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TECH: Physicians and patients at the IX conference

I’m getting a little late start this morning, and sat through a few talks without taking decent notes. Suffice it to say that Al Mulley talked about reconciling patient and physician expectations which funnily enough are not always the same. Geisinger’s Buzz Stewart is re-engineering the patient visit using structured patient history questionnaires. Ashley Peterson has a 5 years old child with severe developmental disabilities, and is very very active in her clinic in essentially managing the teams of clinicians, therapists et al that help care for her daughter. She’s really helping them redesign how they communicate with patients. She has a life most of us would just not be able to handle and she’s really pushing the barriers. Amazing, harrowing and inspiring.

Next is a session about tools being used for Ix. First up was Janet Wright, a cardiologist from Chico in a paper-based office. She’s trying to do the right thing but her job is close to impossible (similar to the Dr. Mom on THCB lately), and she’s not sure how to handle the year of the “switch” if she puts in an EMR. Then Kate Christensen from Kaiser tells up about KP.org, the patient view into the medical record. Pretty soon they’re adding things like pictures and device-entered data to all the other things that patients can already communicate (questionnaires, instant history). And she thinks that physicians will be engaged. Jeff Levin-Schertz from Partners (Mass General/Brigham) who is in charge of getting their community centered docs on board with EMR and Ix, and by the quotes he showed they’re a crotchety bunch. They offer their home grown Mass Gen system and the GE Centricity system (the old Medicalogic) to their docs, most of what their docs have they can also swivel the screen and show the patients. They do have a patient portal but at the moment it has limited functionality—but they are able to push letters, test results and other information to patients that way. There are some good results from rolling out this EMR and some keen early enthusiastic physicians. But as he says “getting physicians on board with this stuff is not easy.” Anyone who thinks it is, should read the lots and lots of comments to the “Can Doctors Ever Learn To Love The EMR” post from last December.

TECH: Brief cuts from mini presentations

The conference has a series of  little demo sessions which look at new tools for Ix

Medseek. Spend the last ten years building web portals and content management systems for hospitals. Their 4 audiences are patients, consumers, employees and providers/physicians.

Their aim is for personalized, targeted in time and documented. What they have put into the eVisit is delivery of written documentation but done through the web. Henry Ford has implemented the MyHealth personal health site relevant to their site. They have inbox for messages, different transactions and different personalization. All this is within Medseek’s tech world (which lies ontop of their home grown EMR) or adjacent to it.

For the eVisit they first present them with a billing set-up and then a profile creation site (very similar)—then patient is matched to a record number in the HFHS EMR. Then they select their physicians—may have been instructed to do this by their physician, and might be able to tell their usual complaint or introduce a new one. Then they go through a clinical questionnaire of 15–25 minutes (like an instant medical history). Then that is all signed off one and sent to the physician. Typically at HF the doc is in the EMR when they get this and they can see the patients questionnaire. They review it as a clinical note (like a SOAP note).

Then the doc can respond within the work flow. They can either send a (secure) email back to the patient (and keep a thread of the message). The physician can end the visit with a diagnosis and a treatment, which involves entering billing and ICD9 codes. The system can add information content (e.g. Healthwise) to the doctor. That is then all documented as part of the encounter in the EMR.

At the moment HF is not really integrating this with the EMR fully (in terms of giving a health history) but this can be done.

Do already do appt requests, Rx refills. Use a CRM system to manage and mine that, and find that the most profitable patients are their online patients. Around 75,000 appt requests. generated $20m from appointment requests.

For these visits instead wanted to not do unstructured text messages (as a doc). Want instead to get the structured history (which is a version of Primetime’s).

Are not charging if they are a HAP plan member (that’s the captive plan of HFHS) but it’s going to be $20 for others.

As an extension of this HF is doing a study. 50K patients already on the portal and now releasing it for 3 clinics (out of 24) Goal is to have 12 using eVisits, 12 are a control. In a 3 year study want to look at outcomes, work days lost, etc. So we’ll let you know in 3 years.

Enhanced Medical Decisions. Has a new product called DoubleCheckMD

Most drug errors are between drugs that should be taken together, but don’t work for those patients. So they’ve built an online system that can match drugs and symptoms and figures out all the various permutations. Essentially a drug-drug-symptom interaction checker system….that can take consumer data (including OTC weird foods, herbals, grapefruit juice)

Also now are adding more than symptoms—e.g are now reading what lab tests that you should have. Here are the symptoms that you should be looking for.

Interesting product gives you back a list of symptoms from drugs, interactions, next steps and information.

Intended to be an early warning for the consumer (not a provider view) which then tells them to how to work with their physicians. Very early days and not on the web yet but well worth watching.

QUALITY/CONSUMERS: Wallace and some patient advocates

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Information Therapy center chair Paul Wallace is from Kaiser Permanente, who quite logically would be interested in Ix.

He notes that the medical care cost, and the costs of poor health to employers far exceed the medical cost. (Absenteeism. etc)

He also notes that no consumer is involved in designing consumer directed health care. How do we get “skin in the game” not to be a blunt tool like managed care? And he explains that the revenue that would pay for the care of the 20% has left the system. let’s not use blunt tools to solve complex problems. That means using co-pays to access selective care, but not for pharmacy, well baby care, etc. And are there incentives to use information therapy in those decisions?

