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Tag: Web/Tech

Reflections from “Health 2.0 in the Doctor’s Office”

Will Sellman has commented on a couple of panels at Health 2.0 and been very prescient. Now he’s spent a bit of time to pen his reflections on what happened in Health 2.0 in the Doctor’s Office, which was held late last month in Florida. Will is at Alameda Family Physicians and is Director of Performance Improvement at Affinity Medical Group

  • Why is there innovation in this sphere?
  • What problems are we really trying to solve, and how?
  • Is there any party missing from the discussion?

These are but three of a series of questions I asked myself during and after the enlightening, and perhaps prescient, Health 2.0 conference that took place last weekend in Jacksonville, Florida. But these particular questions are inextricable from one another when applied to the overarching goal of the movement afoot that Health 2.0 supports. I endeavor here to not only answer these questions, but to communicate their relevance to those striving to maximize a fluid patient experience through technology.

While Health 2.0 is, in my mind, a nexus of technology utilization and process revision with respect to health care, it is also a phenomenon that must be considered within the context of the healthcare industry as a whole if it is to be usefully deployed.

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Healthline on a roll: new funding, Yahoo! deal

Healthline has been a company that we’ve been looking at since we very first started talking about Health 2.0. Check out the very first podcast about Health 2.0 on THCB with Healthline’s Dean Stephens back in late 2006. In fact its roots go back to Yourdoctor.com in the halcyon days of the late 1990s, but these days Healthline uses its taxonomy based search to provide search and content for not only Healthline.com, but also enterprise software for Aetna & UnitedHealth Care, as well as powering health search on several media sites like Ask.com, US News & World Report and AOL. It’s been a hectic couple of weeks for Healthline and I spoke with CEO West Shell about several new developments.

Matthew: First off, tell me about the new funding, and tell me about the state of the business.

West: Healthline just raised another $14M led by new lead Investor Growth Capital. Several previous investors including GE/NBC and Reed Elsevier also were in this round. We doubled the scale of the business last year and this round is designed to add some incremental investment in our R&D for the network services business. We’re doubling down to accelerate the growth of the company. The total capital we raised is now $50m, and this follows on from our last round about 2.5 years ago. We’re already cash-flow positive and profitable, and although we’re not releasing figures, but we have about 100 people—so you can make your own educated guess.

Matthew: You run your own web site, you provide software for enterprise clients, and you have your own advertising network. Where do you aim to spend the money?

West: Essentially we’re investing heavily in expanding R&D. We’re hiring more engineers, more medical informatics staff. We think that this combination is why the big partners are choosing us. Taking on new partners means we need to build out our network services business. We need to support customers and we need to keep delivering the search, content and advertising that they’re looking for.

We’re also investigating some M&A opportunities; we looking both at some technology and content assets. We think that there are some interesting Health 2.0 technologies that would make a good addition to our current portfolio. Lots of small companies have built innovative tools but they don’t have the scale that we have—now over 100 million visits across all our network—so we can help monetize what they’ve built.

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The Health Internet vs. the NHIN — A Matter of Control, Cost, and Timing

David KibbeThere is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.

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Health 2.0 – The Consumer Aggregators

The Consumer Aggregator Panel at Health 2.0 San Francisco

Featuring: Roni Zeiger MD, Product Manager, Google Health, Wayne Gattinella, CEO WebMD, David Cerino, Microsoft Health Solutions

Moderator: Jane Sarasohn-Kahn, Think-Health

Overview: With consumers turning to online sources in record numbers, competition is heating up between the giants in the field. In this segment recorded at Health 2.0 San Francisco, key players at Google, Microsoft and WebMD talk about important shifts in the industry landscape over the last year, their companies’ near term plans and the powerful trends likely to shape the way Americans – not to mention the rest of the planet – use the internet to look after their health and search for reliable health information.

Related video:

Gov 2.0: Obama administration CTO Aneesh Chopra talks about the administration’s call for innovation  in Silicon valley and broader adoption of information technology throughout the healthcare system. A must see in light of the national healthcare reform debate and growing investor interest in health IT.

The future of electronic medical records: Electronic medical records may be the most controversial technology around in an area with little shortage of controversey.  In the popular “Cats and Dogs” panel at Health 2.0, the key players in the debate over the future of this crucial technology take center stage in a culminating debate moderated by Health 2.0 co-founder Matthew Holt.  Dr. David Kibbe of the American Association of Family Physicians (AAFP), is an early proponent of electronic medical records who has since publicly reversed his position. Glen Tullman is the CEO of industry leader Allscripts and a commissioner on the board of trustees of CCHIT, the certification body responsible for overseeing much of the electronic medical records industry. Jonathan Bush is the CEO of athenahealth, a relative newcomer that has enjoyed a good deal of success challenging industry orthodoxies.

