Dealing with the recent computer crash has made me grumpy, and limited time for writing today. There’ll be something somewhat cynical up in the morning.
Above the Fold
BLOGS/TECH: And if you didn’t understand Web2.0 before..
…you definitely will after you watch this!
PHYSICIANS: Barry Bonds and the AMA’s still got management where they want them
The irony is quite staggering. On the same day that Barry Bonds gets the San Francisco Giants to bid against themselves–appalling the local baseball columnists–and give him $16m for one season in his tarnished chase of Hank Aaron, the Congress after a lot of high falooting talk, cancels the fee cut for Medicare Part B and gives a tiny P4P boost. Obviously like Bonds and the Giants management, the AMA still has Congress where it wants it — even though Bond’s numbers for the last two years have not exactly been worth $6m a year let alone $16m, and the cost to Medicare of Part B physician services has gone up despite previous fee cuts, while all the wonks agree that access to physicians for Medicare patients is not a problem (or at least not one affected by across the board fee increases or decreases).
Still let’s not look to baseball teams or Congress for rational decisions, especially with other people’s money. And I won’t even comment on the potential abolition of the limit to which people can put tax-free money in HSAs, other than to note that as they can be used for any spending after age 65 Congress may have just created the biggest tax avoidance scheme of all time!
THCB: Err…comptuer failure
Not much here today. Yesterday my computer started telling me that it had problems with some files in the registry, and after running the reccomended chkdsk utility (which took 2 hours), at the subsequent restart it kept on crashing and restarting without ever booting up (and no safe mode didn’t work, nor did anything else). After hours on the phone with Toshiba and on web searching out every possibility, I ended up doing a failed “recover”, noticed that it was wiping my data, and literally pulled the plug. This is the page that should work, but as Borat says “is no so good for meee!” I’m pretty well backed up other than one big piece and a few days email — I hope–and should be largely OK.
Now I have the hard drive in a bag and need to go buy a new computer. Something I was thinking of holding off on unitl Vista appeared. I guess I’m in the market for a Vista ready one. If you knew the project I was working on at the moment you’d find this all a little ironic.
By the way, I didnt know this but the Apple Macs automatically move your old computer data to your new one. For a PC you need a separate program. And if you only have a damaged hard drive, I guess that won’t work!
PHARMA: Maybe the Dems are serious about drug pricing
It’s hard to see how Medicare Part D as constructed can easily be changed for the government to go after prescription pricing, no matter how much Pete Stark et al may want to. But there are other drugs that Medicare buys directly under Part B, mostly for cancer and kidney care. And notice has been served that the tallest of those poppies may find itself trimmed a little — U.S. payments for Amgen drug criticized at hearing.
And if you thought you understand Part B’s “new” pricing schema, take a hint from JD Kleinke. You probably don’t
TECH: Brief musings on the PHR
Some brief musings on the PHR…given that I gave a talk on it for HIMSS N. Cal yesterday
— Email is unreliable! Not a comment on the PHR but I sent the organizer my talk in both Powerpoint and PDF (one for the talk, one for the web so the secret stuff hidded in the PPT stays hidden). Most of the intellectual property is of course in the fancy “builds” I did in Powerpoint. When I started clicking into my presentation, it became apparent that only the PDF version had gotten tp him, and was the one loaded on the computer. I of course had a copy of the Powerpoint on my thumb drive and this could have been avoided. Motto—always check what’s on the computer you’re presenting from.
— Kaiser Permanente’s PHR is rolling out pretty well, and has decent usage so far. It’s relatively transparent in terms of the views it gives into the patient record (gives full lab results) and links well to Web 1.0 generation content/information therapy.
—One of the points Kate Christensen (from KP) made was that they felt PHRs should be portable. But thus far that means portable within the world of Kaiser. I asked if a member using KP.org changing plans could move all their data to Palo Alto Medical Foundation (which uses the same basic Epic software and is therefore the easiest imaginable “move”). Kate said that a) no one had asked so far and they didn’t yet have a policy on that yet, b) the data structures were different so it was more complicated than I’d made it seem, and c) they had a technical team working on it, really! Take it as read that this is a major potential future stumbling block and view all those slides about “portability” and “interoperability” with extremely jaundiced eyes.
