Search results for ‘THCB Gang’

Donald Trump’s Healthcare Problem

Feb 23, 2016• 20

By ROGER COLLIER

Screen Shot 2016-02-23 at 12.05.28 PM Whether you are elated, appalled, or just plain amazed that Donald Trump is the Republican primary front runner by a considerable margin, one thing should be clear: he’s not a policy guy.

So far, The Donald’s lack of policy specifics seems not to have hurt him. He’s successfully deflected the more searching debate questions, provided vague generalizations or given incomprehensible responses, and—when all else failed—insulted the debate moderators or his fellow Republican candidates.

So far, so good, for the Trump campaign. But is it time to change tactics?

As the number of competing candidates dwindles(So long, Jeb!),the focus in debates and interviews becomes sharper. With the original crowded field winnowed to just a handful,interviewers and debate moderators have time to probe a lot more deeply.And even if the questioners are relatively gentle, every other surviving candidate will be eager to pour scorn on policy statements that lack either substance or rationality.

Like Donald Trump’s healthcare proposals so far.

He’s said he wants the government to negotiate Medicare drug prices, he likes health savings accounts, he wants to be able to buy insurance across state lines, and he wouldn’t cut Medicare. And that’s pretty much it, except for one very big thing: he would “repeal and replace” Obamacare. But by what? “Something terrific” he says.

It’s easy to mock, but all of us – liberals and conservatives — should worry that we might just find ourselves with an incoming president trying to impose such an incoherent healthcare vision that our present system would look like a paragon of rationality.

The Stanford Lectures: So, Is Software Really Eating the World?

Aug 10, 2012• 6

By Blake Masters

Here at THCB we really can’t think of many lectures we’d rather sit in on than Peter Thiel’s Stanford course on entrepreneurship. And we can’t think of a better guest to catch than Netscape co-founder Marc Andreeson. In this talk, Andreeson talks about how healthcare IT is changing in the Facebook and Big Data Era era, the privacy issue and how the cloud may or not be eating software.

Is Software Eating the World?

Marc Andreessen’s most famous thesis is that software is eating the world. Certainly there are a number of sectors that have already been eaten. Telephone directories, journalism, and accounting brokerages are a few examples. Arguably music has been eaten too, now that distribution has largely gone online. Industry players don’t always see it coming or admit it when it arrives. The New York Times declared in 2002 that the Internet was over and, that distraction aside, we could all go back to enjoying newspapers. The record industry cheered when it took down Napster. Those celebrations were premature.

If it’s true that software is eating the world, the obvious question is what else is getting or will soon get eaten? There are a few compelling candidates. Healthcare has a lot going on. There have been dramatic improvements in EMR technology, healthcare analytics, and overall transparency. But there are lots of regulatory issues and bureaucracy to cut through.

Education is another sector that software might consume. People are trying all sorts of ways to computerize and automate learning processes. Then there’s the labor sector, where startups like Uber and Taskrabbit are circumventing the traditional, regulated models. Another promising sector is law. Computers may well end up replacing a lot of legal services currently provided by humans. There’s a sense in which things remain inefficient because people—very oddly—trust lawyers more than computers.

It’s hard to say when these sectors will get eaten. Suffice it to say that people should not bet against computers in these spheres. It may not be the best idea to go be the kind of doctor or lawyer that technology might render obsolete.

The Fall of Berwick?

Mar 9, 2011• 26

By MAGGIE MAHAR

When President Obama named Dr. Donald Berwick to head the Centers for Medicare and Medicaid (CMS) last March, I wrote this:

“Most who know Berwick describe him a ‘visionary’ and a ‘healer,’ a man able to survey the fragments of a broken health care system and imagine how they could be made whole. He’s a revolutionary, but he doesn’t rattle cages. He’s not arrogant, and he’s not advocating a government takeover of U.S. health care.”

