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TECH: PHR conference

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Last week’s PHR conference that I didn’t go to (cos they held it in DC and I’m too cheap to fly there by myself) now has an available transcript. (All big PDFs–you have been warned).

The intro is long but good. It has a talk from Carolyn Clancy (AHRQ chief) then a quick 3 person panel on PHRs from CapMed, Brown and Toland (using Medem’s iHealthrecord) and Cleveland Clinic (similar to the PAMF system Paul Tang spoke about). Finally it has a tour de force from Newt Gingrich, who explains exactly what we should have all have a personal health record and gives me no clue as to why we’ll get there. But that doesn’t stop companies giving him $200K a year to join his Center for Health Care Transformation–purely because they are interested in his words of wisdom; sure, yup that’s all they’re interested in!

I haven’t got to this yet but here is the Intel lunch talk, and here’s the last session with Esther Dyson et al

BLOGS: TCHB tech traumas over

Thanks to John, the tech traumas are over and when you go to www.thehealthcareblog.com you end up in the right place, and it looks like it’s really on a standalone domain although it actually lives on typepad, yet you can get away from there to other sites. Very clever (although for those of you who care apparently TypePad’s instructions are wrong!)

TECH: Privacy, standards, certification and RHIOs–more from AHIMA

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Yesterday’s the AHIMA meeting morning presentations were excellent. The presenters were all on their game, and were also relatively amusing (especially Mark Frisse). But although I know a lot more about the DC based machinations of the national health initiative after this and the Brailer talk yesterday, I’m still of the opinion that there’s less there than meets the eye.

Imgp5093

Carole Diamond runs the Markle Foundation and their Connecting for Health Program with the help of David Lansky, who used to run the Foundation for Accountability which Markle has swallowed (more or less) whole. In her speech she talked about Connecting for Health

Connecting for Health cares about

1 Tech standards and adoption

2 Policy framework for successful EMR/PHR/RHIO implementation

3 The consumer

Continue reading…

BLOGS: Wednesday dog blogging

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Now that I’m a newly "domestic partnered" person rather than a swinging single, much of my day seems to revolve around walking Charlie, who moved in with Amanda (the other domestic partner).

Imgp4193

So I’m thinking much more about dogs than I ever thought I would. So I thought you’d appreciate this story about a New Mexico official promoting a law against dangerous dogs, who’s own dog badly bit him. And this story about a police dog in the UK, who just wasn’t into police activities and would rather hang with the trouble makers

TECH/CONSUMERS: Tang on the unstated information therapy

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Next up was Paul Tang, the CIO of the Palo Alto Medical Foundation. He wanted to talk about patients, and about transparency. PAMF went to open access to physician visits (i.e. you call up, and you get a same day appointment) a while back, but found that half the people would rather treat themselves than come in. Worse, even in those visits patients missed the problem that the doctor talked about 54% of the time. So access to the patient’s information by the physician (even if the physician is immediately available and the information is immediately available to the physician) is not enough becuase the patients aren’t getting the information from the doctors. In the US 71% of patients not given any information after an office visit. PAMF now gives out a post-visit summary which is a simple print out for their EHR and patients love it.

Paul contrasted the health care information system with the air traffic control back up system, and the pilots’ interface in their cockpit with the health care interface in the ICU (guess which one is non-standard). We have not set up the interfaces (e.g ICU’s are all different and non-intuitive) or the standards that work, and have no computer back-up.  American health care sucks (his words).

He suggested 3 solutions —

1) give a warning that the patient has to sign a consent that the physicians is not using and EMR and nothing can be expected to go right. (Somewhat unlikely even if true!)

2) Patients already keep a medical record at home (which some are already doing) or

(his favorite)

3) provide patients with the information that they need when they need it — this is what PAMF does using the Epic patient look-into the EMR.  Their information therapy shows the patient what to do, and allows them to message the doc/nurse — and all of this is captured in the EHR. It shows the personalized content for the patient connected to their actual personal information (e.g. a dabetic diagnosis changes the content offered to stuff about diabetes management).

The most popular feature is lab test results with the physicians annotation and next step instructions. Their systems now has good enrollments and 96% patient satisfaction. Patients are respectful when they communicate electronically with their physicians and docs are 90% happy too. One patient quote "It’s not just a website it’s a good deed", 20% of patients changed their behavior just from seeing their results, such as graphing test results against time helps patients stick to diet.

Somehow Paul gave this whole talk without mentioning the words "Information Therapy". I assume Don Kemper is taking note somewhere.

