on which hopefully a viable PHR will be built.
TECH: The evolution of wireless in hospitals
Now that cell phones and Wi-fi have proven to be safe and essential for health care facilities, there’s a race on to get signals into those buildings. This is proving to have some interesting possibilities, but is also bringing some technical challenges to hospital technology managers. Frequently buildings are too dense to allow good cell phone signal, while increased demand for Wi-fi and VOIP is putting pressure on the ad-hoc Wi-fi networks being built up in many hospitals. One solution gaining traction is to locate PCS, cellular and paging, and Wi-fi services centrally and create a series of ceiling-based transmitters to amplify and distribute the various signals. One company in the forefront of this is InnerWireless, which has announced several installation wins in recent weeks. I recently spoke with Jim McCoy, chief technology officer of InnerWireless, and Tuomo Rutanen of Ekahau to find out a little more about what’s going on inside the wireless world for hospitals.
Wireless and Wi-fi are different. InnerWireless’ technology deploys Wi-fi, as well as PCS, cellular, 2 way radio, 2 way paging and other signals. Conventional practice for Wi-fi is to deploy those points throughout a floor or department. Innerwireless co locates those Wi-fi access points at one place per floor, combine their outputs and then injects them onto their distributed antenna, therefore giving every user the strength of multiple antenna to access. This enhances Wi-fi data and more importantly VOIP performance. There tend to be around 6 distributed antenna per typical 20,000 sq ft floor, each one up in a ceiling panel where it’s installed once and forgotten about. All other services (cellular, PCS, etc) are piped to the same access point from aggregated through a main console room. And of course once the central points are in for cellular, it’s probably more cost-effective to layer Wi-fi into that system than to do it with ad-hoc networks.
In addition InnerWireless, Ekahau, and others are developing the ability to track patients, products and equipment in a cost-effective real time manner using the Wi-fi network–an always-on alternative to RFID which works sort of like an “indoors GPS”. They are both deploying tracking tags on people and equipment, and the size and price of those tags is falling rapidly. Ekahau’s approach takes advantage of the existing Wi-fi network, whereas InnerWireless uses its installed antennas and adds several more battery-operated sensors (probably 20 more per floor) to extend the accuracy of its trackers. Innerwireless is running their tracking over a different system within their infrastructure and are using the 802.15.4 standard for the tags.
These are two innovative companies attacking a key problem for health care facilities. Given the problems hospitals have locating their staff, patients and other movable parts, expect this technology to spread rapidly.
TECH: Cerner stock keeps going up
Cerner’s stock price is up another 5% today. It’s P/E is nearing 45. And this is for a company that basically sells more services (i.e. consulting) than software. No doubt that the re-architecting of their technology back in the last Millenium paid off big time, but this recent spurt really is on no new news, other than GE overpaid for IDX.
But does this mean that one of the oft-mentioned candidates for takeover (Oracle is a frequent mention, but any big tech firm might do) is having another look? Or would the really ballsy play to be shorting Cerner here? Here’s the chart, and yes we should all have bought in May.
Technorati: healthcare, health, technology, policy, politics, economics,medicare
TECH: Just a little more about the PHR
You can skip this one if you’re bored but the Personal Health Record and associated stuff just won’t quite go away. I’ve not only got a tawdry past associated with the PHR/CHR, and have spent far too long thinking about it, but I’ve also fooled myself into creating a paper for a forthcoming academic presentation on the subject–which will be an archeology of the attempt by commercial vendors to get the PHR up and running.
Now USA Today has a piece on PHRs which goes onto talk about yet another new one (Mymedicalrecords.com) which is basically a "fax paper in vault" which looks exactly like half of the ones that came out in 1999, such as PersonalMD.com. And BTW their technology was backwards even for then! So it look as to me as though USA Today has been a little bit snowed.
So let me give you my four categories of PHR
1) The PHR that is looking into a real EMR. See the version that PAMF or Group Health of Puget Sound uses based on their Epic system.
2) The PHR that looks into the claims database of an insurer and changes the view of the CRM system the patient sees. This is the one that I was selling back in the day, and that WebMD via its Wellmed purchase is now just offering to plans, and has had Empire launch (and Wellpoint announce it will be launching). The recent IBM announcement is in this vein, although I doubt any American trust their employer enough for that to be a success. (see yesterday’s 60 Minutes as to why)
3) A PHR that allows a patient to look into their doctor’s system if they have one, or not. RelayHealth has a version of this, and Medem’s iHealthrecord is able to look into Allscripts EMR (and theoretically a bunch of others too). This is the ultimate answer for most of America (or some version of it) but it’s dependent on using physicians as a distribution channel to patients and that’s a bit of nightmare.
4) A standalone device like Quicken, that may in some way be able to take in some portion or version of the EMR from providers. This is the route Capmed is going, and where RedMedic, MymedicalRecords, et al are heading. I remain very, very skeptical about this — particularly their attempts to make consumers pay for it — but to be fair that’s what MedicAlert does and plenty of people are buying that bracelet.