Finally, A Reasonable Plan for Certification of EHR Technologies

A caution to readers: This post is about methods for certifying Electronic Health Record (EHR) technologies used by physicians, medical practices, and hospitals who hope to qualify for federal incentive payments under the so-called HITECH portion of the American Recovery and Reinvestment Act (ARRA). It may not be as critical as the larger health care reform effort or as entertaining as Sarah Palin, but it WILL matter to hundreds of thousands of physicians, influencing how difficult or easily those in small and medium size practices acquire health IT. And indirectly for the foreseeable future, it could affect millions of American patients, their ability to securely access their medical records, and the safety, quality, and the cost of  medical care.

Three weeks ago, on July 14-15, 2009, the ONC’s Health IT Policy Committee held hearings in DC to review and consider changes to CCHIT’s current certification process. The Policy Committee is one of two panels formed to advise the new National Coordinator for Health IT, David Blumenthal. In a session that was a model of open-mindedness and balance, the Committee heard from all perspectives: vendors, standards organizations, physician groups, and many others.

And then, on July 16, they released their final recommendations on what is now referred to as “HHS Certification.” The effects of their recommendations – these are available online and should be read in their entirety to grasp their extent – are potentially monumental, and could very positively change health IT for the foreseeable future.

At the heart of these hearings was the issue of who will define the certification criteria and who will evaluate vendors’ products. Among many others, we have voiced concerns that the Certification Commission for Health Information Technology (CCHIT), the body currently contracted by HHS to perform EHR certification, has been partial to traditional health IT vendors in defining the certification criteria, and in the ways certification is carried out, and thereby able to inhibit innovation in this industry sector. Despite its leaders’ claims that the certification process has been developed using an open framework, CCHT’s obvious ties to the old guard IT vendors have created an overwhelming appearance of conflict of interest. That appearance has not been refuted by CCHIT’s resistance to and delays in implementing interoperability standards, or by its focus on features and functions over safety, security, and standards compliance.

In the hearings that led to the recommendations, longtime IT watchers were treated to some extraordinary commentary, much of which dramatically undermined CCHIT’s position.

“HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects…HHS Certification is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.”

In other words, as the definition of Meaningful Use is now tied to specific quality and safety improvements and cost savings that result from health IT — among them e-Prescribing, quality and cost reporting, data exchange for care coordination, and patient access to summary health data — HHS Certification will closely follow. Rather than pertain to an EHR’s long list of features and functions, some of which have nothing to do with Meaningful Use, certification will be focused on each IT system’s ability to enable practices and hospitals to collect, store, and exchange health data securely.

Who Determines the Certification Criteria

The Office of the National Coordinator – not CCHIT – would determine certification criteria, which “should be limited to the minimum set of criteria that are necessary to: (a) meet the functional requirements of the statute, and (b) achieve the Meaningful Use Objectives.” As regulator, funder for this project, and a major purchaser of health services, the government, not users or vendors, will now determine HHS’ Certification criteria.

A New Emphasis on Interoperability

“Criteria on functions/features should be high level; however, criteria on interoperability should be more explicit.” That is, functions/features criteria will be broadly defined, but there will be a greater focus in the future on the specifics associated with bringing about straightforward data exchange.

Multiple Certifying Organizations

ONC would develop an accreditation process and select an organization to accredit certifying organizations, then allow multiple organizations to perform certification testing. In other words, the Committee recommended that CCHIT’s monopoly end.

Third Party Validation

The “Validation” process would be redefined to prove that an EHR technology properly implemented and used by physician or hospital can perform the requirements of Meaningful Use. Self-attestation, along with reporting and audits performed by a Third Party, could be used to monitor the validation program.

Broader Interpretation of HHS Certification

HHS Certification would be broadly interpreted to include open source, modular, and non-vendor EHR and PHR technologies and their components.

These bold, forward-thinking proposals from the HIT Policy Committee have not been accepted yet. But in our opinion they should be. These measures would encourage new technologies to enter the market for physician medical practices seeking EHR technology, and wrest control away from the legacy health IT vendors that have maintained barriers and delayed adoption, so you can be sure that the old guard players are doing everything possible to have them rejected.

But these are hugely progressive steps in the right direction, toward allowing HIT to enable improvements in care and cost efficiencies that would be in the best interests of users and the public at large. If implemented, the changes recommended by the HIT Policy Committee would create greater choice, more standardization, lower price, less interruption of the practices — as well as a check from CMS or Medicaid each year to help smooth the implementation, starting in 2011.

David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on health care professional and consumer technologies. Brian Klepper PhD is a health care market analyst. Their collected collaborative columns may be found here.

Announcement: 14,000 People With Diabetes Test Their Blood Sugar at the Same Time

July 14 at 4 pm ET, 14,000 people with diabetes are going to test their blood sugar simultaneously and share their results online to help raise diabetes awareness.  People with diabetes have to test their blood sugar as part of their daily routine: it’s like drinking water or brushing your teeth.  Participating is easy: if you are a member of TuDiabetes or EsTuDiabetes, click on the home page banner and share your reading; if you have a Twitter account, post your reading on Twitter (use the #14KPWD hashtag) and link back to: http://14kPWD.org; if you prefer, update your status on Facebook or your preferred social network, linking back to: http://14kPWD.org. If you are a few minutes late, however, or are able to post your blood sugar reading earlier or later that day, it’s OK. What really matters is that you test your blood sugar regularly. If you don’t have diabetes, just tell someone who does to test and share on July 14.

