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TECH: Fred Trotter meets Dr. Peel

I was on my way to see Deborah Peel’s talk yesterday when I was waylaid by a previous engagement that I’d mischeduled in my calendar. Given I had 4 people waiting for me I couldn’t break it but I was very disappointed to not be there.

Fred Trotter was there and had some of his questions answered. Unfortunately he didn’t ask the ones that I am getting so worked up about.

Now I’m off to see Newt Gingrich. Perhaps I’ll get a chance to ask him about his views on it. (And for the record the Google party was fabulous!)

PODCAST/TECH: The new Virtual Palomar West

My first interview at HIMSS is with Orlando Portale, CIO and Michael Covert, CEO of Palomar Pomerado Health in the San Diego area. They’re planning a new hospital and are working with Cisco and have put together a fun video about their new Virtual Palomar West in Second Life. They both had some really interesting things to say about how to build a large new hospital and how to plan for its use for a long, long time ahead. Here’s the interview.

(FD, Orlando and I are both on the advisory board for HIMSS Community for Connected Health, sponsored by Cisco, and I have done consulting work for Cisco in the past).

Health 2.0 – Patient-oriented Health Care, by Dan Kogan

Dan Kogan is a veteran IT developer who built some matching systems now prevalent in financial institutions. He’s now turned his attention to healthcare and has started Health World Web. I (Matthew that is) have been advising him as he gets going, and have therefore (as I allways want good material) bullied him into writing about his view of why health care is ripe for this technology and a little about what his company plans to do. (Don’t forget that the same offer is open to anyone who wants to write on the Health 2.0 Blog)

When exactly did the power of healthcare move out of the hands of the people and into the hands of the doctors? Historically, patients do not take the upper hand when it comes to choosing the proper healthcare. Choosing the right doctor becomes a nerve wrecking game of cross referencing the insurance listings with yellow pages, the general listings of a Google search inquiry with proprietary knowledge or word of mouth. Finding a good doctor often reminds a patient of a game of dice. The chances of rolling two 6’s are equal to 1/36 or about 3%. What comes into the equation is the patient’s insurance, the insurance a doctor will accept, the potential path to the specialist through the gatekeeper (if one is required), locale and then, just pure randomness in getting to one of the more than 700K licensed MDs.

Continue reading…

POLITICS: Ghost in the Attack Machine

I’m up at Spot-on discussing the return of one of the more improbable and unlovable charcters in the last health reform debate, and her recurrence as a Ghost in the Attack Machine. As ever come back here to comment…

It’s almost full-on election season so I’m getting email from the Republican National Committee suggesting that there are problems with both the Sen. Hillary Clinton and Barrack Obama plans for health reform. Funny that – given my politics – but it gets better.

The RNC thoughtfully sent along a copy of a Wall Street Journal op-ed featuring an appearance by that blast from the health reform past, Betsy McCaughey who these days hangs her hat at the ultra-right wing Hudson Institute. In the 1990’s she was a brief star of the new right after writing, in early 1994, a magazine article in the then-quasi-liberal magazine The New Republic. Called No Exit, it contained a damning account of the Clinton Health Plan and got a fair amount of attention at the time. No Exit was a fair load of old tosh (you really keen health policy archaeologists can unearth the Clinton White House’s full rebuttal to see what I mean).

Read the rest

THCB UPDATE

Careseek CEO Gale Wilson Steele writes in to comment on the ongoing controversy over physician ratings:

"It’s not surprising that physicians are uncomfortable with the idea of others "rating" them.  After all, what do others know about how well they provide healthcare?

This, actually, is very similar to the reactions professors first had on RateMyProfessors, where professors protested that students only cared about whether their tests were fair, and scoffed saying that the “kids” knew nothing about the professors’ degrees, research projects, etc.  In the minds of those who stood at the lectern, it was about academic qualifications; for those in the seats, it was about staying awake.  Today, professors are much more comfortable with the fact that they can be listed on a website and reviewed, and in fact, are somewhat insulted if no student has taken the time to list them.  Secretly they even hope to receive a few “chili peppers”, meaning that they are “hot” professors!

Ultimately, a few professors responded in kind and created Rateyourstudents.blogspot.com, a sort of RateMyStudents site.  By now it has turned into a cynical professorial rant about teaching.

So with new physician rating and review sites coming online nearly every week, how are doctors going to handle being rated by their patients?  Physicians also complain “What does a patient know about how well I practice medicine?…Patients don’t know about my years in school, my research, my etc.” 

Will doctors ultimately create a site called RateMyPatients, where they can rant over the injustices of healthcare and the assaults they take daily from their patients?  Or will they praise these sites as a place to learn how to improve their practices or as sources of patient testimonials to their excellence? 