Of course if you want to get everyone using one of these PHRs you’d be better off putting your whole state or national insurance system into it, as the Germans are doing.
Meanwhile, back in the UK, they are trying to get their related Choose and Book system up and running. This is a referral and appointment system between GPs and hospital specialists. (Note that in the UK there is very little patient self-referral). The answer seems to be that it is slowly beginning to work (in some places) and that it is increasing the role of the patient in choosing who they are referred to. (A choice which didn’t really exist before). Meanwhile, this article focuses on the early adopter the Whittington hospital, in North London, using Choose and Book. Of course The Whittington has always been ahead of the game introducing new and amazing things to the world. Yup, I was born there!
CODA: The USA Today piece horribly misquotes Mark Bard as saying that DrKoop.com had this PHR idea back in 2001 but never really got it going. DrKoop.com had this PHR idea before it was up and running in 1998, but couldn’t get it right and took the easier route of instead being a web health content portal. It never got the PHR thing into any level of production and having been an Internet star in 1999, it was on the famous March 2000 Barron’s list of companies that were losing too much money to survive (the article that helped start the dotcom crash). By 2001 it was basically going under. At least I hope Mark is being mis-quoted!
POLICY/POLITICS/TECH/HEALTH PLANS: Trown out in the trash
Politically this has been quite a week. Don’t you think that John Kerry just wishes that we had five year Presidential terms and that he was going into the election this November, rather than a year ago? This week even the great flip-flopper himself came out with a plan as to how to get our troops out of Iraq. Pity he laid off all the attacks till the election was over (and same with Al Gore too!). Bush keeps ranting on about final victory in Iraq as if he had any idea what the hell he was talking about, and that he hadn’t declared Mission Accomplished two years ago. Now he finds that most of the cabal running the country’s foreign policy for the past 4 years are on their way to disgrace and/or jail, and that his incompetence in choosing a secret wingnut instead of a well-known one for the O’Connor seat on SCOTUS has lost him (at least temporarily) the support of the loony right.
What has any of this got to do with health care?
Well as they say on The West Wing, there are a couple of stories sitting in my backlog that I want to throw out in the trash. First BusinessWeek had a profile of David Brailer, stressing that he honestly believes that there’s a free-market solution to interoperability in our current health care system. Well he’s even lost Neal Patterson on that one (and yup last year Patterson spent a fortune failing to get his wife elected to the House as a Republican). Meanwhile, another leading health care IT exec who wants to get himself elected to Senate as a Republican (Rich Tarrant of IDX) is sounding somewhat like a commie in his support for Medicare and Medicaid. (Hat-tip Don McCane) Finally there was an extraordinary long interview in the New York Times with the founders of AFLAC (itself a pretty useless insurance product) in which they showed that you can make a duck famous while having absolutely no idea about how to fix the US health care system, even if you vaguely understand the problem.
All of this leads me to believe that the business class that runs the country is somehow getting around to this problem, and that they might not object to it being solved. If the Administration’s problems continue to pile on for all the crimes and cock-ups they’ve caused us in the last five years, then next October we might, just might, get a change in the Congress and put us on the road to a Democrat in the White House in 2009. If that happens (and I know this is all speculation) then health care will have to be the first issue on the domestic burner — which is a little sooner than I’d predicted. All pure speculation just now, but this week might be the turning point.
TECH: PHR conference
Last week’s PHR conference that I didn’t go to (cos they held it in DC and I’m too cheap to fly there by myself) now has an available transcript. (All big PDFs–you have been warned).
The intro is long but good. It has a talk from Carolyn Clancy (AHRQ chief) then a quick 3 person panel on PHRs from CapMed, Brown and Toland (using Medem’s iHealthrecord) and Cleveland Clinic (similar to the PAMF system Paul Tang spoke about). Finally it has a tour de force from Newt Gingrich, who explains exactly what we should have all have a personal health record and gives me no clue as to why we’ll get there. But that doesn’t stop companies giving him $200K a year to join his Center for Health Care Transformation–purely because they are interested in his words of wisdom; sure, yup that’s all they’re interested in!
I haven’t got to this yet but here is the Intel lunch talk, and here’s the last session with Esther Dyson et al
TECH: Privacy, standards, certification and RHIOs–more from AHIMA
Yesterday’s the AHIMA meeting morning presentations were excellent. The presenters were all on their game, and were also relatively amusing (especially Mark Frisse). But although I know a lot more about the DC based machinations of the national health initiative after this and the Brailer talk yesterday, I’m still of the opinion that there’s less there than meets the eye.
Carole Diamond runs the Markle Foundation and their Connecting for Health Program with the help of David Lansky, who used to run the Foundation for Accountability which Markle has swallowed (more or less) whole. In her speech she talked about Connecting for Health
Connecting for Health cares about
1 Tech standards and adoption
2 Policy framework for successful EMR/PHR/RHIO implementation
3 The consumer
TECH/CONSUMERS: Tang on the unstated information therapy
Next up was Paul Tang, the CIO of the Palo Alto Medical Foundation. He wanted to talk about patients, and about transparency. PAMF went to open access to physician visits (i.e. you call up, and you get a same day appointment) a while back, but found that half the people would rather treat themselves than come in. Worse, even in those visits patients missed the problem that the doctor talked about 54% of the time. So access to the patient’s information by the physician (even if the physician is immediately available and the information is immediately available to the physician) is not enough becuase the patients aren’t getting the information from the doctors. In the US 71% of patients not given any information after an office visit. PAMF now gives out a post-visit summary which is a simple print out for their EHR and patients love it.
