Here’s a quickie round-up of some activity in the patient-physician connectivity space (boy, that word makes me miss 1999!)

The BMJ has a pretty typical academic article summarizing the good and the bad of patient physician email. The two part article basically says that it’s pretty good for asynchronous connections that don’t require the hands-on caring touch. While the article is only worth reading for the harder core among us, the iHealthbeat summary is worth a quick perusal. Meanwhile Manhattan research, also reported in iHealthbeat confirms that only 8% of American docs currently email their patients.

So yes, the level of online interaction continues to be small. But there are some wins taking place. Relayhealth’s service counts my doctor as a sort of user. I can, via Calif Blue Shield, find his “online office” and fill in my health record form, but he doesn’t seem to have any of the features switched on nor has he emailed me back. But overall the concept does appear to be making forward progess, if only painfully slowly. The Rocky Mountain News reports it’s not going so badly in a clinic in Denver that now has over 700 patients using the service. Of course they are not really using it for online consults–the killer apps of online connectivity are appointment setting and prescription refill requests. iHealthbeat has a little more on the subject, and as you can see from the steady number of deals RelayHealth is signing up, interest in the conecpt is slowly taking shape.

Meanwhile, in what’s essentially the same space (sorry!), that of EMR access by patients, Geisenger in Pennsylvania has a success to report. Like Group Health Cooperative in Seattle, which has a similar system that also appends email connectivity to a patient’s view of its EHR, Geiseneger patients can go oline to get their health information from their physicians and also email them about administrative and clinical tasks. An article in JAMIA shows that Geisenger patients found EHRs easy to use. The authors noted that:

Patients preferred email communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information) while they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer email communication.

Something tells me that this is a slow movement of attrition that will hit a tipping point. Perhaps a modest injection of funds as part of the 10 Year Plan might help push it along? Can the VA and DOD get on board first? We’ll see.

J&J’s Cordis unit has been having production problems with its Cypher stent. Boston Scientific has been having such bad quality problems that it recalled almost all its stents last month. Apparently the surgeons (oops! Alwin points out that I mean) interventional cardiologists and radiologists who want to use these drug-eluting stents cannot get hold of them for love nor money.

When I was a lad standing on the terraces at Chelsea (note to my American readers: that’s a soccer team), we used to say about one of our more inept forwards–after he missed yet another open goal–that he couldn’t score in a brothel with a roll of hundreds. If I was running BSC or Cordis right now I’d feel like that striker’s coach!

UPDATE: Friday’s Boston Globe has an article suggesting that Boston Scientific’s Taxus recall is even bigger than first thought. So this problem is actually getting worse before it gets better.

Brad Holmes at Forrester Research has a brief out looking at what they are calling Healthcare Unbound. Don’t get too worked up about the title–it’s the same thing as mobile eHealth (I think!). They think that this could be a $34 billion market in 10 years time. You can tell that Forrester’s a newcomer in forecasting. They break the number 1 rule by putting a number and a date in the same sentence, and $34 billion is a very precise number!

However, the concept that as Brad says “Some of the IT essential to the success of technology in, on, and around the body that frees care from formal institutions is now ready for prime time” is probably correct. Health Hero’s Health Buddy has been around for about 7-8 years now, but is still making steady progress. Meanwhile, my old boss Wendy Everett’s shop, the New England Health Initiative, is out with a study showing that remote heart monitoring is cost-effective and saving lives today. Here’s the key part of the summary:

Remote physiological monitoring (RPM) consists of an electronic device in the patient’s home that collects data on the patient’s condition, technology that enables transmission and analysis of those data, and most importantly a care delivery service that uses those data to communicate with and monitor the patient. It is the coordination of these three elements — the device, technology and care delivery service — that is essential to this innovative tool for disease management. Patients typically use electronic home monitoring devices once a day to collect basic physiological data and to answer specific questions about their condition. The patients’ data are electronically transmitted to a central monitoring station where the data are analyzed by nurses and care managers. These care managers can track early warning signs and symptoms and contact patients, providing feedback, education and medication changes long before they need to be hospitalized.

Reduced Hospitalizations and Costs

NEHI’s analysis found that using RPM for heart failure reduces rehospitalization rates by 32 percent, compared to standard outpatient care for the six-months following a heart failure hospitalization. Applying this reduction to a population of 100 Class III, or advanced heart failure, patients results in an average of 24 fewer hospitalizations, each of which costs, on average $9,700 and involves 5.5 days in the hospital. That results in a total reduction of 132 patient days per 100 patients. In addition, RPM can produce net cost savings of 25 percent when compared to standard care. On a per patient basis, this cost reduction amounts to net savings of $1,861 per patient, or in our 100-patient group, a total of $186,165. RPM use also has demonstrated a statistically significant improvement in heart failure patients’ quality of life as measured in Quality Adjusted Life Years (QALYs), as well as high levels of patient satisfaction.