To understand what I meant, view these clips from the film, Money-Driven Medicine, where Berwick speaks about the need for healthcare reform. Soft-spoken and charismatic, Berwick is as passionate as he is original. His style is colloquial, intimate, and ultimately absolutely riveting. He draws you into his vision, moving your mind from where it was to where it could be.

And now, it appears that we are going to lose him. Thursday, 42 Senators delivered a letter to President Obama demanding that he withdraw his support for Berwick to head CMS. The Boston pediatrician and co-founder of the Institute for Health Care Improvement (IHI) had received a temporary appointment in July while Congress was on vacation. President Obama re-nominated him in January. But Berwick still needs to be confirmed by the Senate, or he will have to leave his post at the end of this year.

With 42 out of 100 Senators firmly opposed to him, it appears that Berwick’s supporters won’t be able to muster the 60 votes needed to clear the Senate floor. Reportedly, Senate liberals already have given up. According to Politico.com’s Brett Coughlin: “At a meeting with Senate staffers Friday, health care lobbyists and advocates were told that there will be no confirmation hearing and that they’ll soon be discussing ‘next steps’ for CMS.” If this is true, Berwick is now a lame-duck CMS director without power—as of today.Continue reading…

A NY Times guest (inadvertently) spanks its professionals

Jun 21, 2010• 26

By Matthew Holt

A couple of weeks back two New York Times reporters (Abelson & Harris) decided to take on the orthodoxy of the Dartmouth school. Frankly their efforts reminded me of England’s performance in the world cup so far—abject and inept and leaving the fans hoping for much better. Within a few hours the mainstays of Dartmouth (Fisher & Skinner) responded correctly accusing Gardiner and Harris of shaky reporting. Although that original article was particularly muddled, there are indeed legitimate questions about some of the Dartmouth research, raised by serious academics (including on the august pages of THCB), but few of those made their way into the hodgepodge that was that original article. And now in their response to the response, Abelson & Harris have descended further into the mire.

The new argument is basically this. Yes, the Dartmouth academics have done all the corrections to regional data that the NYTimes duo accuse them of not having done. But they’re not available on the website within a click, not always portrayed in the maps in the Atlas, and (horror of horrors) you’d have to read Health Affairs to find out what they’d done. And that some of the academics who read Health Affairs hadn’t carefully looked at the maps which showed unadjusted data.

So now it’s not an academic issue or a misstatement. It’s an issue of poor user interface design! Well I guess we’re used to that in health care!

Making (sh)it up as they go along

Dec 9, 2009• 9

By Matthew Holt

So today’s news is that the gang of ten have come up with something. (If you haven’t been following along, the gang of ten are the five “liberal” Democrats and the five DINOs asked by Harry Reid to come up with something to break the deadlock and get some type of compromise that will pass the Senate). More details are here from Brian Beutler at TPM

So it might vanish like a Clinton-era trial balloon, or it might be a stayer, but the core of the new concept is to allow the 55–64 crowd to buy into Medicare, and to ask/allow/mandate a non-profit insurer(s) to provide a substitute public option. Exactly what the second point means is unclear to me. It may turn out to be some collapsing of Kent Conrad’s notion of the cooperative with an extension of the Federal Employees’ Plan (presumably minus the for-profit carriers) and somehow cramming that into the exchange. Of course providing something like the choice among private plans that Federal Employees now get was at the heart of Ron Wyden’s plan. We’ll see if it can last a couple of days scrutiny, or the wrath of the House Democrats.

The Medicare buy-in seems both sensible politics and half-decent policy.

Silly Season: Monty Python Policy Making

Oct 19, 2009• 5

By IAN MORRISON

Editor’s Note: Ian Morrison today makes his first contribution to THCB. Ian was President of Institute for the Future where I learned my health care consulting trade in the 1990s. A more amusing boss one couldn’t have hoped to have and he never minded me (or half of health care) shamelessly stealing his jokes–although his Scottish brogue always gave them a zing none of us can quite match. Ian’s now a full time speaker/writer/futurist and he gave THCB his view of the health care debate, interpreted logically through the lens of Monty Python’s Flying Circus–Matthew Holt

Now we are down to the really fun part of healthcare reform, when they actually write the final bill and figure out ways to pay for it. And to honor the 40th Anniversary of Monty Python’s Flying Circus’s debut, Congress and the Administration have entered the silly season where final policy is turned into law.