The other Michael Jackson mega-mix

Never ones to be shy with an interesting view into celebrity pharmacology (and truth be told responding to a little tickle from me) the inventive folks at PharmaSurveyor have added Michael Jackson to their celebrity drug cocktail page.

It’s an interesting way to show the dangers of multiple drug regimens, and a great way to show off PharmaSurveyor’s computational capabilities of analyzing multiple drug regimens at once. (PharmaSurveyor calls those assessments surveys). You can find it on www.michaeljacksondrugs.net which has a static picture of Michael Jackson’s survey and links to the interactive one on PharmaSURVEYOR.com. (FD I’m an advisor to PharmaSurveyor with a few stock options)

Implementing a Modern Hospital Website

By JOHN HALAMKA

Over the past two years, I’ve witnessed a transition in modern website design from plain text and static  information to multimedia centric and interactive. I’ve written about the new BIDMC website we implemented to meet patient expectations for a modern website.

Many healthcare organizations I work with are considering content managed, new media, highly interactive web 2.0 sites. I thought it would be useful to describe how we approached the BIDMC website so you can leverage our experience.Picture 1

Content Management – BIDMC has a great
deal of .NET expertise, so we wanted a content management system that worked well in our .NET/SQL Server 2008 environment. SiteCore has been ideal for us, providing content templates, distributed content management, and publishing workflow in a load balanced, secure, virtualized environment. At HMS we use Drupal and WordPress for content management. They also work well for hosting institutional web sites.

Interactive features – The Corporate Communications folks at BIDMC really wanted to highly improves interactivity. We built and bought the components they needed as follows:

  • Blogs – Uses a SiteCore provided blogging module
  • Chat – a commercial application called Cute Chat from CuteSoft.
  • BIDMC TV (news and information videos produced by BIDMC)- Hosted by BrightCove.
  • Medical Edge (videos about innovation produced by BIDMC)- Hosted by BrightCove.
  • Podcast Gallery – Hosted on BIDMC servers.
  • Health Quizzes – created using a commercial application called SelectSurvey.NET from ClassApps.
  • Social Networking – entirely hosted by outside service providers (Facebook/Twitter/You Tube).
  • Secure patient web pages for communication with their families – a commercial application provided by CarePages.
  • Conditions A-Z – a web-based encyclopedia branded for BIDMC using commercial reference provided by Ebsco.
  • Search Engine – We’re using a Google Appliance

Thus, the combination of SiteCore plus purchased interactive applications and externally hosted streaming video has worked very well to provide our patients with an information rich, interactive experience.

I hope this is useful to you as you implement your own hospital websites.

Bringing Patients into the Health IT Conversation About “Meaningful Use”

The Obama health team at HHS and ONC are gradually establishing the rules that will determine how approximately $34 billion in ARRA/HITECH funds are spent on health IT over the next several years. But there is a “missing link” in these deliberations that, so far, has not been addressed by Congress or the Administration: how the patient’s voice can be “meaningfully used” in health IT. After all, we, the taxpayers, will pay for all this hardware, software, and associated training. There are many more consumers of health care than doctors or health care professionals. Shouldn’t we have a say in what matters – in what is meaningful – to us?

It may have been an oversight, but patients and consumers have been left very much on HITECH’s sidelines. The attention and the money is squarely aimed at the health care providers – doctors, clinics, and hospitals. The Act’s intention is to create “interoperable” electronic health records that, in the future, will be more accessible to them: doctors, clinics, and hospitals.  This is a policy that is tied unnecessarily to an outdated vision. It is provider-centered, paternalistic and top-down. But it could be re-imagined to take advantage of the new ways millions of consumers, patients, and care giving families are using information and communications technologies to solve problems, form online communities, and share information and knowledge.

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An Open Letter to the New National Coordinator for Health IT: Part 3 — Certification As The Elephant in Health IT’s Living Room

6a00d8341c909d53ef01157012476e970b-pi In the first and second parts of this series we talked about how and why there is no universal definition for the term “EHR.” Instead there is a legitimate, growing debate about the features and functions that “EHR technologies” should offer physicians seeking to qualify for HITECH incentive payments. We explored the layers of network technology, suggesting that federal regulators should “separate the data from the applications.”

We also argued that there is much to learn from development platforms, recently and in the distant past, that have used standards to open the aperture of innovation. The best of these standards have reflected the experience of what works rather than specifying how to make it work. Defining the standards for data, devices, and network technologies too restrictively could choke off innovation, rendering HITECH’s offerings whose expense and complexity are a barrier to, rather than an incentive for, adoption by physicians. Incoming National Coordinator for HIT David Blumenthal, MD seems to have been considering just this concern when he recently wrote:“… [M]any certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.”

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