As with all these technologies, if they build it, they will come (so long as Medicare pays for it–which is where the NEHI’s paper comes in methinks). Whether CMS wants to have another $34 billion line item on its hands is another matter.

Harris Interactive has a new study on the use of personal health records. Around 42% keep personal health records with people tending to do it more the older they get. However, the most interesting part of the study was when they asked people how they kept those records.

Of the 42% who keep those records, (with multiple answers allowed) 86% keep paper files, 15% keep files on in a formal paper record, 13% keep it on a computer. Of those 13%, 11% keep it in their own electronic files, while only 2% purchased a specialised computer software to record their information while just 1% use a web site to keep those records.

Assuming these numbers are about accurate, this suggests to me that the health care business has got a serious problem on its hands and a real opportunity. Buried in this article about online banking fraud is this estimate:

According to Gartner, 45 percent of the 141 million U.S. adults who use the Internet pay bills online. Consumers like the convenience and banks like the operating savings.

The Pew Internet research project has some slightly older numbers

Online banking increased by 127% — more than any other activity about which we asked 2000 and 2002. In March 2000, just 15 million had tried some form of online banking, but by October 2002, 34 million had done so.

It’s a good bet that online banking is now up in the range of 50+ million Americans. And where do they keep their financial records? On the bank’s web site, of course.

So can you keep your health records on your health plan or your physician’s site? In general no — (unless you live in certain parts of Boston, Utah, or Seattle and have the right healthplan). I sort of have an online record, in that I have some information stored in RelayHealth‘s messaging service which my doctor is supposed to be (but isn’t actually) using in conjunction with Blue Shield of California. But for the vast majority of Americans, there is no easy way to get access to your health information and store it. And despite going on 8 years of the Internet revolution, essentially very few health care organizations seem to think that it’s important to provide their members or patients with that service.

Oh, and yes I’m bitter. If you don’t know why, the short version is in the last paragraph here. The longer version is buried in this rather fun article I wrote for iHealthbeat in 2002.

There’s a real mood of boosterism following Stalin’s Brailer and HHS’ 10 year plan to get health IT up and running. First a group of technology companies including Microsoft, Cisco, Allscripts, NDCHealth, HP and industry alliances Surescripts, RxHUB & NCPDP all herded by consultants CapGemini have formed a booster group for ePrescribing called CafeRx.help physicians get access to EMRs and presumably put its nose under the tent for any Federal dollars that may be available to help.Manhattan Research about ePharma docs. They now estimate that:

Next, the AAFP, the EMR project of which Star Wars fans may remember I wrote about a while back, has joined with a bunch more medical societies to form the Physicians Electronic Health Record Coalition which will ostensibly

While I may sound a little cynical about all this, it’s actually good news as it indicates that something may really be happening. Of course we saw some level of this activity in the 1990s with WEDI and the IOM’s CPR report and not much came of it. But the idea of EMR’s seems to be one that’s time has finally come.

To that end, it’s worth looking at the new research out from survey wonks

According to the study, the ePharma Physician market has grown to 379,000 practicing physicians, representing 64% of all U.S. practicing physicians today. Physicians are using online technologies for a broad range of purposes: to find information about drugs and treatment options, participate in electronic detailing for pharma sales, prescribe medications, streamline information at point of care, communicate with colleagues and others, and pursue continuing medical education (CME). About 40% of survey participants were primary care practitioners; 60% were specialists. Requirements for study participation included 1) issuing over 40 prescriptions per week and 2) currently using, or very interested in using, PDA, e-detailing, eCME, and/or pharmaceutical information online.

Over a six-month period, ePharma Physicians visited a variety of sites for health and medical information. Sites were used to research 46 conditions, from acid reflux to erectile dysfunction, hypertension to weight management. Sites most often visited included WebMD,Medscape, Medline/NLM/PubMed, MDConsult, and Merck Medicus. Most ePharma Physicians—87%—report that the Internet is a critical resource for information on prescription drugs and other treatment options. This percentage is a 15% increase over the previous year’s response. Information obtained online can lead to a change in course: Over three-quarters of those surveyed said their behavior sometimes or often changed as a result of what they found online.

Over half of ePharma Physicians find certain online offerings more effective than traditional offline marketing. These offerings include websites with disease information offered by a non-pharma/biotech company, online CME, and sponsored sites with disease information provided by a pharma/biotech company.

