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QUALITY/TECH: A nice conversation with Brent James

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This is possibly the most interesting podcast yet on THCB. And it’s certainly the longest. if you didn’t have the time to listen to the interview with Brent James, here’s the transcript. I really recommend this one–there are so many amazing nuggets that if you care about health care in the US at all you owe it to yourself to read!

Matthew Holt: This is Matthew Holt with The Health Care Blog, and I’m back with yet another podcast and this time it’s really very exciting for me that we have one of the pioneers of the entire medical safety and industrial process of medicine movement in the U.S., Dr. Brent James, with us this afternoon. Brent, good afternoon. How are you?

Dr. Brent James: Good afternoon. It’s a delight to be here.

Matthew: Great, great. Just by way of introduction for those who don’t know, and I’m sure most of my readers will know—I hope they do—given that it comes up enough in the blog. Brent, your official title is VP of Medical Research for Intermountain Healthcare? Is that correct?

Brent: That’s correct, and I’m the Executive Director of the Intermountain Institute for Healthcare Delivery Research.

Matthew: Great. And I would say that that sounds very well and good, but in fact that is really understating Brent’s impact. He’s both at the regional level in Utah with Intermountain been largely responsible with his team for some really dramatic change in the entire way  clinical care is being delivered on the in-patient side, and has had a lot of great information published and distributed out of that. On the national level, Brent, you’ve been involved in both the Institute of Medicine and the more recent Citizens Working Group in Healthcare, and there’s probably some other things you’ve been involved with. I don’t have them on the tip of my tongue, but certainly you’ve been a very visible player on the national level. In addition, and we’ll touch on this at some point in the conversation, you’re currently involved with the Institute for Healthcare Improvement’s — Don Berwick’s organization — new campaign which was announced last week for the Five Million Lives. Is there anything else big and important I’m missing from what you do? [laughs]

Continue reading…

TECH/POLICY: Yet another PHR, and some info on me speaking

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There’s a new PHR for university students in Nebraska only. Not that that really says much other than the buzz around them continues. In response to a question over at HISTalk, I want to remind y’all that many of my latest opinions on PHRs and Health2.0 will be given on Tuesday at the Center for Ix Therapy’s webinar on the topic starring  moi and Josh Seidman. It was so popular they were forced to triple the number of lines they’re using to over 150 sites. This may be my draw at the gate in action, but it’s more likely it’s the combination of the topic and the price (nada).

The price is because the session is a marketing piece for the Center–and if you are the
right kind of corporation/health care organization, I would highly
recommend membership and their annual conference in Park City, Utah, as it’s a deal. They never got around  to opening it up for THCB readers as they (probably rightfully!) suspected that some of you lot weren’t likely to pay up to join the center. But a recording of the webinar with the slides will be up on their site at some point.

Still if your organization would like to know more about PHRs or any other health care topic, you know that I can be persuaded to talk. More info behind the speaking link.

And on the speaking topic, this coming Wednesday I’ll be in Vegas on a panel at a conference on Transparency in Health Care which includes sensible libertarian Michael Cannon from Cato. He’s promised to spend the entire monthly contribution that Exxon-Mobile gives Cato on a big night out for me there….pity he doesn’t work for AEI.

POLICY: The libertarian bickering conintues!

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More bickering between Jon Cohn, me, and the sensible libertarians Arnold Kling & Clark Havinghurst over at Cato Unbound . It’s a follow up to the articles we all wrote, and now Kling replied to all three of us, we’ve all replied back, and he’s replied back too….all extremely good stuff!

POLICY/HOSPITALS: (Google) Mapping NYC Health Care Disparity: 1985-2007, by Mike Connery, The Opportunity Agenda

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About 9 months ago research director of The Opportunity Agenda, Brian Smedley, guest-blogged on THCB about a New England Journal of Medicine study. his colleague Mike Connery wrote to me to tell me about this:

Yesterday, as part of our Health Equity program, we rolled out a new tool that I think you’ll find very interesting. The tool is a new website designed to visually illustrate the economic and racial disparities that exist in New York City’s health care system, and drive all New Yorker’s of conscience to take action by emailing their elected officials. It’s a Google Map mash-up that takes data on NYC hospital closures between 1985 and 2007, and overlays it on an interactive city-wide map that can display either the racial or economic demographics of the Five Boroughs during three periods: 1985, 1995, and 2005. 