He has a vision of putting the patient centered care integrating this around patients not their diseases.

Then it’s on to two patient advocates. Sue Sheridan (who gave a harrowing speech last year that’s well worth re-reviewing) and Jesse Gruman from the Center from Advancement of Health. Sue has got the CDC to engage consumers in telling mothers about the risk that jaundice can cause brain damage. So eventually this fall they are putting out information that are right for new mothers—not about the disease but “how can my baby get hurt and how can I do something about it. Sue thinks fear is a gift that will motivate. Jesse is not so sure, but know that we need to arouse the anxiety just enough to give them something productive to do. Last year Jesse told us about “blunters and monitors.” In other words some people want the second opinion, want to know everything, but others want the doctor to tell them what to do. But there is no neutral health information. So the people trying to engage patients in health information have a major challenge. But Sue thinks that we should create the demand for patients to be engaged because if they’re more involved they’ll have better outcomes.

Jesse thinks that using marketing methodologies that retail et al use to make people buy stuff they don’t really want/need (e.g. data mining connections) needs to be used to deliver information therapy and make people integrate it in their life. We also need to tell people what we expect them to do.

One of the most interesting questions is from a Canadian who is telling about how consumer health information in his hospital (McMaster, in Hamilton Ontario) is worked out in conjunction with marketing academics. In the US he says that this stuff seems to be part of the marketing department, and be kept as proprietary information.

QUALITY/POLICY: Information Therapy conference, the employer coalition view

So as I warned you, I’m at the Information Therapy conference in Park City, Utah.

Andrew Webber from National Business Coalition on Health. Tries to come at Information Therapy from the point of view of an employer—but an employer who was brought up as the son of a Minister living in Spanish Harlem.

Employers are figuring it out….he thinks they can improve quality while controlling costs, and do it by making the health care system more functional. Andrew thinks that employers really want a more productive healthier workforce. He thinks that there should be metrics for how Wall Street looks at individual companies on the health/productivity issue. So we need better stories to get employers to realize that they need to get on board with improving this.

But overall employers want to point at providers and call it their fault! (for a bunch of reasons). But he thinks that employers can do better and they’ve been a big part of the problem. Employers have created a toxic payment system, that pays for poor quality of care.

Andrew wants employers to take responsibility for it! Their vision is health purchasing reform via value-based purchasing community by community.

His 4 pillars (of wisdom) are

1. Performance measurements2. Transparency and reporting3. Payment reform (he wants population-based not a fragmented FFS-based payment)4. Informed consumer choice

But you all know that, so let me show you a photo I took in a slot canyon in Arizona yesterday (taken on my Treo no less!)

Photo_092406_010

Meanwhile, Andrew thinks that this is all wrapped up in the change of Federal incentives (and the recent directive) to do more transparency and get consumer purchasing on the national radar.

Personally I get very nervous when Information Therapy gets wrapped up in the ideology of consumer-directed health care. Somehow he manages to think that what HHS and Leavitt is up to and what RWJ is supporting are consistent with each other! But he does make the reasonable point that Ix needs to somehow connect with the wider movements. I just hope it gets done as a neutral issue without getting into a real war over the ideology. If Ix gets wrapped up in that it will be shot in the crossfire.

INDUSTRY/TECH/POLICY/HOPSPITALS: ID Theft Infects Medical Records

In an LA Times article called ID Theft Infects Medical Records Joseph Menn tells several terrifying stories of people who have had their identities stolen by other people who have used them to get medical care. Not only does this give those people the nightmare of having to try to deal with bills and insurance hassles (as if they weren’t bad enough already) for medical care that was done to someone else, but it also means that false information arrives on their medical records. One victim went ot the hospital for a heart attack and was nearly treated for diabetes she didn’t have. That could of course be fatal, if a healthy person was given insulin, for example.

Lots to think about for health care organizations and the rest of us in this article so read it all!

PHYSICIANS/PHARMA: The oncologists’ chemo junket flies above the radar

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You may have heard just a few things on THCB from Greg Pawelski, Matt Quinn, me and others about the oncologist prescribing franchise, and how it might just change physicians’ behavior a tad. Well Greg informs me that last Thursday the whole issue made it onto the NBC Nightly News.

Greg also notes that the community oncologists (well, he calls them something rather ruder, but he’s insulting the world’s oldest profession so I won’t use his language) have their own response. They are “outraged!”

HEALTH PLANS: Blue Cross cancellation story rumbles on

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With an election in less than 2 months, the state is finally wading into the Wellpoint BC cancellation mess. Blue Cross now faces a fine:

In the first sanction of its kind, California’s top HMO regulator fined Blue Cross on Thursday for illegally canceling a woman’s medical policy because she did not disclose corrective surgery she had 23 years earlier. The $200,000 fine might not be the last resulting from the state’s investigation of allegations that insurers dump sick policyholders to avoid paying claims, said Cindy Ehnes, director of the Department of Managed Health Care.

And Arnie has broken his silence:

“Californians — who make the right decision to have health insurance as security for themselves and their families — should not be afraid that if they use it, they will lose it because of confusing applications,” he said in a statement. “oh and please vote for me in 6 weeks” (OK he didnt say that last part)

Meanwhile, the east coast establishment has noticed—or at least Paul Krugman has—it’s the lead in his column today calling for single payer Medicare for all

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