Most ePharma Physicians (79%) responded favorably to the concept of physician-targeted customer service portals offered by pharma/biotech companies. The top five services of greatest importance to respondents include links to medical education, disease information directly on the portal, links to CME resources, patient education materials, and links to disease information. Compared to last year’s study, a 28% increase was noted in ePharma Physicians who expect online customer service from the pharma and biotech companies they regularly deal with.

While most of these nerdy eRx docs are probably just using ePocrates’ downloadable PDR for actual clinical tools, it’s a start on the eRx front. And where eRx goes I believe the EMR will surely follow.

Apparently a new and different type of problem has emerged for Boston Scientific’s Taxus stent. In one instance it had problems with its balloon deflation. This follows the big recall story last month, and the particular stent in question was made after changes at the manufacturing plant. For the average Boston Scientific shareholder there are probably a few too many stories like this at the moment.

A survey of family practice docs conducted by the AAFP estimates that some 20% are now using EMRs. Given that I know something about surveys of this topic, I remain a little dubious about the numbers until it’s much clearer how EMR was defined and who was surveyed, but the direction is at least clear. About 13% are using one already, 7% just starting up and another 50%-odd intending to start in the medium term.

Of course in many other countries the rate of GPs using the EMR is well over 80%, and in most industrialized ones it’s way higher than here. So we have plenty to aim at if we are to really have the best health information system supporting the "finest medical care" in the world.

For some time various people in health care have been talking about the Walmartization of health care. What they are talking about (and you know who you are Mr. Singerman!) is the development of a low cost generic health care service that could deliver primary and walk-up care very cheaply. Well as iHealthbeat reported the other day, it looks like these quick clinics are indeed turning up in large mall stores, but the first ones are appearing in a Target and Club Foods…..although if they’re a success you know the Beast of Bentonville won’t be far behind. What do these clinics do?

Diagnose and treat several common ailments, provide vaccinations and offer cholesterol and blood pressure screenings. Staffed by nurse practitioners, these "MinuteClinics" use clinical guidelines software to help diagnose and treat patients. The $15 million software incorporates established clinical guidelines and notes patients who come to the clinic frequently with the same complaints so they can be referred to a doctor, said Catherine Wisner, director of national operations for MinuteClinic.

There have also been reports of more and more actual surgery happening overseas, particularly in India and Thailand,and the Brits have been sending patients overseas to buy cheap surgery in France and Spain (at a cheaper marginal cost than building more facilities at home).  So are we at the start of a globalization of surgery, in which the easy stuff will be delivered by low-paid staff backed up by smart computers, and the expensive staff will be contracted out to cheap but well-trained foreigners?  Probably not a reality any time soon, but a trend worth watching.

Jane Sarasohn Kahn gave THCB readers a sneak preview of the meeting last week to launch the Federal govenrment’s new NHII plan. Here’s her much more detailed take in her iHealthBeat column.

So following in the footsteps of like-minded Lenninists Stalin and Mao, HHS secretary Tommy Thompson announced a 10 year plan for health technology on Wednesday. Speaking as a Lenninist (or at least someone who agrees that it’s usually better fewer but better) I can now say that I approve of something the Adminstration has done. For the guts of David Brailer’s (the new Health IT Czar–not such a Lenninist title I guess!) speech come several new initiatives–detailed in this article. The associated report has serveral overall reccomendations:

The report identifies four major collaborative goals. With these goals are 12 strategies for advancing and focusing future efforts:

Goal 1: Inform Clinical Practice. This goal centers largely around efforts to bring EHRs directly into clinical practice. Three strategies for realizing this goal are: Strategy 1. Provide incentives for EHR adoption. The transition to safe, more consumer-friendly and regionally integrated care delivery will require shared investments in information tools and changes to current clinical practice. Strategy 2. Reduce risk of EHR investment. Clinicians who purchase EHRs and who attempt to change their clinical practices and office operations face a variety of risks that make this decision unduly challenging. Low-cost support systems that reduce risk, failure, and partial use of EHRs are needed. Strategy 3. Promote EHR diffusion in rural and underserved areas. Practices and hospitals in rural and other underserved areas lag in EHR adoption. Technology transfer and other support efforts are needed to ensure widespread adoption. Strategy 1. Regional collaborations. Local oversight of health information exchange that reflects the needs and goals of a population should be developed. Strategy 2. Develop a national health information network. A set of common intercommunication tools such as mobile authentication, Web services architecture, and security technologies are needed to support data movement that is inexpensive and secure. A national health information network that can provide low-cost and secure data movement is needed, along with a public-private oversight or management function to ensure adherence to public policy objectives. Strategy 3. Coordinate federal health information systems. There is a need for federal health information systems to be interoperable and to exchange data so that federal care delivery, reimbursement, and oversight are more efficient and cost-effective. Federal health information systems will be interoperable and consistent with the national health information network.