I love the American healthcare system, not because it is the best in the world, but it is the funniest. The laughs keep coming. Here are a couple of my latest favorites.

Is Hospital Peer Review a Sham? Well, Mostly Yes

Jun 3, 2009• 16

By BOB WACHTER, MD

Dr. Sidney Wolfe, healthcare’s answer to Ralph Nader, spends most of his days unhappy with somebody. Pragmatic, see-both-sides types like me naturally recoil from Wolfe’s reflexive indictment of institutions ranging from the FDA to Medicare.

But Wolfe’s blistering condemnation of medical staff peer review contained in the new report, Hospitals Drop the Ball on Physician Oversight (co-written by Alan Levine, both of Public Citizen’s Health Research Group) is timely and, I believe, largely correct.

The report focuses on the National Practitioner Data Bank (NPDB), established in 1986 to collect data about problem physicians, mostly to help credentials committees make informed decisions about medical staff privileging. The legislation that established the NPDB requires hospitals to submit a report whenever a physician is suspended from a medical staff for over 30 days for unprofessional behavior or incompetence. Although the public cannot access NPDB reports on individual physicians, healthcare organizations (mostly hospitals) ping the database about 4 million times per year. When it was inaugurated, the best estimates (including those of the AMA) were that the NPDB would receive 5,000-10,000 physician reports each year.

Not so much. Since its launch two decades ago, NPDB reports have averaged 650/year, and nearly half of US hospitals (2845 of 5823) have never reported a single physician! The most extreme case is that of South Dakota, where three-quarters of the hospitals have never reported a single case to the NPDB. I’m sure South Dakota has some wonderful doctors, but the idea that the state’s 56 hospitals have never had a physician who needed to be suspended for incompetence, substance abuse, sexual harassment, or disruptive behavior since the Reagan presidency is a bit of a stretch, don’t you think?

Public Citizen chronicles several cases of egregious behavior by physicians who dodged NPDB reports – the cases either received no peer sanctions or were dealt with in ways designed to skirt the reporting requirements, such as – wink-wink – leaves-of-absence and 29-day suspensions. Most famously, a cardiologist and CT surgeon at Redding Medical Center in Northern California performed hundreds of unnecessary cardiac procedures but were not reported to the NPDB – largely because Redding’s medical staff and hospital were cowed by the physicians’ power and reluctant to kill two geese who laid many golden eggs. (Interestingly, the Joint Commission whiffed on this one too, a major reason why Congress removed its near monopoly on the hospital accreditation business last year.)

Levine and Wolfe recommend powerful medicine to fix the NPDB system, including much more vigorous legislative oversight, substantial fines to hospitals for failing to report, and linking NPDB reporting practices to accreditation standards and to Medicare’s Conditions of Participation.

A few years ago in our book Internal Bleeding, Kaveh Shojania and I described the limits of peer review; the Public Citizen report provides statistical confirmation of our observations. We wrote,

It is undeniable that hospitals do have a tendency to protect their own, sometimes at the expense of patients. Hospital “credentials committees,” which certify and periodically recertify individual doctors, are toothless tigers. Most committees rarely limit a provider’s privileges, even when there is stark evidence he presents a clear and present danger to patients. Instead, they assign a committee member to “have a chat” with the physician in question, perhaps gently suggesting he or she shouldn’t do a particular procedure anymore. They might even ask another physician, not on the committee but in a similar specialty, to “keep an eye on old Doug” and let them know if he continues to screw up, even if patients or other staff members don’t report it….

