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POLICY: Breakfast of Champions By Brian Klepper

THCB welcomes back frequent contributor Brian Klepper. Brian is the president of the Center for Practical Health Reform in Baton Rouge Louisiana. Brian has something to say about economist Daniel McFadden’s recent OP-ED piece in the Wall Street Journal.  If you like this post, you may enjoy his most recent post: "Can Consumerism Save Healthcare?"   

Several people dropped me notes last Friday, asking for comments on a WSJ piece
by Daniel McFadden, a Nobel Laureate in Economics at the University of
California Berkeley. Dr. McFadden provided an eloquent view of the
crisis and its necessary solutions, and also argued that Medicare D
was, according to his research, working well.

 

This
is an interesting problem. After all, Dr. McFadden IS a Nobelist and,
well, I’m not. And he’s a formally trained and obviously highly
respected economist while, again, I’m not.

 

On
the other hand, he’s not really a health care professional. So it may
not be unreasonable to point out that some of his assumptions are naïve
and – how do I say this – exactly wrong.

Continue reading…

INDUSTRY: THCB Job Board

After a good deal of pestering email from readers, I’ve finally decided to offer a healthcare job board on THCB. If you have a health care related job you’d like to advertise to a readership of 35,000 plus industry people, you can send it to us.  For a reasonable fee, your posting will be available to job seekers from around the country and up until you ask us to take it down. You can mail John for details.

Meanwhile, if you haven’t had a chance to sign up for THCB UPDATE
yet, you really should. You’ll get a helpful reminder email from us a
few times a week when important posts go up on the site. In the two
and a half months since the service launched more than 700 950 people have
signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who
sign up, but I can tell you that list reads a bit like a health care
who’s who. Go on: It’s free. It’s useful. And people seem to like it.
Go visit the sign up page.

TECH/HOSPITALS: Voice recognition and instant translation

Those of you who’ve been listening to the podcasts I’ve been doing and reading the blog will notice quite how excited Cisco’s Jeff Rideout is with the Health Care Interpreter Network, which is a video over IP based network currently being used to share translation services in several safety net hospitals in California. Of course moving human translators by the magic of video telephony is a great advance over waiting for them to show up from wherever they are, and when providers have to deal with patients speaking as many languages as a typical Bay Area, LA, New York or similar facility sees, avoiding getting lost in translation is pretty critical.

But of course this being America there’s another way, and it too is pretty damn clever. I was shown a demo by a company called Spoken Translation which has an English-Spanish automatic medical translation tool. Here’s a cut from their blurb (as I’m too lazy to describe it all) but I’ve seen it and it works as advertised.

Converser for Healthcare provides 24/7 live interpreting. Its initial product will be targeted to the healthcare market and is a Spanish to English, English to Spanish translation. The system allows people who do not speak the same language to hold broad health-related conversations in real time, without a human interpreter.

 Converser represents a fundamental advance in Machine Translation (MT) technology. No other system on the market today can provide reliable, bi-directional, real-time, wide-ranging translation via multiple interface modalities including speech recognition. Never before has a commercial product for conversational translation enabled a user to verify in real time that the translation is accurate, and, if not, to correct it on the spot. While Spanish is first out the door, other languages are planned for release later this year. Chinese is planned for the healthcare market, while German and Japanese are currently under development for other markets. Converser can run on Tablet PCs or laptops (full-size or ultra-portable), and release is planned for numerous handheld devices.

The tool allows input via typing, onscreen keyboard, voice (using Dragon Nat Speak 9) and handwriting recognition. It’s a touch cumbersome in that of course each phrase needs approval and potential correction (in case of possible English/Spanish ambiguities) but it appears to be damn clever, and at $1500 a seat, a darn site cheaper than having a human sitting around.

Now, if they just make one in Arabic, that’ll solve a wee problem the US military has in another part of the world.

TECH/CONSUMERS: Internet health use survey, with UPDATE

For you survey geeks, Cisco sponsored a study of Internet use in health care among patients. Here’s the press release & here’s the detailed results
.
If anything the “demand” numbers look lower than in some other surveys (things like wanting to use email with docs, access lab results, etc). But the “supply” numbers (those doing that) are much lower, of course.

UPDATE: I got a really good comment/question about this from Dirk at Aurora IT. "Those numbers really seem to conflict with most of the other
healthcare-related Internet use surveys I’ve seen. Do you buy it or
rather them?"
  So here’s my answer to Dirk, given that this type of survey is absolutely in my wheelhouse.

