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TECH: JSK’s 2006 Health IT Forecast

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Skip over to iHealthbeat to see the ever wonderful Jane Sarasohn Kahn’s 2006 Health IT Forecast

Jane is pretty gung-ho about ePrescribing. She says:

I predict that e-Prescribing will come of age in 2006. With Medicare kicking the tires on e-prescribing standards, we’ll see adoption of eRx on a selective basis. An innovative handful of health plans will foster adoption by providing incentives to prescribers in regional marketplaces. By the end of 2006, e-prescribing will reach a tipping point, and it will take off in 2007 because of Medicare’s push for adoption.

It’s not secret that we share this view — after all we spent last year writing a study about it that will be out shortly! this is one of the times when Morrison’s corollary to Herb Stein’s law comes into play. Stein said that “if something is unsustainable in the long run, it will end”. Morrison riffed on that to say, “If it’s going to be a big deal eventually, it’s got to start somewhere”.  We think that the next 18 months is the “starting somewhere” period for eRx. I hope that we’re not being too optimistic!

Jane is however a little too polite about RHIOs. Ann Donovan from the California RHIO told me last week that the CEOs of the big players in Claifornia were sending people to their meetings but the people showing up didn’t know why they were there. Reading between Jane’s lines this looks like CHINS all over again. The first report we wrote together in 1994 was also about CHINs, and we said there that they might end up as a sideshow, and again we were being too optimistic!

BLOGS/POLICY: My readers are way smarter than I am

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The best thing about this year in THCB has been opening the comments up for discussion, which was actually a function of changing hosts from Blogger to TypePad, and not part of some grand design. Although certain themes have been overly repeated (and you know who you are, Ron), the overall quality of the discussion in the comments has been excellent, especially in last weeks EMR discussion, and in yesterday’s responses to what was really a throwaway piece about the tax-deductability of health care benefits. Having spoken to several of my regular commenters, and having had email back chats with many more, I can only say how impressed I am. Take a look at both of those threads and see the variety of high level discussion, arguments and counter arguments.

I am only saddened by the fact that this type of discourse (the intelligence rather that the civility of it) is so far way from being typical in American political life. That’s why in my own small way by starting a column over at the political site Spot-On I’m trying to, so to speak, bring it to the masses. But long may THCB stay a place where the smart health care wonks can thrash out the big issues.

TECH: Interesting post on physician IT education

Tech-over-achiever Shahid Shah’s new IT aggregator blog — the HITSphere— has started up a community feature that’s well worth tracking. Several people have started their own blogs there and one is an MD called Mike. He has some interesting things to say about how to get doctors to the point that they can “learn to love the EMR”. His piece is called: Healthcare IT, Informatics and GME: Are We Doing Enough? Go take a look but here’s a flavor.

If we teach our future physicians the basics and give them the tools to self-teach in the future, they will be better equipped to adapt, optimize and lead. Future challenges related to standards/inter-operability, languages and security should not be left entirely to non-physicians. We as a group want functional cost-effective solutions and so we should be willing to invest in that future by training leaders to help guide us.

TECH/CONSUMERS: Joe Paduda is nice to Steve Case

Here’s Joe Paduda on Steve Case’s strategy for Revolution Health

Loyal readers know I have been less than impressed with Case’s strategy, team, and acquisitions to date. While I admire the audacity, I question the judgment.

Joe is too nice.

It’s all very well Case going to talk to Warren Buffet about this. The guy he should have talked to was Jim Clark who said exactly the same things as Case is saying now in 1995 before he started HealthEon. Luckily for Clark the stock market insanity enabled HealthEon to buy up some real companies with their valuable paper despite the fact the company had basically no revenue and no products that seemed to actually work. Amazingly enough they didn’t completely kill their acquisitions in the process—although it was a damn close run thing. Case tried the same thing with Time Warner when AOL bought it….and it survived but as a very wounded beast.

Still if he wants to piss away his $250m or whatever, it’s up to him. But perhaps he should talk to someone who knows something about health care first.

However, if he really wants to change the system he’d have been better off taking either Bill Gates’ approach or trying to agitate for a political solution like Philippe Villers did with Families USA.

QUALITY: Can a hospital CEO get us all to integrate (medicine, that is…)

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This is pretty interesting. A fairly hard nosed hospital CEO, under it appears the tutelage of his new wife, gets into alternate and preventative medicine. 

Three years ago, Treuman Katz got some troubling news: At 60, he was on his way to becoming a diabetic. Katz, CEO of Children’s Hospital & Regional Medical Center at the time, could have relied on the region’s top specialists. Instead, the man who had spent nearly 40 years running two of the country’s pre-eminent hospitals reached out to a naturopathic doctor. He took herbal supplements, changed his diet, started yoga and hired a naturopathic trainer. Soon, his blood sugar dropped and he began to feel healthier than he had in years, he said.