It is not that hospital credentials committees never take action. They do – removing a physician’s privileges at a hospital or recommending to the state board that a doctor’s license be suspended – when there is clear, repetitive evidence of gross negligence and incompetence. But when this happens – and it is really rare – it comes only after an orgy of soul-searching, handwringing, buck-passing, second-guessing and second chances that is painful, and sometimes embarrassing, to watch. In most cases, committee members just swallow hard and – unless the physician is under felony indictment or is so stewed that he can’t walk down a corridor without banging into both walls – the credentials are rubber-stamped.

Kaveh and I offered three reasons why medical staff self-policing is so wimpy. The first is the “fraternity of medicine” thing – no gang members like to “rat out their pals,” and in this regard, we’re no different from the Crips. The second is that credentials committee members are acutely aware of the amount of time and effort that it takes to become a practicing physician, which makes them reluctant to take away a doc’s livelihood.

A third reason, we wrote,

is simply that doctors aren’t very good organizational managers. Their people skills are usually confined to bedside chats and working with colleagues and support staff in task-oriented jobs; they aren’t particularly adept at managing conflicts and confrontations, so they avoid them. This is a pretty dumb reason to let an error-prone doctor continue to prowl the hospital wards, but because litigation… lurks behind any challenge to professional competence… many physicians are reluctant to go into that particular swamp unless the trail is awfully solid.

The fear of litigation is undoubtedly one of the major reasons why peer review doesn’t work. Although the statute establishing the NPBD provides immunity to physicians who perform good faith peer review, many hospitals and reviewers lack confidence in these protections. An American Hospital Association analysis of the NPDB concluded, “The specter of baseless, time-consuming and expensive litigation serves as a powerful disincentive to effective peer review.” If peer review is to be strengthened, these protections must be unambiguously robust.

Writing in his book Complications, Harvard surgeon and bestselling author Atul Gawande sees in the medical profession’s failure to perform aggressive peer review something understandable, even a tad noble. When it comes to disciplining a basically good but troubled doctor, “no one,” he says, “really has the heart for it.” Atul writes:

When a skilled, decent, ordinarily conscientious colleague, whom you’ve known and worked with for years, starts popping Percodans, or becomes preoccupied with personal problems, and neglects the proper care of patients, you want to help, not destroy the doctor’s career. There is no easy way to help, though. In private practice, there are no sabbaticals to offer, no leaves of absence, only disciplinary proceedings and public reports of misdeeds. As a consequence, when people try to help, they do it quietly, privately. Their intentions are good; the result usually isn’t.

There are still other reasons for the failure of peer review. When questions of clinical competency arise, there are often insufficient data to refute the inevitable arguments that “my patients are older and sicker.” When the issue is disruptive behavior, unless there has been documented scalpel throwing (by a surgeon with good aim), finding the bright line that separates the behavior of an aggressive, passionate, patient-advocate-of-a surgeon from the surgeon whose disruptive behavior creates a hostile work environment or places patients at risk can be elusive. Finally, peer review conducted by professional colleagues is fundamentally tricky – one the one hand, how could one’s practice be dispassionately reviewed by a golfing buddy? On the other, peer reviewers might well be competitors of the physician-in-question, with a financial stake in the outcome.

Is it any wonder that medical staffs kick this particular can down the road so often?

Layered on top of these traditional impediments is a new one: the paradigm shift introduced by the patient safety field. Remember, our patient safety mantra has been “no blame,” which is unlikely to be in the first verse of the Peer Review Fight Song. Haven’t we just finished convincing ourselves that most errors are due to dysfunctional systems and not bad apples? If that’s the case, who really needs peer review, anyway?