Goal 2: Interconnect Clinicians. Interconnecting clinicians will allow information to be portable and to move with consumers from one point of care to another. This will require an interoperable infrastructure to help clinicians get access to critical health care information when their clinical and/or treatment decisions are being made. Three strategies for realizing this goal are:

Goal 3: Personalize Care. Consumer-centric information helps individuals manage their own wellness and assists with their personal health care decisions. Three strategies for realizing this goal are: Strategy 1. Encourage use of Personal Health Records. Consumers are increasingly seeking information about their care as a means of getting better control over their health care experience, and PHRs that provide customized facts and guidance to them are needed. Strategy 2. Enhance informed consumer choice. Consumers should have the ability to select clinicians and institutions based on what they value and the information to guide their choice, including the quality of care providers deliver. Strategy 3. Promote use of telehealth systems. The use of telehealth — remote communication technologies — can provide access to health services for consumers and clinicians in rural and underserved areas.

Goal 4: Improve Population Health. Population health improvement envisions improved capacity for public health monitoring, quality of care measurement and bringing research advances more quickly into medical practice. Three strategies for realizing this goal are: Strategy 1. Unify public health surveillance architectures. An interoperable public health surveillance system is needed that will allow exchange of information, consistent with privacy laws, to better protect against disease. Strategy 2. Streamline quality and health status monitoring. Many different state and local organizations collect subsets of data for specific purposes and use it in different ways. A streamlined quality-monitoring infrastructure that will allow a complete look at quality and other issues in real-time and at the point of care is needed. Strategy 3. Accelerate research and dissemination of evidence. Information tools are needed that can accelerate scientific discoveries and their translation into clinically useful products, applications, and knowledge.

While we can all agree that these are laudable goals, which should have been pushed by the government long ago, the obvious reaction is along the lines of "Show me the money!" In iHealthBeat’s excellent roundup George Isham, chief medical officer for Minnesota-based HealthPartners said the 10-year plan is "awfully ambitious" and will "take a lot of money and a lot of time," but is "needed. I hate to mention it here but the equivalent of what the Brits will spend on their 10 year Health IT plan in US dollars per population is about $100 billion and they are starting from 80% use of ambulatory EMRs by their GPs! And of course if you adjust that spending per capita spending on health care, you’d need to spend more like $250 billion or $25 billion a year. (Brief Editorial: My proposal is that we stop blowing the $25 billion a year we waste on the Drug War and spend it on this instead!)

Now that’s not exactly a fair comparison as American private sector spending on IT is going to be the driving force here, but there is still a need for government funding and pump priming. So what was the atmosphere in DC Wednesday, and are we likely to get that pump priming? For that here’s some comments from the ever wonderful Jane Sarasohn Kahn:

Carolyn Clancy’s (head of AHQR) assertion that, "The framework ROCKS!" was indicative of the level of excitement and passion around Dr. Brailer’s report that, in the words of Secretary Thompson, "launches the decade of health IT."  Dr. Brailer introduced the day by invoking the image of Neil Armstrong walking on the moon (as I was thinking good karma all the while for the other Armstrong of the day, Lance).  The day was full of gravitas lent by Senator Frist and Rep. Nancy Johnson, and Patrick Kennedy had a front-row seat waiting to introduce his legislation for comprehensive electronic health system in ten years’ time.  The morning had the key Federal health care leadership all committing to the plan, from the VA and DoD (both far ahead of the private sector, which you can do with scale and one large purchaser) to AHRQ, the FDA, and the eloquent Elias Zerhouni of NIH.    The afternoon was quite interesting: on the private sector vendor panel, Neal Patterson (Cerner) spoke about railroads and the Federal input on "gauge."  But it was Dan Garrett of CSC who made Mr. Patterson’s blood pressure boil as Garrett waxed lyrically about open standards, with our old friend Neil deCrescenzo of IBM echoing the same.  In fact, open standards are crucial to Dr. Brailer’s vision of interoperability and could be the friction point for moving forward.  But Tommy Thompson wants to take no prisoners in this effort and is very aggressive on the topic of the health IT decade.  Even Mark McClellan of CMS is pushing forward with a Medicare Internet portal in Indiana later this year to roll out nationally after they learn what they need to learn.  And he’s also pushing eRx sooner rather than the MMA mandate suggests.

So keep your eyes on this. After 40 years of activity towards electronic health records the Feds have finally called for the building of a Railroad, and the train may begin to leave the station sooner rather than later….