I know it can’t have been funny at the time, but this is my favorite Christmas story: Parade driver takes float on wild ride
See you after you’ve had your fill—have a happy holiday.
Above the Fold
PODCAST/QUALITY/TECH: An hour with Brent James
This was a total pleasure. Yesterday I got to spend an hour talking with Dr. Brent James, one of the leaders in the patient safety movement, instituting process change in health care, and the man responsible in large part for InterMountain Healthcare’s status as the health care system known for delivering some of the best quality care in America (and the world). Brent of course was on the IOM Committee responsible for the "To Err is Human" report and is involved in the new IHI "5 Million Lives" campaign. Brent has much to say about all of that and a lot more, and it is fascinating stuff.
So for your year-end enjoyment here’s the podcast of our conversation. (A transcript will be up in a few days).
BLOGS: Bob Laszewski joins the cult
Bob Laszewski, a real inside the beltway health policy/politics heavyweight, has started his own blog (or as I told him has joined the cult). His blog is called Health Policy and Marketplace Review
I hope the de-programming wont be too painful, Bob!
TECH/CONSUMERS: Deciphering a revolution?
Fard gets a sneak peak at Revolution Health’s site over at HealthCare Vox.
HEALTH PLANS/TECH: Looks like the Deal’s over–or is it?
So it looks like from Justen Deal’s website that he’s essentially going to be fired in absentia by Kaiser. My assumption is that he knew this was going to happen all along, and was essentially preparing the way for some kind of entry into politics and/or law career. Kaiser too seems to yet again be getting unnecessarily gummed up about the whole thing—for example according to Deal having people from the insurer side handle the case, rather than from the medical group which he works for.
I don’t know much about employment law, but I do know that California is an “at-will” state, which means that you can fire anyone for basically any reason. It’s obvious from Halvorson’s reaction, let alone the exasperated comments from Permanente’s Andy Wiesenthal on THCB, that they had no further interest in communicating with Deal after he went public, and didn’t want him around. So I don’t see why that didn’t happen straight away. Making up a (fake?) policy about “not abusing the email system” is basically a waste of time.
Deal seems to be appealing to a base of supporters within KP in order to “right” the ship. But if there really is malfeasance and/or an Enron-type meltdown going on within KP over HealthConnect–as opposed to normal teething problems from a huge IT installation (which as you know I suspect to be very, very unlikely) –the best route would be to go to those people who do oversee non-profits. That is regulators and the politicians who supervise them.
Given the various issues that Kaiser is having with the State DMHC over other aspects of its behavior , I suspect that Deal must be involved in some protracted discussions with local politicians. After all if there really is financial mismanagement going within KP, then Chuck Grassley is interested in this type of thing, as is Pete Stark.
If on the other hand, Deal is not pursuing those options, then I’m a little curious as to what this whole thing has been about. As an appeal to the massed ranks of KP employees about HealthConnect might seem appropriate if it was a worker’s collective, but it’s hardly likely to sway the board. Unless of course there’s something going on in the works that we can’t see.
TECH/POLICY/PHYSICIANS:American medical care, or Larry Weed on Speed
(This one is long on links and short on explanation….sorry, but it’s all old ground here on THCB).
Larry Weed was at IHI last week using the same line that he was using in 1998 and was probably using for years before that.
"What’s the point of outcomes data?" Weed wonders. So what if there are four times the rate of prostate surgeries in Salt Lake City as in Denver? "I wouldn’t know whether I should move to Salt Lake so they don’t miss my cancer of the prostate or move to Denver so I wouldn’t have unnecessary surgery."
That statement has been true for a while, but Eliott Fisher et al are basically now showing that care is better in Salt Lake City. As Fisher says in the roundtable in the Health Affairs blog
The increasing fragmentation — almost atomization — of medical care, and a payment system that rewards commercial behavior on the part of physicians that, from all of my work, looks as if it’s on average certainly wasteful and quite often harmful.
The situation is certainly worse in Miami (and the rest of Florida), and it costs a hell of a lot more there. I know that’s true because Brian Klepper says so too! (read down in the article for his quote). And even the pestilent sore-lickers at the NY Times have finally figured it out.