But this represents a fundamental misunderstanding of “no blame.” I struggled with this tension while writing Internal Bleeding, and went to The Source for guidance: Dr. Lucian Leape, the father of the patient safety movement. Lucian, I asked, how can we reconcile systems thinking with the necessity of standards and peer review? His answer was spot on:

There is no accountability. When we identify doctors who harm patients, we need to try to be compassionate and help them. But in the end, if they are a danger to patients, they shouldn’t be caring for them. A fundamental principle has to be the development and then the enforcement of procedures and standards. We can’t make real progress without them. When a doctor doesn’t follow them, something has to happen. Today, nothing does, and you have a vicious cycle in which people have no real incentive to follow the rules because they know there are no consequences if they don’t. So there are bad doctors and bad nurses, but the fact that we tolerate them is just another systems problem.

I’m proud to say that over the past five years, my hospital (UCSF Medical Center) has taken Leape’s challenge to heart, withdrawing clinical privileges (and filing accompanying NPDB reports) in several cases for behavior that, I’m quite confident, would have been tolerated a decade ago. This is progress. As Kissinger once said, “weakness is provocative.” As more hospitals take this tougher stance, I think we’ll see the boundaries of acceptable behavior shift everywhere. And patients will be safer for it.

A profession is group of individuals with special knowledge, who are granted privileges by society in deference to their expertise and in exchange for self-regulation. When thousands of hospitals can go 20 years without disciplining a single physician on their medical staff, our status as a profession is called into question.

In the end, peer review is about answering one deceptively simple question: Is it more important to protect problem physicians or vulnerable patients? If we can’t answer that question correctly, we should not be surprised when the Sid Wolfes of the world call us to task, nor when we find ourselves under an unpleasant media, legislative, and regulatory microscope. Professions don’t need that kind of outside scrutiny to do the right thing, but we just might.

Dr. Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”

Creating Currency to Care For the Elderly

Aug 1, 2008• 9

By MAGGIE MAHAR

Did you know that Japan has found an ingenious way to “create” money that can be used to care for the elderly?

Bernard Lietaer, author of Access to Human Wealth: Money beyond Greed and Scarcity (Access Books, 2003) describes the system in this interview with Ravi Dykema, publisher and editor of Nexus, a leading Holistic journal.

Lietaer begins with the basics, by explaining what money is: “I define money, or currency, as an agreement within a community to use something as a medium of exchange. It’s therefore not a thing, it’s only an agreement – like a marriage, like a business deal…And most of the time, it’s done unconsciously. Nobody’s polled about whether you want to use dollars. We’re living in this money world like fish in water, taking it completely for granted.”

Lietaer, who co-designed and implemented the convergence mechanism to the single European currency system (the Euro), and served as president of the Electronic Payment System in his native Belgium, doesn’t take currencies for granted. He knows that a dollar is simply a piece of paper (which is no longer backed by gold). It has value because we have agreed that it has value.

HEALTH2.0: Brief update and lots going on

Jul 6, 2007• 2

So the Health2.0 Conference is really heating up. We will be announcing a raft of new sponsors and some interesting media tie-ins next week. There are already well over 100 attendees including lots of people from across the worlds of technology, providers, plans, pharma and finance. If you’re planning on attending and haven’t signed up yet, you may want to act quickly to reserve your spot. The number of guests is limited by space considerations so a sell out is possible, and in fact, looking quite likely. A number of you — at least 25 – have also signed up but have
not yet completed your registrations. Places will only be reserved
those who have completed the registration process, so its probably a good idea to take care of things if you’ve been holding off.

Next week we will be having a contest to fill a slot on the Social Media for Patients panel—I’m hoping that THCB readers will help. Meanwhile, search is a screaming big deal, so in some snippets of related Health2.0 search engine news that I’m just catching up on:

Curbside.MD has new version of its medical search engine out, it matches tagging with natural languages recognition.

iMedix.com has launched in stealth alpha. Wanna be invited to look? I have a few invites to give out.

Revolution Health and Kosmix have signed a partnership deal in which Kosmix’s technology will categorize Revolution’s site. For more on that see my interview with Venky Harinarayan from Kosmix (transcript to come shortly)

Healthline Networks has had Richard Carmona, former Surgeon General, join its board of directors.

