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

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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…

More on Google and the Cleveland Clinic

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For a start, as I said in my last post  and many times, and at least one of these commenters has written at length, the benefits of sharing health data in clinical situations massively outweigh the risk. So that should be the focus of the discussion.

I am NOT saying that there shouldn’t be privacy protections and there is no reason in my mind why, for all HIPAA’s flaws, it cannot be extended to PHR providers as covered entities.

However, as far as I can tell nothing that is happening here violates HIPAA. Showing you keyword based advertising may not to everyone’s taste, but it does not mean your private health data is being transferred to anyone. And presumably your data will only end up in these services if you give them permission to accept it, which will include consent to provide whatever services and advertising you’ll see.

And that’s assuming that either company does advertising based on records rather than search terms (which is Google make that 98% of their money).

But exactly where are Microsoft and Google suggesting that they’re going to be selling private identified data? Nowhere. Microsoft has bent over backwards to demonstrate that they have no intention of allowing themselves or anyone else to access your health records without permission. And Google will likely do the same when it announces its plans officially.

Continue reading…

TECH: HIMSS Today

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Today it’s HIMSS. Yesterday I spoke to the CHIME CIOs and had a good time. Today I’m talking to the Cisco Community for Connected Health and the rest of the time I’ll be accosting people with a microphone. Come back over the days to come to see.

Google, the Cleveland Clinic and the Privacy Zealots

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So Modern Healthcare‘s Joseph Conn has a whole page to write about the Cleveland Clinic and he writes just about HIPAA and the fact that this pilot is not going to be covered by it. Writing in the San Francisco Chronicle Victoria Colliver talks about not a lot more, but at least she has someone stating the bleedingly bloody obvious—

"If it’s made convenient
enough and easy enough, people will be no more concerned about privacy
with these systems than they are with their financial information," he
said. "Far more people die because health information is not released
or difficult to get … than anybody’s ever been harmed because the
information has been inadvertently released."

OK so it was me she quoted, but someone needs to give Deborah Peel
and whoever the hell the World Privacy Forum is a big shake. I say this
as a card-carrying member of the ACLU and Amnesty International who is
deeply concerned about anyone’s private information and what use is
made of it.

And the shake is, if a government overhears your private information
illegally (or quasi-legally) it can use that information to take away
your freedom and worse. So the standard for their ability to access
that information should be an awful lot higher than it is in virtually
every country—including this one.

If a private corporation unwittingly lets slip your private health
data, or even uses some aspect of it knowingly to target you for
marketing, the chances of you suffering much from it are very, very low.

These are vastly different things, and conflating the two does not help in the least.

Continue reading…

Where have all the savings gone, long time passing? by Eric Novack

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Where have all the savings gone, long time passing?

I am not the first to comment on this New England Journal of Medicine article, but it does deserve a place here at THCB. 
It has been the dogma of many at THCB that prevention = savings, and substantial ones at that!Put in the context of this study from the Netherlands, also published this month, is it time for some health care reformers to change their tune on how the health care reforms they promote will save money?

And before simply putting the savings to ‘pay’ for this on the elimination of administrative costs, please see my previous post.

And before saying that electronic medical records will, by themselves save 80 billion dollars per year (as I heard former President Clinton say at a Wisconsin rally this weekend- as an aside, I love XM radio for unlimited access to C-SPAN), consider the $4 billion struggle at Kaiser Permanente to get medical records for a measly 8.6 million patients… Now, with over 300 million in the country, that might mean an investment of well over $120 BILLION (with a B) to TRY to computerize the electronic medical records of the country.
 

Do not misread me to claim I am a proponent of the status quo, nor that I am not in favor of the WORD OF 2008—change— it is simply that I would like to hear more from those who want to institute certain kinds of change— how will they really ‘save money’ while simultaneously increasing access without severely impacting my liberty as a patient.

HEALTH PLANS: $9 million? OK, We’ll change our tune

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On Thursday HealthNet was being sued by the LA City attorney’s office and saying that it was doing nothing wrong and would keep on trucking:

Health Net’s Olson said the company’s application had been approved by regulators and didn’t need to be changed.”There are 110,000 Californians who figured it out and were able to fill out the application in a way that got them low-cost, high-quality coverage,” he said. “It’s fine and it’s working.”

Presumably they had faith that the arbitration process that many health plan policyholders have to go through would mitigate any risk.

What a difference a day makes.

Friday, the arbitrator in the case of the cancer patient whose insurance was retroactively terminated—this was the case which revealed the bonuses paid to staff who cancelled policies— awarded $9 million in punitive damages to the patient. This isn’t quite the $89 million that was awarded against HealthNet in 1993 in the Fox-Hipple case, but the difference is that in arbitration there’s usually no appeal (that $67m was never paid in full).

Jay Gellert, HealthNet’s CEO immediately announced that they would stop retroactive cancellations. But of course with lawyer William Shernoff now smelling blood, and with Blue Shield still fighting for the “right to recission” in the courts, the damage isn’t over.

Hopefully this will eventually mean that the companies will accept real regulation and real reform in the individual market, which essentially means ending it. 

(FD I am a HealthNet individual policy holder and they haven’t “recivved” me yet. Then again I haven’t had a claim in 3 years!)

HEALTH PLANS: L.A. sues Healthnet

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In the latest fall out over health plans behaving badly, the City of Los Angeles is suing Healthnet about its policy of paying bonuses to staff for cancellations.

The suit alleges that Health Net sold at least 100,000 individuals policies over the last four years. If the city attorney proved that each policy was falsely advertised and vulnerable to an unfair cancellation — and if the maximum penalty was assessed in each case — the company’s liability could run into the hundreds of millions of dollars, sources close to the investigation have concluded.

Healthnet isn’t sounding too contrite, though. 

Health Net’s Olson said the company’s application had been approved by regulators and didn’t need to be changed.”There are 110,000 Californians who figured it out and were able to fill out the application in a way that got them low-cost, high-quality coverage,” he said. “It’s fine and it’s working.”

POLITICS: Ghost in the Attack Machine

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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

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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?"

TECH: Google to Store Patients’ Health Records

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The AP has announced that Google’s first step into the world of storing health records will be in conjunction with the Cleveland Clinic—which of course already has a boatload of patients using EMRs and PHRs on the Epic MyChart system. The idea (presumably as this is a leak from within Cleveland Clinic not an official announcement) is that those records can be stored in Google, and presumably will be transportable—somewhat similar to what Microsoft and Dossia are promising. Nothing earth-shattering yet, but an interesting beginning.

And of course we’ll hopefully get some more details next week at the HIMSS conference where Google CEO Eric Schmidt is speaking, and the Health team is having a party to which they kindly invited me (Thanks, Missy!)

Google has been much criticized for its slow pace in health. But speaking as one who now runs big components of our little business on Google via Checkout (and integrates it with rival services like WuFoo and TypePad) — I think that this (and HealthVault et al) is a small step towards a much bigger online future for health care transactions. At least, I hope so!

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