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Above the Fold

HIT Newser: A Setback for MyMedicalRecords

Jan 12, 2015• 2

By MICHELLE RONAN NOTEBOOM

There’s No Place Like Epic’s Home

Epic reveals plans for a fifth campus, which is slated to include half a million square feet of office space and pay homage to literary classics like “Charlie and the Chocolate Factory” and “The Wizard of Oz.”

A Setback for MyMedicalRecords

A US District Court rules against MyMedicalRecords in its patent case against Walgreens, Quest Diagnostics, and others. MyMedicalRecords, a company that many label a patent troll, contends its patents covered a method of providing online PHRs in a private, secure way. However, a judge ruled that “the concept of secure record access and management, in the context of personal health records or not, is an age-old idea,” and is therefore abstract.

Despite the setback, I doubt MyMedicalRecords will stop demanding organizations to pay up or risk facing a lawsuit. I predict they’ll make some tweaks to their business plan, such as focusing only on organizations with not-quite-so-deep pockets that are willing to settle without a fight.

What Has $564 million Bought Us?

Sens. Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) ask the General Accounting Office to review the ONC-funded health information exchanges to determine what exactly the exchanges created with the government’s $564 million in grant money.

It’s a valid concern, given the significant number of providers and regions still lacking electronic exchange capabilities and the millions that have been spent.

Physicians Reject Stage 2 Attestation

Fifty-five percent of physicians say they won’t attest for Stage 2 MU in 2015, according to a SERMO survey of about 2,000 physicians. Respondents cite several reasons for not attesting including financial concerns, difficulty engaging older patients, and lack of software usability.

Given the lackluster Stage 2 attestation numbers so far, the findings are not particularly surprising. It will be interesting to see what CMS and ONC intend to do in the face of the overwhelming evidence that many providers simply don’t think it is worth the effort.

On To Stage 3

The Office of Management and Budget is currently reviewing the proposed Stage 3 MU rules and will likely publish them in February. CMS states that Stage 3 will include changes to the reporting period, timelines, and structure of the program, including a single definition of Meaningful Use. CMS also adds that “these changes will provide a flexible, yet clearer, framework to ensure future sustainability of the EHR program and reduce confusion from multiple stage requirements.”

Can’t wait to see what is included. And, I can’t help but be a little amused that it’s been six years since the passage of the HITECH legislation and we are just now getting a definition for “Meaningful Use.”

Show Me the Money

Allina Health and Health Catalyst sign a $100 million definitive agreement to combine technologies, clinical content, and front-line personnel.

Rush University Medical Center will implement Merge Healthcare’s cardiology PACS.

Healthcare operating system platform provider Par80 closes $10.5 million in Series A funding led by Atlas Ventures, Founder Collective, and CHV Capital.

Health analytics provider Apervita, formerly knowns as Pervasive Health, completes an $18 million Series A round of funding led by GE Ventures and Baird Capital.

Teledermatology provider PocketDerm raises $2.85 million from an undisclosed investor.

Caremerge, developers of a care coordination platform, raises $4 million in a second round of funding. Investors include Cambia Health Solutions, GE Ventures, Arsenal Health, and Ziegler-LinkAge Longevity Fund.

Getting to Pareto Optimality from Sermo–The Dan Palestrant interview

Jan 12, 2015• 2

By MATTHEW HOLT

Daniel Palestrant was one of the first big stars of the early Health 2.0 movement, and he was often at Health 2.0 conferences and on THCB. He founded the biggest (US based) online doctor network Sermo in 2005, rode it like a rocketship, and then left with little explanation in late 2011. Rumors swirled about the company, then it was bought by WorldOne, while Palestrant (and colleague Adam Sharp) was seen in a series of photos with a cutout of an obscure economist. He then seemingly vanished. Now he’s back, and the company named for that economist, Par8o, just announced a funding round of $10.5m and a series of impressive clients.

But what happened at Sermo? And how did that get him to Par8o? I met Dan for a in-depth reminiscence. But briefly in his words; all the investors (including him) in Sermo were happy with the WorldOne buyout; what he learned from the ACA was the inspiration for Par8o; and, he’s now building the underpinning health care operating system. We’ll have more later this week, but watch our catch up.

Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)?

Jan 11, 2015• 14

By ALAN PITT, MD

I’m not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old. There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation. Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need. Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform, I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed. Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer. These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient. For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program. Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google. Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees. As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive. And that extends to things that keep us healthy. To interact with your health means you are imperfect, you are mortality.

“I Smoke and I Am Not Going To Quit. My Physician Says I Need a CT scan. Do I?”

Jan 7, 2015• 5

By ROBERT McNUTT, MD

Case:

I get asked by many who smoke or who have just quit smoking for help making the decision to have/not have a CT scan to screen for lung cancer. The man responsible for the question above had been smoking his entire life, and, at age 62, he raised the question.

Screening is the term used when tests are done for patients without symptoms. The hope of screening is that a test will find lung cancer (or any other clinical situation for which screening tests are considered) early in the course of the condition so treatment may be beneficial. In the study above, 87 fewer people of the nearly 54,000 in the study died of lung cancer in the LDCT arm. In addition, the number of people dying of other conditions beside lung cancer was fewer (1526 died of other conditions in the LDCT group and 1557 in the CXR group). I did not present this data on the figure as the difference is small and it is unclear why LDCT would reduce other reasons for dying.

The harm of screening, as discussed in earlier blog posts, is that some people will have a positive test and not have cancer. This can cause worry, but in this clinical situation, additionally, the abnormalities found by the test are located in the lung. Getting to these lesions to provide assurance that cancer is not present may be dangerous and costly, and in this study, more people did die early in the LDCT arm.