TECH: The latest from Brailer

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Monday crack of dawn saw me heading of to San Diego to sit in a room with thousands of (almost all female) hospital coders at the American Health Information Management Association conference. You know the reality of "information" in health care when you figure out that this conference is not about the $25-30 billion spent on hospital IT systems, it’s about the $25-40 billion spent on transcription and coding, and up coding, down-coding and paper records management. This ugly step-sister of the EMR hype is still there and not going no-place any time soon.

First up (and earlier than advertised so I missed half his talk) was none other than Health IT Czar David Brailer. Those of you following the press releases know that he’s been a tad busy, even if Cerner’s Neal Patterson thinks that it’s all inside the beltway bullshit. Brailer said that the Fed’s process is at the "end of the beginning" — October is a pivotal month. The time for discussion is soon over, and the Federal government is moving towards exact plans and near and certain deadlines for health care IT. Brailer views health care IT as being inevitable. He notes that interns in training today were born a year before the IBM PC came to market…so doctors will use computers at the point of care.

But he was clear that we can still get this whole thing wrong. In his view portability and interoperability is not an option, it’s essential — so we need to do interoperability right and build it in from the beginning. (Yup, I’ve been cynical about this before, but the man is trying!)  Meanwhile, for presumably political reasons his office had a study about Cyberfraud out Monday, and he mentioned fraud about 5 times. After all, who can be against stopping fraud — so long as it’s not called a no-bid contract to an oil-services company, in which case Dick, Scooter and the boys love it.

Brailer said that we will have a single process for creating standardized standards. Standards bodies now are siloed. Standards start now with types of data, which is why they’re siloed. Instead he wants to move to standards addressing business problems and then use them to solve those problems. The Federal government will be bringing them together and he was insistent that we should have high expectations from the new supra-standards body. In addition we also now have a certification commission (made up of HIMSS, AHIMA, & NCHIT) which will be judging EMR based on three features a) security, b) clinical features (prompts, reminders) c) interoperability. The commission will later move to inpatient tools, etc. While some of my capitalist friends fear this will restrict innovation, my thought is that this certification process will be a floor not a ceiling on getting EMRs that are somewhat effective onto the market.

And soon NHIN will will award national Health information contracts to develop the nation’s infrastructure. Of course this has been getting controversial (especially after Cerner’s CEO’s remarks last week). Brailer simply said that apparently someone had disagreed with him for the past year and a half but forgot to tell him. He never mentioned Patterson’s name.

Brailer wants criteria for the architecture of the infrastructure for interoperability. He likens the EMR to the cell phone network, and hopes that like with cell phones, for a regular fee you can plug your EMR in and get on top of that infrastructure. He thinks that once the base is set that there’ll be lots of competition in services running on top of it. But it’s not just hurtling towards any old infrastructure, but the Feds will be making sure that it’s tied together, that it’s integrated and secure from day one.

He is also (rightly in my view) concerned about the adoption gap, and thinks that we need to make it easy for everyone — not just big organizations. For this he thinks that the recent anti-kickback exception (Stark exception) so that hospitals can donate EMRs to physicians, but has to be linked to certified EHRs, is very significant. And finally, in order to count how effective this all his, HHS is buying a bunch of surveys to objectively tell us how we’re doing. I wish I was still selling them!

BLOGS: THCB hosting prob

Your crack technical team here is trying to get the address bar in your browser to say "TheHealthcareBlog.com" but add all that stuff after the slash that indicates which page you’re on, rather than either just saying "TheHealthcareBlog.com" whatever page you go to, or having that long Typepad address.

Part of that process means that for a little bit (hopefully just a few hours) if you go to "TheHealthcareBlog.com" you’ll end up at a GoDaddy parking site. It may not do you much good, but if you got here anyway, for now you might want to try http://matthewholt.typepad.com/the_health_care_blog/ when you come back for the next few days.

PHARMA: Can you trust Tufts and should we trust the FDA?

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Today I’m off to San Diego to hear David Brailer et al at the AHIMA conference, so expect some more about that later on this channel.

Meanwhile, the pro-PhRMA academics at Tufts have a new study which suggests that rushing drugs through the FDA process is neither better nor worse than slowing them down.  Note these are the same guys who keep coming up with the BS numbers of $800 million plus, plus, plus on how much a new drug costs, a stat that has been well fisked by the anti-big Pharma forces on many web sites. However, take a look at their new study and consider whether it’s the speed of approvals that’s the problem, or whether it’s that the FDA cannot be trusted to be open with the public about all the data it knows about a particular drug.

Then consider again whether any of the top brass at the FDA can be trusted, given all the recent shenanigans about Plan B, and Crawford’s recent rush to get out of town — allegedly ahead of an indictment — and the latest news that he won’t help an investigation about whom he was carrying the bag for when he stopped Plan B’s OTC approval. (Hint: it might be some people who have other problems on their minds right now.)

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