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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.

HOSPITALS: The best way to spend the money?

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One THCB reader apparently was boring their partner about this, and seeing eyes glaze over got so steamed up they decided to write to THCB:

I was at a health care board meeting last night (the organization involved must go unnamed) where a new 100 bed hospital was approved for $220,000,000!!!! $2,200,000 per bed/room. (slightly higher since they are building the infrastructure to later support construction for more beds, but nonetheless even at half the price….)

Are we nuts? I believe the Plaza Hotel on 5th ave in NYC sold recently for only $1,000,000 per room. What sort of reimbursed revenues will be necessary to recoup that investment? I don’t fault our little hospital group, but this seems to me a damning statement about the status of the US health care system. It’s simply not sustainable at such ridiculous levels of investment (AND with the lower levels of clinical outcome we get for all this dough, it’s a travesty.) I wonder what a new hospital in Europe goes for?

Good question. Anyone got an answer?

TECH: Healthcare Informatics 100 is not very helpful

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The Healthare Informatics 100 list of companies in Health IT is out. It’s fawned over with reverence by lots of companies on the list, and it even gets an encouraging nod from MrHISTalk—who’s usually a lot more sensible. Which is a pity because the list is basically rubbish, and not very helpful to the industry.

Who’s the biggest Health IT company, and #1 on their list? It’s Cardinal Health. Err, really? Well they may have $80–odd billion in revenue, but that’s because they sell lots of drugs wholesale. Even Healthcare Informatics realizes that and has a note saying “share of revenue from IT” and for Cardinal they say it’s 3%. Even that ($3ish billion) from sales in Health IT is a big number, although I think it’s stretching the definition to say that Cardinal has that amount in IT sales. And of course on that logic McKesson should be #2 on the list. But they only make it to #9, somehow down from #4 in 2006

Who’s next? #2 is SAIC. A big time defense contractor with lots of revenue ($8 bn)  from the taxpayer, but only 4% ($200m) in health care. Third and fourth are Henry Schein and CGI. Who? Exactly. (Henry Schein is a medium sized medical products distributor and CGI is a Canadian version of SAIC which bought mid-sized US based outsourcers AMS which had a decent health care business in 2004). Neither of them are real players in health care IT. Henry Schein claims less than $100m in health care IT sales.

#5 is Perot, which is probably in the right place, but #6 is SAS. Great company and all that but it’s probably not even the biggest business intelligence company in healthcare. By the time we get to #7, 8, 9 & 10–Agfa, Sage (ex-Emdeon/Medical Manager), McKesson Provider Technologies and Cerner, we’re now talking about real health care IT companies. Although again the Agfa & Sage rankings are way high as there’s lots of non-health care revenue in there too.

And then there’s a few small companies not on the list — and like in War Games what’s not on the list matters. One is called Siemens, another is GE, and a third is called Philips. Two of those are in the top 4 health IS companies by revenue, not to mention each of their PACS sales alone which probably exceed Agfa’s. For that matter if SAIC belongs on the list where is EDS, ACS, or CSC? (And I’m not talking about #88, an Ohio company with $18m in revenue called strangely enough “The CSC Group”). By the way GE used to be on the list at #1 before it bought IDX because the dummies at Healthcare Informatics used to count its medical imaging business as IT revenue. Now for some reason it’s disappeared.

Finally a bunch of consultants are on the list including some great niche firms like #79 ECG and #89 Healthia. But if they’re on the list where the heck is Deloitte, Accenture, IBM, PWC etc, etc.

So what does Healthcare Informatics, one of the “bibles” of health IT say to defend this schlock it puts out every year?

As you peruse our annual ranking, keep in mind that the data is self reported. As such we rely on the companies to report only healthcare IT-generated revenues and to do it accurately. Though not perfect we have faith that our survey provides a valuable resource to the industry. <SNIP> Some companies may have a significantly different ranking to previous years because in changes of how IT revenues were attributed or defined as a result of reorganization. And absent entirely are some large industry players due to limits on the granularity of the information they are willing to share.

So in other words we’re printing garbage, but it’s not our fault. For a start they know that they’re not ranking companies by their health IT revenue or else they wouldn’t have Cardinal #1, SAIC #2 or Henry Schein in there at all. So it would be easy for them to rank the order by reported health care IT revenue. Why they don’t do that I can’t fathom.

But that’s not the real problem. Do you think Forbes uses the “self-reported” approach when it’s putting out its list of the world’s richest people. Do you think that the Hong Kong shipping magnates, Colombian drug dealers and Arab princes and terrorists on their lists fax in a form detailing their net worth?

Exactly how hard would it be for Healthcare Informatics to make a couple of phone calls to Wall Street (which of course knows the real numbers), do a bit of real investigative work, talk to a few consultants and come up with a decent list. That would provide a real “resource to the industry”. But someone coming to try to figure out the real state of who’s big and who’s not in health care IT from this list would be hopelessly confused.

CODA: And if you’re searching for Healthcare Informatics online, good luck

POLICY/POLITICS: Giuliani sorta has a health care plan

Great. So the fake hero who made millions out of talking tough has a fake health care plan. About as rational as Bush’s and very similar.

Giuliani has blasted Hillary Rodham Clinton and the other two top Democratic contenders for pushing "socialized medicine." Clinton, whose failed 1993 health proposals were dubbed "HillaryCare," has said she wants to cover all 47 million people with no health insurance. Giuliani makes no mention of covering everyone. His health care proposals instead mirror those made by President George W. Bush last year, including Giuliani’s proposal to allow families to set up health savings accounts of $2,000 to $6,000 to cover medical expenses, before insurance kicks in.Bush urged expanding such accounts and proposed tax incentives to encourage people to buy their own health insurance, instead of relying on employers. But his proposals were controversial, in part because critics said they would undermine the employer-based health insurance system. Experts said the youngest, healthiest patients would go into the private marketplace, leaving behind those with serious — and expensive — health problems.

No doubt he’ll find a criminal co-conspirator to help run it. What is Bernie up to these days anyway?

But what’s more concerning is that the actual Republican politics will be to attack the Democrats as promoting government-run Stalinist health care. This may well keep the status quo in place even if Rudy is the Republican who loses the election—which seems likely at this point.

TECH/POLICY: Mr Quinn is a little cynical about Dr Brailer

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Ex-Health IT Czar David Brailer is starting a fund for health care IT with a pretty damn ambitious goal — reducing health care costs —and some $500m in funding from the state of California (or at least its employees pension plan CalPERS). Most amusing comment so far is from my old i-Beacon colleague Matt Quinn.

Dr. Brailer is starting a healthcare focused VC company with a pretty significant benefactor…too bad this wasn’t around in the i-Beacon days! I really don’t think that more money flowing to entrepreneurial HIT companies will solve the underlying reimbursement, financing and adoption issues that are limiting HIT today.

It will make for a more interesting HIMSS, though.

I look forward to sharing a pint or two of that “interest” with Matt and Dr Brailer too!

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