Using this tool, visitors can visually see how hospital closures disproportionately impact poor neighborhoods and communities of color.  Text on the sidebar guides the user through each decade and demographic overlay, explaining the changing conditions of the city and the impact that closures have on underserved communities.But the site is more than just a visual resource, it is also a data-rich resource for researchers that contains a variety of reports and fact sheets (as well as data on the patient demographics, payer source, and quality scores for each hospital), a community forum for health care advocates and New Yorkers, and an activism tool that encourages New Yorkers to write to their elected officials in support of creating a health care system that works equally for all. 

All data on the site is from the census bureau, the New York State Department of Health and the New York State Planning and Research Cooperative System.  The data were analyzed by Darrel Gaskin of the Johns Hopkins School of Public Health. The Opportunity Agenda, in partnership with a coalition of NYC health care advocates, assembled this map in response to the activities of The Berger Commission (aka the hospital closures commission), whose recommendations are now sitting on Gov. Spitzer’s desk. You can find more info on the Berger Commission here.

When we talk about health care policy in America, very rarely do we mention the roles that class and race play in determining our access to and the quality of health care that we receive. Hope you find the tool interesting and useful.

HEALTH PLANS/POLICY: Meter Reading–How Regulation Might Fail

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Today I’m up at Spot-on in a piece about the influence of big health plans on reform efforts called Meter Reading: How Regulation Might Fail.

Maybe, just maybe, we’re getting serious about health care.


This week’s news says yet more unlikely allies are advocating healthcare overhaul.


The alliance between the Business Roundtable, unions and interest groups – an even more unlikely bunch of reformers than Republican Gov. Arnold Schwarzenegger and the insurance association  (both already out with their own plans) –  are all saying, loudly and clearly, that something must be done. It’s all leading to an odd sense of optimism – one I don’t, sadly share.


Forces outside of health care are starting to talk the talk about
forcing change. Former Massachusetts governor and Republican
presidential hopeful Mitt Romney’s health plan, the election of a
Democratic majority in Congress, and ever- increasing costs are all
forcing everyone to get those old reform plans out again. And as
evidenced in this discussion even political columnists from the WaPo think that something is going to happen – although they do tend to misread the light at the end of the proverbial tunnel. Continue

As ever come back herre to comment

POLICY: Kling’s Response to Holt, Havighurst, and Cohn

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Arnold Kling’s response to Holt, Havighurst, and Cohn is up at Cato Unbound. You know that I and Jon Cohn are going to largely find fault with Arnold Kling, while Clark Havighurst is a fellow traveler who actually says very sensible (but probably unrealistic) things about the tax treatment of health benefits.

In his response Kling agrees with my premises but doesn’t agree with my conclusions. Fancy that!  Still go over there and read all the essays, because it’s good stuff!

TECH: More on Revolution Health

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Over at tech blog TechCrunch, there’s a piece on Revolution Health. What’s most interesting is the comment section, where the CEOs from DailyStrength, Organized Wisdom, and others and the Chief Medical Officer of Revolution itself all pitch in.

Frankly, the nit-picking over who does what best reminds me of the line about the fleas arguing about who owns the dog. For this Health2.0 stuff, these are such early days that the only people I really discount are the ones arguing that we shouldn’t rate doctors or allow patients to talk to each other in communities. (Yes, there are a few commenters saying exactly that).

Of course people will still be trying to close that door long after the horse has bolted.

TECH: Free eRx from Allscripts and friends, with UPDATE

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Allscripts, backed by a cast of friends, is going to let any physician in America sign up for its ASP-based eRx system (which links into Surescripts) for free. The coalition is called the National ePrescribing Patient Safety Initiative (NEPSI) and it has its own website and press release and everything!

Also in on the deal are two biggie health plans, Wellpoint and Aetna, several tech companies (Dell, Cisco, Fujitsu, Microsoft, Sprint, & Google), Surescripts (connection to pharmacies) and Wolters Kluwer (drug databases). I assume there is some money flowing around (presumably from the health plans) to cover the costs, but it’s not clear how much or to whom. I’ll endeavor to find out.

The old joke is that for physicians to adopt technology, free isn’t cheap enough. I guess that we’re about to find out.

UPDATE: Well I actually listened to the whole webcast (yes, my life is pretty sad!). The most interesting thing is the Glenn Tullman (Allscripts, CEO) said that the 5 years commitment was $100m. That’s real money, and the only real place that they can expect to get (most of that) is from the health plans—unless Glenn’s got the negatives of Bill Gates or Larry and Sergey with the goats. And it’s probably a similar amount that Wellpoint and the others have already spent on these initiatives, much of that with Allscripts—so there’s probably a migration of those regional projects going on.

The other thing mentioned was that the system would have interfaces with practice management systems—what that means in reality remains to be seen of course.

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