I’m looking into it. Hopefully the Cisco guys will share more data with me. They did this survey through one of their main mkt research vendors who isn’t too well known in the obscure part of the survey world that focuses on consumer health care IT use. I don’t know if they have good data to compare it to historically on the same questions, but I kind of doubt it. My first take is that the numbers saying that they can get services from their doctors are a touch higher than usually reported–but that may be an indication that these services are spreading (finally!!). The demand side numbers seem to be quite a bit lower than I’ve seen from other surveys, especially Harris over the years. (e.g. Harris has reported more than 70% wanting their lab results online both in 2001 and 2002 –I think they did it again more recently but I can’t find it). But that seems to be connected to the way that they’ve asked the questions, and frankly it’s unclear how they’ve done that from the results reported. (multiple choice vs most important on the question "Assuming these services were all available from your primary care provider, which would be most important to you?"). But we’re way down in the weeds of survey methodology here.However, the good news is that this is new data on the right topics, and I’ll ask the Cisco folks if they can share a little more of the results.But kudos to Cisco for researching into this–especially as they don’t sell anything that directly relates to it.! As you can tell, there’s a paucity of good data about the specifics  of who does what and who wants what in this arena, and they’re helping to fill those holes. And given the amount of people who are offering solutions in this space, well it’s clear that more needs to be known about what consumers really want rather than less!

TECH: Matthew’s HIMSS mash-up wrap-up

So after taking a super-shuttle all round San Francisco to save a couple of bucks on a cab, I’m back home and my mind is still trying to digest the last few days. It just won’t let me join my fiancee and the dog in a peaceful slumber. So I thought I’d channel my best Hunter S Thompson and give you my thoughts on HIMSS Gonzo style. You can pick and choose from this the way you like.

First off, I got to see about half Colin Powell’s talk. Man is he funny. I would never have believed it. Fantastic comic timing and facial expressions a la Eddy Izzard or Bill Cosby. Why they didn’t have him instead of Ballmer as the opening keynote I don’t know. He also said some very poignant things about immigrants, and the American spirit of generosity—which are clearly lost on several of his former Administration colleagues—and also was very clear about the debt to veterans. Unfortunately I don’t know if he raised the point or was challenged from the audience about one of the other notable speeches he gave. I mean the one when he went to the UN, was not funny and convinced enough Americans that there really were WMDs that several thousand more names will be on a  future war memorial. And it’s clear he knows that he was basically peddling discredited information at the time.

Distance—please can someone remind me next year to schedule meetings by booth number. Oracle gave me a pedometer late on the last day, but I walked miles too far. At least twice I scheduled back to backs in booths at least half a mile away from each other.

And then Intensity. There were at least 5 or 6 people I promised I’d meet up with that I just never got to (sorry David, Laura, Steve and a bunch of others). And you have to believe that the same was true for everyone. You’re at this for 12–14 hours a day, meeting maybe 3–4 new people an hour (sometimes more) trying to figure out who’s doing what to whom—just keeping it straight is really hard work. Harder still when someone you haven’t seen for 5 years takes you on a tour of Bourbon street that Hunter S Thompson himself would have been proud of (no mescaline, though). Thanks Adam (I think!)

Podcasts—I hope you like them and that it catches a little of my flavor. It’s way easier doing them than writing up notes, plus it gets you a much closer idea of what the interviewees are really doing. Transcriptions will be up soon.

THCB’s live blogging coverage of HIMSS 2007 New Orleans would not be possible without the generous assistance of the kind souls at CDW Healthcare. Take a moment to go check out their specials for physicians and other health care providers and you’ll help us continue to provide independent coverage and cutting edge discussion of the issues facing healthcare. We get credit for every person who clicks over, so please take twenty seconds and go visit their site. If you decide to place an order, tell them the Health Care Blog sent you — Matthew

Notoriety—I’m never going to be as well known as MrHISTalk in this crowd, especially as I was wearing the “I am MrHISTalk” badge, but there’s clearly a few people who are starting to read THCB, and recognizing it as something.  I think that if you read Tim Gee’s Medical Connectologist blog, and mine and MrHISTalk’s you get a great flavor. Shahid Shah was supposed to write the official HIMSS blog, but he never made it due to the weather, and the blog just looked like a bunch of information about the show logistics. Hopefully next year will be better.

Plus a couple of other blogs have been started that are worth a mention. Sun’s health care guy Jorge Schwarz bought me a fabulous lunch and told me that he has a real Sun healthcare blog too (like that other Schwartz guy who works there). Another is Doug Goldstein’s blog. Doug is an eFuturist (hey I’m a failed former futurist!) who’s actually out there promoting collaborations and electronic knowledge sharing with his health care clients. He has a scad of books out, and is a hell of a nice guy to boot. I’ve known him on and off for 10 years, but we randomly connected a few times at this HIMSS and it was a real pleasure. Finally MedSpehere founder and legal combatant Scott Shreeve is writing about Health2.0 on his blog as well as great HIMSS stories.