Finally, Molly, a black Labrador of indeterminate age has been traded from the Washington DC dog parks to the city with more dogs than children, San Francisco. In related news Molly’s human pet John Lane has been traded from Revolution to Healthline to strengthen the Marketing bench— one of the first free-agent moves in the new Health2.0 season. Probably not the last!

And in the unintended consequences department, our Dutch correspondent tells THCB that Web2,0 is now being used by schoolkids in the UK looking to organize a mass brawl!

TECH: Matthew’s HIMSS mash-up wrap-up

Mar 1, 2007• 1

So after taking a super-shuttle all round San Francisco to save a couple of bucks on a cab, I’m back home and my mind is still trying to digest the last few days. It just won’t let me join my fiancee and the dog in a peaceful slumber. So I thought I’d channel my best Hunter S Thompson and give you my thoughts on HIMSS Gonzo style. You can pick and choose from this the way you like.

First off, I got to see about half Colin Powell’s talk. Man is he funny. I would never have believed it. Fantastic comic timing and facial expressions a la Eddy Izzard or Bill Cosby. Why they didn’t have him instead of Ballmer as the opening keynote I don’t know. He also said some very poignant things about immigrants, and the American spirit of generosity—which are clearly lost on several of his former Administration colleagues—and also was very clear about the debt to veterans. Unfortunately I don’t know if he raised the point or was challenged from the audience about one of the other notable speeches he gave. I mean the one when he went to the UN, was not funny and convinced enough Americans that there really were WMDs that several thousand more names will be on a future war memorial. And it’s clear he knows that he was basically peddling discredited information at the time.

Distance—please can someone remind me next year to schedule meetings by booth number. Oracle gave me a pedometer late on the last day, but I walked miles too far. At least twice I scheduled back to backs in booths at least half a mile away from each other.

And then Intensity. There were at least 5 or 6 people I promised I’d meet up with that I just never got to (sorry David, Laura, Steve and a bunch of others). And you have to believe that the same was true for everyone. You’re at this for 12–14 hours a day, meeting maybe 3–4 new people an hour (sometimes more) trying to figure out who’s doing what to whom—just keeping it straight is really hard work. Harder still when someone you haven’t seen for 5 years takes you on a tour of Bourbon street that Hunter S Thompson himself would have been proud of (no mescaline, though). Thanks Adam (I think!)

Podcasts—I hope you like them and that it catches a little of my flavor. It’s way easier doing them than writing up notes, plus it gets you a much closer idea of what the interviewees are really doing. Transcriptions will be up soon.

THCB’s live blogging coverage of HIMSS 2007 New Orleans would not be possible without the generous assistance of the kind souls at CDW Healthcare. Take a moment to go check out their specials for physicians and other health care providers and you’ll help us continue to provide independent coverage and cutting edge discussion of the issues facing healthcare. We get credit for every person who clicks over, so please take twenty seconds and go visit their site. If you decide to place an order, tell them the Health Care Blog sent you — Matthew

Notoriety—I’m never going to be as well known as MrHISTalk in this crowd, especially as I was wearing the “I am MrHISTalk” badge, but there’s clearly a few people who are starting to read THCB, and recognizing it as something. I think that if you read Tim Gee’s Medical Connectologist blog, and mine and MrHISTalk’s you get a great flavor. Shahid Shah was supposed to write the official HIMSS blog, but he never made it due to the weather, and the blog just looked like a bunch of information about the show logistics. Hopefully next year will be better.

Plus a couple of other blogs have been started that are worth a mention. Sun’s health care guy Jorge Schwarz bought me a fabulous lunch and told me that he has a real Sun healthcare blog too (like that other Schwartz guy who works there). Another is Doug Goldstein’s blog. Doug is an eFuturist (hey I’m a failed former futurist!) who’s actually out there promoting collaborations and electronic knowledge sharing with his health care clients. He has a scad of books out, and is a hell of a nice guy to boot. I’ve known him on and off for 10 years, but we randomly connected a few times at this HIMSS and it was a real pleasure. Finally MedSpehere founder and legal combatant Scott Shreeve is writing about Health2.0 on his blog as well as great HIMSS stories.

