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The news that former Bush administration Health IT czar David Brailer will head a private equity fund
backed by $700 million from the California Public Employees Retirement System (CalPers) drew a  cynical response from a number
of readers.  Vijay Goel MD writes:

"Strangely
enough, Dr. Brailer will be getting 5 times as much to invest in Health
IT from the state of California as he did as Bush’s Health IT czar …
I’ve been somewhat puzzled why certain health IT applications haven’t
been marketed more toward consumers. Things like emailing providers,
access to electronic records (for things like vaccine records), and for
simple questions seems like it would be of significant benefit. Why do
these services also waiting for the big payers to push forward? "

Bev MD had this to say about Sermo’s recently announced partnership with the American Medical Association:

I belong to Sermo, although I don’t use it much since there are few
posts in my esoteric area, pathology. My first reaction to Sermo’s
partnership with AMA was that they’ve sold out the docs to the
Establishment. However, I admit I’m attracted by the free access to
JAMA, a journal which i’d like to read, and by the advertised ability
of the members to have access to senior AMA leadership for constructive
criticism. There has already been posted an open letter to AMA
leadership criticizing their, well, leadership. We’ll see where this
goes."

Marlon Williams chimes in Thomas Goetz’s op-ed in the New York Times
encouraging physicians to adopt VistA, the open source electronic
medical record considered by some to be the leading competitor to
proprietary systems. Safe to say he doesn’t concur with Mr. Goetz’s prescription.

"The introduction of WorldVistA was a
terrible decision," he writes, "that is only confusing the market. A lot of people
are wasting their time and efforts on a system that is as antiquated as
the first PC. The laggards are finally catching up to the fact that
transformation is necessary. Unfortunately, they are stuck on 20-year
old technology."

Continue reading…

HEALTH2.0: Knowledge Prostitution

The powerhouse that is Scott Shreeve, not content with jetting around the US, looking after his newest (and 4th) kid and filling my inbox with amazing stuff, is having a go at prostitutes by comparing them to doctors! Personally I’ve never logically understood the stigma about prostitution, and I like the Heinlein novel where one of the lead characters is a prostitute who charges her son by the hour to see her after he’s 21. After all, they’re providing our society’s most cherished function, and when you pay a high price for great service for anything else in this world it is regarded as a good thing. (And yes I do understand the stigma in this version of the alternate universe).

But I digress….

What Scott’s piece, Knowledge Prostitution, suggests is that for social networking sites to pay members for opinions is not healthy. He particularly looks at Sermo, and he also suggests that the information gained from his inquiry about a rare form of wrist pain is not too helpful.

FD about me and Sermo here. CEO Dan Palestrant bought me dinner to pick my brain (I think I won!), Sermo has paid for advertising for the THCB jobs board, and Sermo is a sponsor of the forthcoming Health2.0 conference—for which Scott is on the advisory board. I like both Daniel and Scott a lot, so it’s good to see a little healthy dispute between MD computer geeks!

Continue reading…

POLICY: And just in case you thought things were getting better

• 2

The answer is not much.

Aon surveyed more than 70 leading healthcare insurers and found that healthcare costs are projected to increase by 10.9 percent for HMOs, 10.8 percent for POS plans, 11.2 percent for PPOs and 10.7 percent for CDH plans. This represents rates of increase lower than one year ago, when HMO cost increases were 12.2 percent, 11.9 percent for POS plans, 12.4 percent for PPOs and 12.5 percent for CDH plans.

So in this survey premium cost growth rates are still well, well above wage growth. So a bigger and bigger share of wages (or the total available to pay wages) is going towards healthcare. And now the public sector, with its new accounting requirements, is starting to run into the same problems. So at some point those “unsustainable” trends start becoming apparent. While the NY Times focuses on the problems within the system, the LA Times has been focusing on the impact on financing and insurance. Maybe the word will get out of those two august organs and make it into the Six O’Clock news sometime.

But it’s all part of the same issue, and eventually there will be some kind of political solution. But of course things might get much worse before they get any better.

POLICY: Wow!–sensible stories in the NY Times

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Monday’s NY Times had a sensible story about practice variation, essentially writing a guide to the Dartmouth Atlas. What’s remarkable is that it’s the second story about the topic in less than a week. David Leonhardt wrote a sensible one a few days back that was featured in THCB.

This is from the paper that couldn’t stop licking its festering sores on the same topic last year, when it printed four articles in quick succession that said that all our health care spending was essentially demanded–and worth it–and that there was no reason that we shouldn’t spend 20% of GDP or even more on health care. After all it was what we wanted, and what did we have to spend the money on that was better?