More on Health2.0 plans from me and others anon.

Speaking of Sun, at their lunch was the CIO of University of Alabama (and former school bus driver) Joan Hicks and some of her team. (NOTE: Her colleagues suggested that it’s only fair to point out that Joan was a school bus driver as a side job in college, and that that’s not the only qualification she has for her current job!) It’s not till you chat with a bunch of geeks who have to connect a gazillion systems at a ton of facilities before you realize that inter-operability is an internal more than an external health care problem. I spent some time trying to convince the Axolotl folks that was true too and that that’s what they were really doing. But they still think they’re a RHIO company.BTW their CEO Ray Scott is a really tall, really pointy headed Brit mathematician, who must be nuts—in that he had already made it good in the UK in the 1990s and still decided to get into health care. Still at least two gorgeous former employees came up to him and gave him huge hugs and kisses while I was chatting, which makes you think he must be a cool guy to work for—or maybe it’s just good to be the CEO. Thanks to Nicole Spencer for the wine I didn’t drink (leetle bit suffering from the night before)

Back on Gonzo trail. Apparently, if you have a ten week old kid you value crashing out early more than drinking with your old buddies on Bourbon street—you know who you are Mr Big Time drug database sales dude!

I’m feeling old—I met some really sharp young kids who are new to the business and know stuff. Matt Guidin at F&S is one, and opinionated and cynical to boot (we like those qualities at THCB). Jonathan Pearlstein at NORC is really young, but knows a whole lot more than I did when I was 22 (or 32). Watch for his thesis on EMRs (an undergrad thesis? Mine was on beer and soccer!) to come out in JAMIA sometime.

Eric Brown from Forrester, not so young but just as cynical as me about CDHP and just as willing to scarfe down fabulous chocolate desert at the Sun lunch that someone ordered but couldn’t stay for!

Another really nice guy I was delighted to meet—Reed Liggin at (now) RelayHealth. We’ve been emailing and chatting for a couple of years and I would never have met him other than via THCB. Rather more than I’d like to admit that I know about ePrescribing comes from Reed.

Not from Reed though, another little birdie told me that despite Surescripts certification process many vendors were having trouble getting their eRx transactions into pharmacy systems and a lot of re-keying in the pharmacy is still going on for allegedly ePrescriptions. Apparently there’s a NHIN report coming out next month that will put the cat amongst those pigeons. Plus what happens to RxHub if 1/3 of its owners are now a big pharmacy chain?  We shall see. But as an ePrescribing proponent, I’m worried. Can someone please reassure me?

However, my faith in being an eRx and EMR advocate was reinforced by Dr. Jim Morrow, who’s in the interview with Glen Tullman from Allscripts. Jim said straight out that before using the EMR, he may have thought he was a good doctor, but he was not. So by implication you cannot be a good doctor without using one. That’s a ballsy statement, but he made it with real conviction. (Go listen to the podcast—he’s not shy about it).

Speaking of Glenn Tullman, man I wish I had a tenth of his energy, poise, drive and diplomacy (not to mention money of course). I didn’t know that he’s an Obama supporter—I had him pegged as a liberal Republican (He told me he was a conservative Dem, not that there’s too much difference!). But if he’s not a major political figure within 10 years I’ll be very, very surprised. As I told him, Barack’s hoping to leave a Senate seat vacant in 2 years!

My favorite phrase of the conference? Medecision’s John Capobianco description of the job of his company— “making the unknown known”

Meanwhile, If you haven’t had a chance to sign up for THCB UPDATE yet, you really should. You’ll get a helpful reminder email from us a few times a week when important posts go up on the site. In the two and a half months since the service launched more than 700 950 people have signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who sign up, but I can tell you that list reads a bit like a health care who’s who. Go on: It’s free. It’s useful. And people seem to like it. Go visit the sign up page.

Even despite the fact that they’re a client of mine (thanks Frances, Casey, Mike, Nick et al), the Cisco gang seem very happy. Could that be that now there are networks everywhere there’s more and more useful stuff to run over them? Just perhaps.

People on the rise—CMIOs everywhere. Holly Miller did such a great job creating the eCleveland Clinic online that the other guys in town (University Hospital) stole her to input their new system (which will be Eclipsys plus a new PHR/patient connectivity suite). But apparently when you’re a dignified CMIO having your exhibit hall companion threaten your vendor with firing them for not being able to provide you with a diet coke on instant command is apparently not encouraged! Hey if you’ve got clout use it, I say!