Paul contrasted the health care information system with the air traffic control back up system, and the pilots’ interface in their cockpit with the health care interface in the ICU (guess which one is non-standard). We have not set up the interfaces (e.g ICU’s are all different and non-intuitive) or the standards that work, and have no computer back-up. American health care sucks (his words).
He suggested 3 solutions —
1) give a warning that the patient has to sign a consent that the physicians is not using and EMR and nothing can be expected to go right. (Somewhat unlikely even if true!)
2) Patients already keep a medical record at home (which some are already doing) or
(his favorite)
3) provide patients with the information that they need when they need it — this is what PAMF does using the Epic patient look-into the EMR. Their information therapy shows the patient what to do, and allows them to message the doc/nurse — and all of this is captured in the EHR. It shows the personalized content for the patient connected to their actual personal information (e.g. a dabetic diagnosis changes the content offered to stuff about diabetes management).
The most popular feature is lab test results with the physicians annotation and next step instructions. Their systems now has good enrollments and 96% patient satisfaction. Patients are respectful when they communicate electronically with their physicians and docs are 90% happy too. One patient quote "It’s not just a website it’s a good deed", 20% of patients changed their behavior just from seeing their results, such as graphing test results against time helps patients stick to diet.
Somehow Paul gave this whole talk without mentioning the words "Information Therapy". I assume Don Kemper is taking note somewhere.
TECH: The latest from Brailer
Monday crack of dawn saw me heading of to San Diego to sit in a room with thousands of (almost all female) hospital coders at the American Health Information Management Association conference. You know the reality of "information" in health care when you figure out that this conference is not about the $25-30 billion spent on hospital IT systems, it’s about the $25-40 billion spent on transcription and coding, and up coding, down-coding and paper records management. This ugly step-sister of the EMR hype is still there and not going no-place any time soon.
First up (and earlier than advertised so I missed half his talk) was none other than Health IT Czar David Brailer. Those of you following the press releases know that he’s been a tad busy, even if Cerner’s Neal Patterson thinks that it’s all inside the beltway bullshit. Brailer said that the Fed’s process is at the "end of the beginning" — October is a pivotal month. The time for discussion is soon over, and the Federal government is moving towards exact plans and near and certain deadlines for health care IT. Brailer views health care IT as being inevitable. He notes that interns in training today were born a year before the IBM PC came to market…so doctors will use computers at the point of care.
But he was clear that we can still get this whole thing wrong. In his view portability and interoperability is not an option, it’s essential — so we need to do interoperability right and build it in from the beginning. (Yup, I’ve been cynical about this before, but the man is trying!) Meanwhile, for presumably political reasons his office had a study about Cyberfraud out Monday, and he mentioned fraud about 5 times. After all, who can be against stopping fraud — so long as it’s not called a no-bid contract to an oil-services company, in which case Dick, Scooter and the boys love it.
Brailer said that we will have a single process for creating standardized standards. Standards bodies now are siloed. Standards start now with types of data, which is why they’re siloed. Instead he wants to move to standards addressing business problems and then use them to solve those problems. The Federal government will be bringing them together and he was insistent that we should have high expectations from the new supra-standards body. In addition we also now have a certification commission (made up of HIMSS, AHIMA, & NCHIT) which will be judging EMR based on three features a) security, b) clinical features (prompts, reminders) c) interoperability. The commission will later move to inpatient tools, etc. While some of my capitalist friends fear this will restrict innovation, my thought is that this certification process will be a floor not a ceiling on getting EMRs that are somewhat effective onto the market.
And soon NHIN will will award national Health information contracts to develop the nation’s infrastructure. Of course this has been getting controversial (especially after Cerner’s CEO’s remarks last week). Brailer simply said that apparently someone had disagreed with him for the past year and a half but forgot to tell him. He never mentioned Patterson’s name.
Brailer wants criteria for the architecture of the infrastructure for interoperability. He likens the EMR to the cell phone network, and hopes that like with cell phones, for a regular fee you can plug your EMR in and get on top of that infrastructure. He thinks that once the base is set that there’ll be lots of competition in services running on top of it. But it’s not just hurtling towards any old infrastructure, but the Feds will be making sure that it’s tied together, that it’s integrated and secure from day one.
He is also (rightly in my view) concerned about the adoption gap, and thinks that we need to make it easy for everyone — not just big organizations. For this he thinks that the recent anti-kickback exception (Stark exception) so that hospitals can donate EMRs to physicians, but has to be linked to certified EHRs, is very significant. And finally, in order to count how effective this all his, HHS is buying a bunch of surveys to objectively tell us how we’re doing. I wish I was still selling them!
