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Above the Fold

POLICY/BLOGS: More interesting stuff from the young liberals

Oct 21, 2005• 3

Now that I’ve upset every young liberal in America, here’s a blog that I was pointed to by Ezra Klein. It’s called I am Stella, by Kate who is a young health policy wonk in waiting with her own tale of woe of being a patient. She has a very interesting post on the private vs public cost control issue (although there is a slight flaw in her portrayal that her commenters have noticed–so no cheating before you see what you think). She also has an excellent post on the Phantoms in the Snow article on cross-border medicine which I was in at the start of, but ducked out of too early to get any credit for….(and which probably improved the credibility of the article!)

Those of you who want to really get into the Canada issue can look here.

TECH: Mr HISTalk’s Thoughts on Clinical Systems: introduction (histalk.blog-city.com)

Oct 20, 2005

We like MrHISTAlk over at THCB, even if he has a bit of a tendency to mouth off like the southern redneck he may be. So go read his thoughts on clinical information systems and CPOE in an article called Thoughts on Clinical Systems: introduction.

POLICY: Abstinence and universal health insurance prove very popular

Oct 20, 2005• 4

Now I’m 42 and never been married, so I don’t agree with most Americans about the very last question on this new Harris/WSJ survey. But the rest of it shows that we’re a damn site more of a liberal nation than our leaders in DC and on Fox News would have us believe.

On the other hand there is some chance that one day we’ll have universal health insurance, which is not the case for abstinence before marriage, whatever 62% of Americans believe. How many hypocrites are in that number?

TECH: PHR conference

Oct 20, 2005• 1

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

Oct 19, 2005

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

Oct 19, 2005• 4

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.

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

BLOGS: Wednesday dog blogging

Oct 19, 2005• 1

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).

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

Oct 18, 2005• 2

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

Oct 18, 2005• 1

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!