Fair enough. But then he tries to integrate it with the care his institution delivers.

That opportunity came five years ago, when Katz and his medical staff
started to notice an intriguing trend: More than half of their patients
were using natural medicine but not telling their doctors. Therapies
ranged from herbal supplements to acupuncture.

So Katz organized a small group of physicians to visit Bastyr to
start connecting NDs — naturopathic doctors — and MDs, Molteni said.Brown-bag lunches with Bastyr naturopaths followed. The hospital put
together a group to study how herbs could affect drugs. It hired two
anesthesiologists/acupuncturists and will work with Bastyr to bring on
a chiropractor, a naturopathic doctor and a traditional
Chinese-medicine practitioner within the next year or two.

I live in a city with more than 70 yoga studios and probably more than 300 acupuncturists, so there is something going on in the alternate care movement that deserves some level of integration with tradition western care. This might be one approach that makes sense.

BLOGS: Grand Rounds up at Medpundit, and here next week

Whoops. If you’re looking for the December 28th, Grand Rounds please click HERE.

——

Grand Rounds is up at the ever-wonderful Medpundit’s site. OK I rag on Syd a lot, but she’s a great blogger in addition to having a real job. I just wish that her no-nonsense views on medicine transfered over to her views on politics, but I’d be happy to have her as my physician (but no, I’m not moving to Ohio!)

Meanwhile, next week Grand Rounds will be here at THCB. It’s a best of the YEAR 2005 edition, so send me you favorite post from the year. Email to matthewATmatthewholtDOTnet

 

POLICY: Tax health care benefits, go on I dare ya!

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Hat tip to Ezra, who clearly wasn’t partying enough this weekend and read the NY Times on Sunday. In it there’s a rational argument that me, Fuchs, Enthoven and Eric Novack all agree with: get rid of the tax deductibility of health benefits.

Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance. The amount is substantial: it is equivalent to about 11 percent of all federal income tax revenue and more than a fifth of federal spending on Medicare and Medicaid. And it is growing fast: the bill is expected to surpass $180 billion in 2010.

Of course, this was recently proposed  by the same panel that suggested getting rid of tax deductibility of mortgages, and immediately disowned by the politicians who set up said panel.  But linking this to the issue of the uninsured and showing that it’s unbelievably regressive on those people who buy their own insurance and don’t get the tax break can’t be a bad meme for us wonks to pursue.

PHYSICIANS/PHARMA: Is academic medicine beyond salvage? by The Industry Veteran

Several people are concerned about the integrity of our medical leaders, and the latest Cleveland Clinic spat has upset a few people, notably local MD Medpundit. I have a more jaded view. I liken it to when I heard that lawyers have to take an ethics test but are only not allowed to practice if they fail it, I assumed that any lawyer passing an ethics test lacked the aptitude required for the job! However, making a welcome return to THCB, even the usually cynical-beyond-belief contributor The Industry Veteran appears a little concerned. He writes:

I had previously viewed the tussle between renowned cardiologist Eric Topol and his boss at the Cleveland Clinic, Delos Cosgrove, as principally an academic spat whose significance did not extend beyond the personal fortunes and the organizational power positions of the two principals. The Times’s article, by contrast, suggests the Cleveland bash reveals that the integrity of academic/high research medicine is fundamentally compromised. Instead of remaining disinterested researchers who help to develop and evaluate new medicines and technologies, big time researchers and their institutions own equity positions in the companies whose products they evaluate. The very notion that medical researchers are gatekeepers for the public, motivated by professional ethics and the search for scientific truth, remains a fool’s myth. Who guards the guardians?I recently asked a friend who teaches marketing ethics at his university to tell me his views about the recent editorial in the New England Journal of Medicine. That was the one where the Journal’s editors belatedly said they were shocked, shocked by the fact that Merck’s shills neglected to include three instances of myocardial infarction among a sample of Vioxx users. The specific issue for which I sought clarity concerned the relative responsibility of the academic physicians who authored the study (or, more accurately, whose names appeared above the study, since Merck’s medical writers doubtlessly wrote the paper) versus that of Merck, who sponsored the research. My friend’s pontifications assigned the lion’s share of blame to the physicians. They must reasonably be expected to know that the first and final interests of any corporation’s operators lie in obtaining profit to satisfy shareholders. In this particular case, the academic physicians would have been psychotically detached from reality not to have known that Merck’s pursuit of Vioxx profits included a thoroughly unethical inclination to twist and hide data. “If they were willing to accept research money and sponsorship from known crooks such as Merck,” he wrote, “then they had a responsibility to act with the very highest possible standards of ethics, and my guess is that they fell far short of that.” The Times article flicks off the lid to reveal that these kinds of self-aggrandizing conflicts are the routine condition of high powered, medical research.

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