And much of the reason is the inconsistent incentives that, Jeff Goldmsith points out in a recent Health Affairs article, are making the physicians primarily in the Sunbelt leave their compact with the hospitals and open up their own shops/heart hospitals—all of which are turbocharging the natural incentives that FFS gives them to do more anyway. Not that this is exactly hurting all hospitals; some of the biggest of which are having banner years. But while everyone in the business makes hay, there are those who suffer as a consequence.
And we’ve known about this for thirty years and nothing has been done to stop it.
PS. “Larry Weed on Speed” is an Ian Morrison line about the future of the EMR. 25 years later no one is using the Problem Knowledge Coupler. Which is a pity and a problem.
POLICY: Health insurance 101
Head over to Managed Care Matters for Joe Paduda’s just excellent health care 101 (or should it be 001) rendition of why universal coverage and community rating require each other, and are both essential for health care reform to work.
And of course remember that this is true both for multi-payer and single payer solutions.
BLOGS: Dmitriy’s round up on the HC Blogging Summit
All at Blogging Summit Coverage, Trusted.MD Launch, Partnership with Transmarx and Plans for 2007.
TECH: Interview with David Blauer, CEO of Click4Care
David Blauer is trying to raise the profile of Click4Care. He gave an interview to HISTalk a while back, and we tried to connect then. It didn’t happen for a few technical and timing reasons, but thanks to the diligence of his PR slave handler Kim Miller, it happened this week. Click4Care is a relatively new software company (although a lot older than most of those Health2.0 companies I’ve been featuring) that’s spent a lot of time building a very, very complex system for what can broadly be described as care management, sold primarily to plans and payers—with United HealthGroup being the marquee customer so far.
But their goals go way beyond that..to the edges of consumers and patients managing their entire life & health via their software.
Take a listen to the podcast—transcript will be up in a few days
TECH: More wingeing Brits complaining about IT
Those damn Brits are whining about their shiny new technology again
As revealed in a joint investigation last week by Computer Weekly and Channel 4 News, after Newham Primary Care Trust in East London and Nuffield Orthopaedic Centre at Oxford implemented a system from US supplier Cerner, some patients did not receive a timely appointment with a specialist because of IT-related problems. An enhanced version of this same Cerner system is due to be implemented across England as part of the NPfIT. John Bourn, head of the National Audit Office which investigated a report of a serious untoward incident after the go-live at Nuffield, said in a letter to MP Richard Bacon, "The [Cerner] system reported that it was printing letters inviting patients to clinics, and yet it soon became clear that far fewer people were turning up to clinics than expected as they had not received any notification to do so. "Conversely, other patients were turning up for clinics that they were not recorded as having been invited to. The impact of this was inconvenience to patients, wasting of doctor and staff time and a need to reschedule appointments. The missed appointments then resulted in a backlog of outpatient appointments building up." After a go-live at Newham hospital, details on patient appointments were lost – more than 110 of them for children. The problem was spotted in October 2004, but it was six months before health staff tried to contact parents of the children, and 30 were never tracked down. The incidents at Newham and Nuffield were not specifically the fault of the supplier or the trust, but happened for a variety of reasons.
Why they can’t just order in more pizza and fix it themselves, I (and Neal ) just don’t know. And while I’ve scooped MrHISTlk on this piece of tech news, (and that doesn’t happen often!) he’s clearly in the top 3 health care bloggers, whatever Fared says, and the link to the Patterson (Cerner) Pizza Memo comes via him.
On a more serious note, the UK problem sounds relatively trivial, but it appears that no one followed up to fix it. Given that Nuffield was one of the first to go live with Cerner and both London and the South are following (now that they’ve changed in IDX for Cerner) and with who knows what happening in iSoft land in the North West this problem needs to be jumped on pretty quick. The Brits are very attached to their health care system, but not so to major government IT initiatives. I still remember people telling stories about the ill-fated initial computerization of the DVLC (national car and driver registry) in the 1970s, particularly the mistaken registering by the new computer of a scooter as a “2 wheel fire engine” being featured on That’s Life (a consumer tales of woe show which was a British national institution). The UK is not like the US where a big governmental agency IT screw up won’t matter politically, and the NHS NPfIT is a) way behind where it should be, and b) losing the support of the doctors and the public.
It doesn’t do any of us any good (other than the total luddites) to see the major IT project in world health care go down in flames, especially as the vendors are the same ones as are working over here…