—One word baby: Autopopulation
— I didn’t smell sulphur. In fact the entire HealthConnect EMR (clinician part) was basically unmentioned, other than by me saying I didn’t smell sulphur. I think that knocks the conspiracy theory on the head.
—This article finally confirms that the just announced Intel/Walmart/BP et al initiative will be using PHR’s developed by JD Kleinke’s Omnimedix Institute. He was keen to point out when I last talked with him that his was a data auto-population and storage, non-profit, trusted 3rd party model, which others could build applications on top of. (i.e. competition for WebMD/Intuit).
— Cleveland Clinic has rolled out its Epic System including the PHR, faster and harder (if that makes sense) than Kaiser. They also have a way that allows referring physicians to get access to their patient’s records when they’re at the Clinic’s hospitals. This is a model for how providers not integrated with insurers or using a “monogamous we hope” (to quote Kate) medical group can roll out EMR and PHR. However, it was very hard work. Holly Miller, the doc in charge of eClevelandClinic, had to buy a lot of pizza. She’s leaving next year to take up the CMIO role at University of Cleveland. I joked that this meant that the Clinic’s docs had succeeded in running her out of their organization, but not yet out of town! Rather more likely, the Univ. Hosp likes her pizza buying/persuasion skills and realizes that the quickest way to catch up with its major cross-town competitor is to steal the talent! (Isn’t that what the Dallas cowboys and the 49ers used to do to each other in the 1990s?)
—Cleveland Clinic is also doing virtual visits into Mexico and Arizona, separating the reading from the diagnosis, and they’re pushing second opinions online as a service. Clearly they see their brand as a major weapon in getting national and international market share. They may be early, but if enough records go online, why does your second opinion need to come from the same city or country? And more importantly why does the patient have to be in the same physical room, when a tech can move the stethoscope or instrument around the patient, and the doc can see it all on screen, or an entire team of experts can be assembled virtually online?
—One reason why is that state laws restrict practice across state lines, and in some states (Holly think Ohio, but it was certainly true till recently in Georgia) even a prescription has to be handwritten and signed by the doctor. So 200 years of trade protection will not go quietly into the night.
—Matthew Guidin from Frost & Sullivan has done some real research on PHRs, which may make my back of the envelope stuff obsolete (or more valuable?). He seems to think that the health plans are talking a good game about interoperability, but have little intention of doing much. He also thinks that CCR (the AAFP-based standard for moving data between EMRs) is being sabotaged by the IHE crowd before its really gets off the ground.
—Everyone I met at the meeting that used to be a client is now a consultant! Who’s doing the hiring these days?
—Whenever a new incredible “innovation” on their PHR was shown by KP or Cleveland Clinic Phil Chuang (my ex-i-Beacon colleague) and I kept whispering to each other “Didn’t we build a better version than this in 2000?” And we did. Which goes to show that timing, politics and marketing are everything. And technology is largely irrelevant.
POLICY/POLITICS/HEALTH PLANS: Igleheart, Glasscock, pussycats
After a little prompting (i.e. 30 minutes after I posted a blog comment asking why it wasn’t up) Health Affairs has posted a letter I wrote two days ago in response to John Iglehart’s interview with Larry Glasscock in its web exclusives section. I already had some in depth discussion about that over here on THCB, so my letter attempts to use the rifle rather than the shotgun. Let me (and HA) know what you think.
POLICY/PODCASTS: Radio stardom
My erudite tones from the YourCall radio show on Monday–available streaming or in MP3 for download
PODCAST/TECH: Health Communities 2dot0
This is the transcript from the recent Health 2.0 Communities podcast–original post here.