(Leonhardt somehow has written about the Dartmouth Atlas stuff and still believes that we should spend 20% of GDP on health care according to an email he sent me! So they’re not out of the woods yet. But David Cutler seems to be having some sort of a conversion too…)

But what’s really amazing is that after years of writing mostly nutty stuff about health care that caused Brian Klepper to wear out his keyboard writing protests, in perhaps the most health care articles in one issue ever of the NY Times on Monday you could also read about:

  • Why patients couldn’t trust information from other patients and should blindly do what their doctor says (not too bright an article, as the doctor is often wrong as RAND knows)
  • Whether WebMD’s stock is a good buy (Probably)
  • mandatory health insurance–why an individual mandate is hard (a not bad job of explaining the basics of risk pools, but ignoring the easier way of doing it through the tax system–although I preferred my interview with John Kingsdale who features heavily in the NY Times piece)
  • that putting in an EMR is very expensive for doctors and doesn’t necessarily pay off (Duh! But probably important given the stress on IT in many health policy plans); and,
  • that a human life is worth something–a not-bad introductory article on cost benefit analysis in health care although in all its explanations on what a life-year or even a QALY is, it never mentioned the most useful number–how much a human might earn in a year. That number is of course how the rest of the economy values a human life, and sadly folks it’s much lower than what health economists like David Cutler likes to use.

But the big picture is that by my count that’s six in depth analysis articles in one issue of the NY Times about health care, four of which introduce relatively sophisticated concepts in a not-too dumb fashion. My friends, this is what we call progress!

And just perhaps this health care stuff might be important?

POLICY: Uninsured in LA? Want to tell the BBC?

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A BBC reporter called me looking for uninsured people in the Los Angeles area to tell their story. Is that you? Want to be a star on radio in the UK?  You have to be in LA, but if you want to tell your story contact her directly. Regan Morris 323 467 4134 or cell 323 828 6852

HEALTH2.0/TECH: Kosmix unveils new page

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Kosmix has been known for having a number of search engine deals going with Revolution, Vimo and others. I spent a little time with the crew last week down in Mountain View, and will be interviewing Founder/CEO Venky Harinarayan later this week.

What’s most interesting is that they’re going into the portal business in a kind of mix between search and categorization. The site is called RightHealth –here’s an example of the different categories a search for diabetes brings up.

At the moment Ask.com is changing it’s search representation, Healthline is providing a mix of search and content, Healia and Medstory (now part of Microsoft) are doing a separate filtering approach, and you suspect that more is brewing within a small tech company in Mountain View (which BTW has city-wide WiFi up and running there…)

So search is continuing to get more and more interesting. (and yes most of these folks will be at the Health2.0 conference)

POLICY/TECH: AP exposes Gingrich, well sorta

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The AP says that Newt’s Center for Health Transformation is a front for companies that want him to promote their points of view and that he’s doing it for the money. Well first this is not exactly news–and Newt has had his ethical issues over the years.

But for some time I’ve been wondering exactly what paying Newt 200K a year gets Sutter et al.. But I think I know the answer and it’s not that he mentions nice things about his members in op-eds or generally promotes things in public that might help them, nor is it that his group is delivering completely compelling research. At least if it is, it doesn’t come up much in his speeches. Maybe ol’ Newt just still have a little pull as a non-official lobbyist, per chance?  Although a little less so since last November.

HEALTH2.0/TECH: PeerWisdom vs OrganizedWisdom

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In the great Pacific Northwest, today’s fun start-up is called PeerWisdom, which apparently has pulled down a quick $2m to build something in the patient communities space. They’re not alone of course, and even the articlethat "exposes" them (in an “add”) mentions PatientsLikeMe. And of course DailyStrength and a lot of others are trying to figure out if there’s a there there in not only the patient community realm, but also in using it as a data gathering vehicle. But when one of the most interesting community outfits is called OrganizedWisdom, perhaps PeerWisdom could have thought of another name.

Or perhaps we’re going to get a rash of “wisdom” names and that Charles Mackay dude has lots to answer for.

TECH/POLICY: Obama–looking to Neal Patterson for a contribution?

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I was called by the LA Times for a comment on whether increasing access would increase cost. After giving my standard lament about how no one talks about the real underlying problem of practice variation and waste (or at least about the political realities of dealing with it) I thought I should spend a bit of time seeing if that was true. And the answer is that, if you read deep into his plan, Obama does talk about that—although he doesn’t go after a solution quite yet. He instead proposes some intermediate solutions. more disease management, better care coordination, and more spending on health IT. In fact, a lot more spending on health IT:

Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen.

All you need to know is that health IT is roughly a $30 billion market now. Obama wants to pump it up another 25%. I assume Neal, Judy, Pam Pure et al have their checkbooks out! And now I know why Glen Tullman is such a big fan (Just kidding, Glen!)

Actually to suspend my cynicism, I’m now among the converted and I think that this type of national program is a good idea, so long as it’s done in conjunction with a significant change in incentives. We’ll see how it shakes out as these proposals all develop.

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