The Web Returns to Health according to the Washington Post. Who knew? Sadly not too much in the story. WebMD is still around, Steve Case, Time Warner put money in to something called EveryDayHealth—not launched yet. Healthcentral is back; rescued by defense-contracting money-bags the Carlyle Group. All these guys are aping the mainstream health success of WebMD.

Not in the report but more interesting is the attempt by Healthline, and a host of others—and of course Google—to create health information search verticals, and then the coming attempt to get at consumer long-tail sites which several people have been writing to me about.

Finally, the most interesting development is the integration of this information with the actual health information of individuals—that’s the role of the emerging PHR movement, and that’s where the really interesting health web activity is going on. And one version of that is the combination of those records with physician communication systems. yeah, yeah, I know you’re expecting some crack about RelayHealth and it’s long slow evolution, but the fact that at least the service exists is finally making some news. Today it’s in the Wall Street Journal in the column by single-payer touting Dr. Benjamin Brewer.

We’ve had our Web site going for about a year now and while only about 50 of my patients have taken advantage of our online services, they seem to like them. Currently, my patients pay $30 upfront for virtual office visits with a credit card. The software on the Web site takes a systematic and thorough history for any of more than 3,000 different complaints. I review the information and decide who can be treated online and who needs a face-to-face visit. Patients who are referred for office care are only charged for the standard office visit.

The histories these patients generate via the Web site might sound like a waste of time, but they aren’t: They go right into their electronic medical records, so I have their information ready when they come to see me. Patients like not having to repeat the same story to the receptionist, the nurse and then the doctor. I like it because it saves me time and eliminates transcription costs related to summarizing and recording what the patient told me — instead, I can just add some nuances I picked up while talking to the patient, as well as a key note or two. Online patient registration and insurance updates are our most-popular Web-site features, followed by secure bill payment and prescription-refill requests. (We don’t charge for simple email questions or for processing refill requests.) Patients will soon be able to access their own lab results and review their records online.

And of course there is the minor issue of consumer convenience, and competition for it!

Meanwhile, retail health clinics are springing up in a lot of places. These clinics are dedicated to treating simple problems quickly, and they’re threatening to skim the easy patients and the easy money out of the office. For doctors, online visits are a way to keep this from happening. Two weeks ago I was in a CVS pharmacy in Seattle and noticed most Minute Clinic visits cost $59. My patients get online consultations for the same sort of problems for about half the price — and they get them from their own doctor.

It seems like only yesterday that officials at the Veteran’s
Administration were issuing public  apologies and pledges to get serious about
security after the theft of a laptop containing the personal data for 26
million U.S. servicemen and women. Laptopgate turned out to be a little less serious
than the early reports predicted. The missing laptop was eventually recovered. The perps dragged away in chains. And
government officials left feeling highly embarrassed. Desktopgate looks to be a little more serious. This time
a large government contractor (Unisys) appears to be responsible.

Leaving aside the question of how exactly you lose a desktop in the first place, this looks like it actually might be a bigger deal than the original security breach at the VA. While less
data is involved, the missing information includes the names, addresses and
social security numbers for tens of thousands of veterans treated at VA
hospitals in Philadelphia and Pittsburgh. It  also includes insurance information and details about medical conditions. Making things even worse, data for an additional 20,000 patients
recently treated at the Pittsburgh hospital may also have been, er … lost. 

Before anybody resigns or holds a press conference blaming a
culture of official incompetence at the VA, let’s think about this. If the incidents over the past few years are
anything to go by, computer theft is a problem that has now reached epidemic
proportions. It seems logical to assume
that the number of unreported incidents is far greater than the number we’re
hearing about.  Unlike government
agencies, corporations are under no legal requirement to inform anybody if data
goes missing. Not many are willing to
take the PR hit that goes along to owning up to a mistake. Why would they?