Matthew Holt: Welcome to another podcast here at the Health Care Blog. This is Matthew Holt, and with me today are two more leaders of what we’re starting to call the Health 2.0 Movement. They are Daniel Palestrand, founder and CEO of Sermo, a community-focused site that focuses on physicians, and Unity Stoakes, President & COO of Organized Wisdom, which is a community site focused on patients and consumers. Good afternoon, both of you.
Daniel Palestrand: Thank you very much. Nice to be here.
Unity Stoakes: Likewise, Matthew. Thank you for setting this up.
Matthew: Let’s start off by getting right into it. I suspect that a lot of people reading the blog haven’t heard of Sermo or Organized Wisdom, and you guys are on different sides of the same coin. This is all to do with the open health care issue, and the idea of getting many more voices online. Daniel, why don’t you start off? Tell us a bit about the core idea behind Sermo, what it does, and what kind of activities are going on on your side?
Daniel: Sure. Up until about fifteen months ago, I was a surgical resident at one of the hospitals here in Boston. I had done some startups in ’98 and ’99, but really had no near-term plans to go back to the business world.
I started seeing a trend more and more with my colleagues, where we would be talking about cases or recent news in the mainstream press — perhaps a new revelation about a new approach to treating a disease, or a problem with a drug or device, or a new resistant form of bacteria. What we were remarking on was that we had inklings of this — it had come up in conversation weeks or months ago — that there was an idea there. We realized that this wasn’t a fluke event. So often in the trenches of medicine, at the bedside, in grand rounds, physicians were talking about these phenomena long before it appeared in the conventional press. That set me about thinking: what would you have to do to capture these clinical insights and make them useful?
My starting point was coming up with a business model. I had done other startups that involved physicians and health care IT, and I knew that trying to get people to part with money is particularly difficult in health care IT. So from the start, we had a model where we would not have physicians paying for anything. We would look to get the parties who find value in the information to pay — to underwrite the business model.
My second thought was, assuming we could get physicians to make these insights, how would we distinguish the signal from the noise? I had had enough experience with my early work with the CDC and Device Registry to know that getting the initial observations isn’t the challenge. The real challenge is separating the signal from the noise in the background. What I wondered was, could you create a model whereby the valuable information would be determined by the users themselves — in other words, the people on the front line.
That was really when Sermo was born. In our model, we have a system where any licensed and credentialed physician can submit an observation, but what really distinguishes the value of that observation is the degree of corroboration that it gets from other physicians. It started out with a very simple, basic idea. We were thrilled to see that it was a very patentable and fundable idea, and has now turned out to be extremely scalable. We are seeing an incredible torrent of information coming out of our system.
We’re now a thriving young startup company, part of what we’ve realized is a much broader trend, variously called social media, Web 2.0, or prediction markets. We’re very excited to see other companies, like Organized Wisdom, tapping into the same trends.
Unity: I’m actually the president and co-founder of Organized Wisdom. We’re a health-focused social networking site. The easy way to think about what we’re doing is that we’re a mash-up between WebMD and Myspace.com. We’re really focused on integrating expert content with user-generated content, and eventually flaring in industry content and research from health organizations as well.
We got started… actually, my partner Steven Krein and I have been in the online space for the last twelve years. We took a company called Promotions.com public in the late ’90s. It was an online marketing company that was later acquired by iVillage. So we spent many years seeing a lot of these community trends taking shape in other industries, but we didn’t see a lot of progress being made with online health. At the same time, over the last couple of years, we’ve seen eight out of ten people going online to search for health information. We’ve also seen a lot of research indicating that people are turning to their friends and family to get health information. So we got the idea to combine the two and really try to create a community for consumers, patient experts and leaders of health organizations to come together and share their wisdom and knowledge in an organized, structured way… to build a very useful, helpful knowledge base covering thousands of health topics, conditions and diseases, so that any consumer needing health information could easily come in and find the information that they need.
BLOGS: Fox News touts THCB?
Fox News? Likes a commie site like this? Believe it baby!