More on Health2.0 plans from me and others anon.

Speaking of Sun, at their lunch was the CIO of University of Alabama (and former school bus driver) Joan Hicks and some of her team. (NOTE: Her colleagues suggested that it’s only fair to point out that Joan was a school bus driver as a side job in college, and that that’s not the only qualification she has for her current job!) It’s not till you chat with a bunch of geeks who have to connect a gazillion systems at a ton of facilities before you realize that inter-operability is an internal more than an external health care problem. I spent some time trying to convince the Axolotl folks that was true too and that that’s what they were really doing. But they still think they’re a RHIO company.BTW their CEO Ray Scott is a really tall, really pointy headed Brit mathematician, who must be nuts—in that he had already made it good in the UK in the 1990s and still decided to get into health care. Still at least two gorgeous former employees came up to him and gave him huge hugs and kisses while I was chatting, which makes you think he must be a cool guy to work for—or maybe it’s just good to be the CEO. Thanks to Nicole Spencer for the wine I didn’t drink (leetle bit suffering from the night before)

Back on Gonzo trail. Apparently, if you have a ten week old kid you value crashing out early more than drinking with your old buddies on Bourbon street—you know who you are Mr Big Time drug database sales dude!

I’m feeling old—I met some really sharp young kids who are new to the business and know stuff. Matt Guidin at F&S is one, and opinionated and cynical to boot (we like those qualities at THCB). Jonathan Pearlstein at NORC is really young, but knows a whole lot more than I did when I was 22 (or 32). Watch for his thesis on EMRs (an undergrad thesis? Mine was on beer and soccer!) to come out in JAMIA sometime.

Eric Brown from Forrester, not so young but just as cynical as me about CDHP and just as willing to scarfe down fabulous chocolate desert at the Sun lunch that someone ordered but couldn’t stay for!

Another really nice guy I was delighted to meet—Reed Liggin at (now) RelayHealth. We’ve been emailing and chatting for a couple of years and I would never have met him other than via THCB. Rather more than I’d like to admit that I know about ePrescribing comes from Reed.

Not from Reed though, another little birdie told me that despite Surescripts certification process many vendors were having trouble getting their eRx transactions into pharmacy systems and a lot of re-keying in the pharmacy is still going on for allegedly ePrescriptions. Apparently there’s a NHIN report coming out next month that will put the cat amongst those pigeons. Plus what happens to RxHub if 1/3 of its owners are now a big pharmacy chain? We shall see. But as an ePrescribing proponent, I’m worried. Can someone please reassure me?

However, my faith in being an eRx and EMR advocate was reinforced by Dr. Jim Morrow, who’s in the interview with Glen Tullman from Allscripts. Jim said straight out that before using the EMR, he may have thought he was a good doctor, but he was not. So by implication you cannot be a good doctor without using one. That’s a ballsy statement, but he made it with real conviction. (Go listen to the podcast—he’s not shy about it).

Speaking of Glenn Tullman, man I wish I had a tenth of his energy, poise, drive and diplomacy (not to mention money of course). I didn’t know that he’s an Obama supporter—I had him pegged as a liberal Republican (He told me he was a conservative Dem, not that there’s too much difference!). But if he’s not a major political figure within 10 years I’ll be very, very surprised. As I told him, Barack’s hoping to leave a Senate seat vacant in 2 years!

My favorite phrase of the conference? Medecision’s John Capobianco description of the job of his company— “making the unknown known”

Meanwhile, If you haven’t had a chance to sign up for THCB UPDATE yet, you really should. You’ll get a helpful reminder email from us a few times a week when important posts go up on the site. In the two and a half months since the service launched more than ~~700~~ 950 people have signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who sign up, but I can tell you that list reads a bit like a health care who’s who. Go on: It’s free. It’s useful. And people seem to like it. Go visit the sign up page.