The latest twist on who rates whom is eliminating the issue of reviewer qualification, namely NursesRecommendDoctors.com.  No one will deny that this population of over 3,000,000 trained medical professionals has a keen insight into the practices of physicians, their bedside manners and clinical competence.  It will be interesting to see if this trusted group of patient advocates will have the willingness to share what everyone wants to know…who are the best doctors?"

HOSPITALS: The SEIU & Paul Levy lovefest continues

The SEIU has been trying to organize Beth Israel Deaconess Medical Center, who’s CEO Paul Levy’s most famous accomplishment is writing a blog called Running a Hospital. (What could be more worthy than that? Yes, we feature Paul’s posts on THCB fairly often because we think he’s really good).

In his writing about the SEIU Paul has been, as Eric Idle (or was it Graham Chapman) used to say, cruel but fair. He nominally is neutral on what his employees decide to do about unionization but it doesn’t take much reading between the lines to show what he really thinks about the SEIU and its campaign.

And now, while Paul is off luxuriating on the sunny climes of an English February, the SEIU is striking back—pointing out that BIDMC includes bad debt in its charity accounting and is therefore overstating the amount of charity care it gives out. This isn’t exactly a rarity amongst hospitals, but it’s not that often that the SEIU gets it reported in that collectivist organ known as The New York Times.

POLICY: The financial castrophe of uninsurance will get worse

Just another reminder about the perversity of our insurance system. Steve Lopez in the LA Times writes a about a 57 year undergoing chemo whose COBRA benefits are running out . Whether or not chemotherapy is always the right option in these cases (and you’ll get plenty of arguments about that here on THCB), there is no excuse for a system where financial catastrophe will be visited on families by the random luck of getting sick.

But of course this problem is growing rapidly. Health Affairs confirms today with an Urban Institute study what’s well known—health insurance coverage has been declining while the economy has been expanding. This is the complete opposite of the 1990s, where the numbers covered by employer-provided health insurance increased as the economy improved.

So of course in the coming (or present?) recession the horror stories like that of the teacher and those Jon Cohn wrote about in Sick are just going to multiply.

HEALTH 2.0 Accelerator

At the end of Health 2.0 in September 2007, CommerceNet’s Marty
Tenenbaum proposed the creation of an industry initiative to accelerate
the Health 2.0 vision. This initiative would do for Health 2.0 what
CommerceNet did for e-commerce, educating and catalyzing the market
through visionary integration projects that demonstrate the potential
of Health 2.0 to improve people’s lives. This first organizational
meeting will forge a direction for the Health 2.0 Accelerator,
exploring potential projects and organizational structures.

Come prepared to share your ideas about the need for a Health 2.0
Accelerator and what it should focus on: What are the problems that are
preventing your technology or organization getting specific tasks done?
What standards are needed to facilitate data exchange and mash-ups?
What partnerships would make your services or products more valuable?
How could a Health 2.0 Accelerator help?

This session is open to attendees at Health 2.0 San Diego only. Please pre-register for this session by clicking on this link.
You are also encouraged to propose a specific topic for discussion as a
potential project, and should come prepared to speak about it briefly
(PowerPoint ok).

UPDATE: Health 2.0 Connecting Consumers and Providers is officially sold out. You can sign up for the waiting list here. You will be notified by email if additional passes become available due to cancellation or a capacity increase.

EXHIBITORS: Want to get your healthcare service or product in front of the right people?  Health 2.0 is the place to be. Connect with investors and high level executives and opinion leaders at the top health systems, health plans and technology companies around the country.  Email in**@********on.com with "exhibitor info please" in your subject line and we’ll get back to you in two shakes.

A Blueprint for Healthcare Reform by Maggie Mahar

On this blog, we have often debated these questions: “Why is U.S. healthcare so expensive? Why is it that states like Massachusetts and California just can’t seem to find a way to provide high quality, affordable medical care for all of their citizens?”

In the past, I have suggested that the answer can be found in the work done by Dr. Jack Wennberg and his colleagues at the Dartmouth Medical School. The story that I have posted below provides the narrative behind that assertion, tracing how, over a period of thirty years, Wennberg and his team uncovered the incredible, incontrovertible waste in our health care system.

Wennberg’s work reveals that roughly one out of three of our health care dollars is squandered on unnecessary tests, ineffective, unproven, sometimes unwanted procedures and over-priced bleeding-edge drugs and devices that are no better than the less expensive products that they have replaced.

Only a Luddite would fail to appreciate the wonders of 21st century medical technology. And Wennberg is no Luddite. He is quick to acknowledge that the most expensive, aggressive care that U.S. doctors and hospitals provide is often the most effective care.

But not always. This is what is less obvious. It would seem that by spending so much more than other countries, we would be buying the best care on earth. But the evidence shows that, often, we are not. And therein lies the conflict at the heart of our money-driven health-care system: while more health care equals more profits, it does not necessarily lead to better health.

Continue reading…

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