As many observers have noted, it is apparently human nature to lose/take computers. So what can be done? Developing realistic
policies for data control would be a good start. One sensible approach might be
to equip all government laptops with RFID tracking technology (See: If he
beeps, He’s clean Bob) so that if a computer escapes it can be easily tracked
down. Alternatively,  we could use the Tommy Lee Jones method and handcuff people to their computers. But that doesn’t sound like a very good solution in the long run, given that handcuffs are generally considered fairly uncomfortable things.  I have a feeling that a fortune – not to mention a government contract – awaits whoever comes up with a clever solution to this problem …

USA Today tells us that 3,000 Patients with defibrillators are now broadcasting their signals wirelessly

Patient demand is growing as the U.S. population ages. Use of implantable defibrillators has risen from about 21,000 in 1995 to more than 250,000 last year. With such high numbers involved, some doctors worry whether they’ve got enough staff and time to process the influx of data home monitoring systems can provide. For example, what responsibility do medical staff face to respond immediately to a potential sign of trouble that turns up in a batch of downloaded data? How do they sort out real problems from the false alarms?"There are concerns about information overload," said Dr. David Martin of the Lahey Clinic in Burlington. "Physicians have less and less time, and they don’t want to have fewer patients coming to their clinics at the expense of having too much paperwork." But Martin expects remote monitoring will enable his team of five electrophysiologists to track their more than 4,600 patients more closely. "There are not enough doctors and nurses to follow these people, so it makes sense to use technology to automate some of the functions that don’t require physicians’ input," Martin said.

So as the technology races ahead, the service organizations which will do the monitoring need to be put into place. But of course this being health care they are only going to be put into place if someone pays for them. And that someone is Medicare. So the key question remains, is this a medical service that has already been granted Medicare’s blessing, or is this some type of disease management service that is still in trial? We know which end of that scale the manufacturers want this to be on, but if this technology cuts physician visits and doesn’t replace them with other funding streams, it won’t be too popular amongst doctors. Which means that it’s all very well but for now these patients are a bit like the guy with the first fax machine!

English comedian Jasper Carrot once did a great election night skit which had a parent explaining politics to a kid in the same way they explain the birds and bees. Hence the line “It’s not how big your cross is, it’s where you put it” (Yes in the UK people just put a cross next to the name on the ballot paper, and the polls stay open way longer, but their electoral results aren’t ridden with fraud….unlike here)

A new article in iHealthbeat by Colleen Egan basically says that same thing about CPOE. Essentially Seattle Childrens and Pittsburgh Childrens both put in Cerner’s Powerchart in their Pediatric ICU. The title is Not Quite the Same: CPOE Studies Using Identical Technology Report Different Results.

Pittsburgh you may recall saw a big rise in infant mortality. Seattle saw a slight drop.

What was the difference? As I said in THCB when the Pittsburgh brou-ha-ha broke, it’s process. Particularly getting the clinicians involved in the implementation and workflow design.

For example, unlike Pittsburgh, Seattle “had active involvement of [the] intensive care unit staff during the design, build and implementation stages,” according to the study. Also, “Both institutions placed a great deal of effort in designing and implementing order sets, but CHP did not have the order sets for the critical care setting available at implementation,” the CHRMC study notes. According to the Seattle study, “implementation issues … rather than inherent issues with the CPOE itself … are the primary risk factors affecting mortality during implementation of CPOE.” Del Beccaro notes that CHP did not have the benefit of extensive previous data or studies to use as a model, so “some of the things they learned were by trial and error.”

That’s no surprise and it goes for virtually every kind of major software implementation—including of course CPOE, as we’ve known from the days of the Cedars-Sinai debacle.

Not exactly a surprise, but when they talk tough about P4P (or anything else) remember that CMS lives in the real world, and where the real power lies.

The federal government on Tuesday softened proposed double-digit cuts in reimbursement to hospitals in 2007 for procedures involving pricey medical devices, a win for medical equipment companies that had lobbied hard against the cuts.