Even despite the fact that they’re a client of mine (thanks Frances, Casey, Mike, Nick et al), the Cisco gang seem very happy. Could that be that now there are networks everywhere there’s more and more useful stuff to run over them? Just perhaps.

People on the rise—CMIOs everywhere. Holly Miller did such a great job creating the eCleveland Clinic online that the other guys in town (University Hospital) stole her to input their new system (which will be Eclipsys plus a new PHR/patient connectivity suite). But apparently when you’re a dignified CMIO having your exhibit hall companion threaten your vendor with firing them for not being able to provide you with a diet coke on instant command is apparently not encouraged! Hey if you’ve got clout use it, I say!

Talking of clout. You heard it hear first. IntercomponentWare’s LifeSensor PHR is terrible and doomed to failure. I mean, you may have really cool technology which works well, and very nice and smart people (not to mention the German government shoveling wads of cash at you) but if you can’t fix a simple prize drawing so that the world’s leading PHR interested blogger can win some Bose headphones, when there are only 5 people in the draw and he’s walked miles to be there and risked missing his flight to stay—what hope have you got in the rough and tumble world of health care IT?! (I can sense my opinion could be changed with only modest bribery! But a threat is a threat!)

Just kidding guys…

Talking of giveaways, while I never got to meet up with MrHISTalk to interview the Eclipsys booth babes as intended. I actually saw another booth down the other end giving away a plasma screen TV with some of the finest evidence of American medical science seen outside of a Playboy centerfold spread. Wish I could remember the company name.

Other quickies—Cool health2.0 type Emergency Department app from Puerto Rico called Sabiamed demoed by a lovely woman called Leslie who sat next to me on the plane on my way in from Miami. I fell asleep immediately as I had flown there from London and she had to punch me to get me to wake up to go to the restroom!

WebVMC has a Health Hero like telehealth application box that looked very interesting.

I don’t understand what NTR Global does (kinda like go-to-my-pc remote access/management but better) but Julie Weiner persuaded me that it was really important!

Random connection of the show. For 2 mins I was walking with a woman from Mobile, AL, who used to play soccer for Charlton Athletic ladies and the Univ of Alabama. She spotted my accent, and the story spilled out. I don’t know her name, but if you’re reading and you’re in San Francisco, my fiancee and I down load Match of the Day every week, come by watch and take us for a ride in the mini!!

Second biggest mistake (after waking up Tuesday morning), was not organizing anyone to buy me dinner on Tuesday night. That used to be the night when I bought my clients dinner in my IFTF days, but these days especially as I was attending the show as a blogger on my own nickel, it’s what they call in football “a mental error.”

Worst giveaway—The AthenaHealth kids were fun, smart savvy and cute. And I never got past the front desk. No one over 30 anywhere, and all having a lot more fun than I did in grad school in my 20s. But they didn’t invite me to dinner on Tuesday night (But did Scott Shreeve—yes I’m bitter) and all they had as give-aways were white bouncy stress balls. As I said to them, “your giveaways suck, so I assume this means you think your products are pretty good!” Bonus points, though, if you can tell me which group in their backyard just went with someone else (Don’t worry guys there’s plenty for everyone…)

Biggest cojones—Bob Lorsch (see my interview with him below). A cancer survivor who’s put more than $7m of his own cash into building exactly the type of stand-alone, fax-it-in PHR that the “experts” say won’t fly. Of course not many of us experts have that to spend in the first place, which may define our expertise somewhat!

Worst forecast of the week—my taxi driver from Kenya leaving the convention center told me that we’d take 90 minutes and that I’d miss my plane. We were there in 25!

So that was the HIMSS that was for me. Let me know about your time in the comments, and feel free to abuse me back!