Talking of clout. You heard it hear first. IntercomponentWare’s LifeSensor PHR is terrible and doomed to failure. I mean, you may have really cool technology which works well, and very nice and smart people (not to mention the German government shoveling wads of cash at you) but if you can’t fix a simple prize drawing so that the world’s leading PHR interested blogger can win some Bose headphones, when there are only 5 people in the draw and he’s walked miles to be there and risked missing his flight to stay—what hope have you got in the rough and tumble world of health care IT?! (I can sense my opinion could be changed with only modest bribery! But a threat is a threat!)

Just kidding guys…

Talking of giveaways, while I never got to meet up with MrHISTalk to interview the Eclipsys booth babes as intended. I actually saw another booth down the other end giving away a plasma screen TV with some of the finest evidence of American medical science seen outside of a Playboy centerfold spread. Wish I could remember the company name.

Other quickies—Cool health2.0 type Emergency Department app from Puerto Rico called Sabiamed demoed by a lovely woman called Leslie who sat next to me on the plane on my way in from Miami. I fell asleep immediately as I had flown there from London and she had to punch me to get me to wake up to go to the restroom!

WebVMC has a Health Hero like telehealth application box that looked very interesting.

I don’t understand what NTR Global does (kinda like go-to-my-pc remote access/management but better) but Julie Weiner persuaded me that it was really important!

Random connection of the show. For 2 mins I was walking with a woman from Mobile, AL, who used to play soccer for Charlton Athletic ladies and the Univ of Alabama. She spotted my accent, and the story spilled out. I don’t know her name, but if you’re reading and you’re in San Francisco, my fiancee and I down load Match of the Day every week,  come by watch and take us for a ride in the mini!!

Second biggest mistake (after waking up Tuesday morning), was not organizing anyone to buy me dinner on Tuesday night. That used to be the night when I bought my clients dinner in my IFTF days, but these days especially as I was attending the show as a blogger on my own nickel, it’s what they call in football “a mental error.”

Worst giveaway—The AthenaHealth kids were fun, smart savvy and cute. And I never got past the front desk. No one over 30 anywhere, and all having a lot more fun than I did in grad school in my 20s. But they didn’t invite me to dinner on Tuesday night (But did Scott Shreeve—yes I’m bitter) and all they had as give-aways were white bouncy stress balls. As I said to them, “your giveaways suck, so I assume this means you think your products are pretty good!” Bonus points, though, if you can tell me which group in their backyard just went with someone else (Don’t worry guys there’s plenty for everyone…)

Biggest cojones—Bob Lorsch (see my interview with him below). A cancer survivor who’s put more than $7m of his own cash into building exactly the type of stand-alone, fax-it-in PHR that the “experts” say won’t fly. Of course not many of us experts have that to spend in the first place, which may define our expertise somewhat!

Worst forecast of the week—my taxi driver from Kenya leaving the convention center told me that we’d take 90 minutes and that I’d miss my plane. We were there in 25!

So that was the HIMSS that was for me. Let me know about your time in the comments, and feel free to abuse me back!

PODCAST/TECH: Medecision interview, “making the unknown known”

Next I talked with John Copabianco, President of Medecision. They’ve been helping some big payers roll out payer-based health records, building on their core utilization and care management business. Here’s his take.

I’ll be doing a little more later today and tomorrow and may have time to jot some other impressions of interesting things and people I saw…or the French Quarter may distract me. We’ll just have to see!

PODCAST/TECH: Interview with the Cisco health care brains trust

Then I got the Cisco health care brain trust together (Jeff Rideout and Frank Grant) who told me why Cisco really cares about health care. I wasn’t too contentious with them, but then again they are an occasional client–and anyway they’re doing interesting stuff! Here’s the interview with the two of them.

Imgp6646Here’s the Cisco team photo (Jeff and Frank are not the two good looking ones at either end!)

PODCAST/TECH: Purkinjie–EMR for the masses?

My next interview is with Bryan Dieter, CEO of Purkinjie. Not as well known as Allscripts but
with a new product to market aimed at the problem area of the small
physician practice, and a new round of $10m in financing, most of which
John Doerr (of Kleiner Perkins) probably found under his couch
cushions.  Here’s Bryan

 

UPDATE: Bryan didn’t mention this snippet, and I didn’t notice, but Tom Leith in the comments did! He’s still a fan, though

> new round of $10m in financing, most of which John
> Doerr (of Kleiner Perkins) probably found under his
> couch cushions.

I guess it helps to have a rich brother(?) (Matthews’ note: The bro in question is Tom Doerr MD, the Chairman of Purkinjie)

Anyway, FWIW I have helped to implement the Purkinje CareSeries EMR
and PM system with a solo doc here in St. Louis. Too early yet to give
a good report on effectiveness, but I think the prognosis is good. I
think their model and price point will be disruptive in the market.

assetto corsa mods