Since I believe only patients can decide for their tests/treatments, a person would have to trade-off the potential 0.4% added chance of not dying of lung cancer in the future against the potential 40 fold greater chance of a false positive finding and a potential 0.24% added chance dying early or having a major complication by following a LDCT strategy.Continue reading…

THCB Marketplace

Jan 7, 2015

(Big) Garbage In. (Big) Garbage Out.

Jan 7, 2015

FROM THE TECH DESK

In December, THCB asked industry insiders and pundits across health care to give us their armchair quarterback predictions for 2015. What tectonic trends do they see looming on the horizon? What’s overrated? What nasty little surprises do they see lying in wait? What will we all be talking about this time next year? Over the next few weeks, we’ll be featuring their responses in a series of quick takes.

Joe DeSantis, Vice President of HealthShare Platforms, InterSystems

Information Exchange is dead. Long live Information Exchange: There was a lot of talk in 2014 about the failure of information exchange. When people take a closer look, they are going to see there are actually some good examples of this working and changing how care is delivered. We’ll see lots more examples in 2015.

(Big) garbage in, (big) garbage out: People are looking to big data and analytics to tackle population health and other problems. They will soon find that without addressing data quality and conditioning up front, the results will be disappointing at best. This will be the year of clean data.

Keep it simple: The mobile revolution has not yet had the impact on healthcare that it has had in other sectors. Recreating desktop applications on a phone is not the answer, nor are retreads of messaging standards. We will have to rethink how healthcare information is presented and used.

One portal, please: Everyone agrees that patient engagement is essential – but giving me four separate portals, six more for my wife and three more for my mother makes me enraged, not engaged! Thought leaders will begin to realize that patient engagement must be built atop true information sharing.Continue reading…

Does Restricting Physician Duty Hours Improve Patient Care?

Jan 6, 2015• 8

By RICHARD GUNDERMAN, MD

Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted? Two recent studies in the Journal of the American Medical Association suggest that the answer is no. In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented. Their test scores did not improve either. In the other, hospitalized Medicare patients being cared for by physicians working shorter hours experienced no improvement in mortality or readmission rates.

US resident duty hour restrictions were born in 2003, when the ACGME, the organization that accredits medical residency programs, capped the work week at 80 hours. It also mandated that residents have 10 hours off between duty periods and a 24 hour limit on continuous duty, with 1 day in 7 free from patient care. In 2011, the organization revised its policy, further restricting the total number of continuous duty hours for physicians in the first year of training to 16.

How could well-intentioned attempts to ensure that hardworking young physicians get sufficient rest fail to benefit patients? To begin with, simply restricting duty hours does not guarantee that residents will use their extra off-duty time to sleep. They might, for example, use it to study, exercise, or socialize. It is also possible that the outcomes being assessed by these studies are influenced by so many factors that merely changing duty hours is insufficient to cause a change. Yet if such changes do not benefit patients, how strong is the case for their implementation?

Some educators worry that duty hours restrictions are undermining the quality of medical education. For example, a survey of surgery program directors published last year showed that 21% believe that residency graduates are unprepared for the operating room, 30% believe they cannot independently remove a gallbladder, and 68% believe they cannot perform a major procedure unsupervised for more than 30 minutes. Another survey showed that 38% of residents themselves lack confidence in their preparation even after 5 years of training.

Do You Really Know What’s in That Cracker? Tellspec Does

Jan 6, 2015• 2

By KIM KRUEGER & MATTHEW HOLT

There’s a lot we don’t know about food and our health. Butter in your coffee, eat like a caveman, or no animal products: you name it and there’s an expert backing it. Even the nutritional labels placed on the majority of food items can be misleading and inaccurate. Fortunately, Isabel Hoffman is tackling this problem head on with her company Tellspec. Motivated by a personal history of allergies and ill health, Hoffman has developed a hand-held food-scanning spectrometer that immediately tells users the exact chemical composition of their food.

Matthew Holt, Co-Chairman at Health 2.0, interviewed Hoffman, who performed a live demo of the Tellspec device, shared her thoughts on Tellspec’s path to widespread consumer adoption, and the future possibilities for Tellspec.

You don’t need to be a rocket scientist to understand the excitement around Tellspec. The device would demand transparency and accountability from the food industry, help refine the connection between diet and health, and answer a wide variety of consumer concerns from general nutrition to chronic disease to allergies. Of course, this all depends on Tellspec delivering on its claims, something the company has failed to do in recent history.

Critics jumped on Tellspec for not being able to deliver on its crowdfunding campaign, but it remains unclear whether that was a production issue or if there are bigger concerns with the technology Tellspec depends on. As some may recall, other crowdfunded devices with lofty claims, like the passive calorie tracker GoBe, have turned out to be bogus. So is Tellspec the real deal? It’s hard to tell at this point. Hoffman scanned a cake on stage at TED, Health 2.0 staff saw a live scan of Wheat Thins, and you can watch a scan below, but don’t hold your breath for the day you can take the device down to In-N-Out to see what’s really in those Animal Fries.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is the Co-Chairman.

RingMD: The Newest Entrant in the US TeleMedicine Market

Jan 5, 2015• 2

By Prerna Anand

At 22 years old, Justin Fulcher looks like an average, newly graduated, young entrepreneur. But don’t be mistaken by his humble appearance. He is the Founder and CEO of RingMD, one of the fastest growing patient-provider communication platform, granting quality and affordable health care to people worldwide.

Founded in 2012 in Singapore, RingMD is a mobile based platform that connects patients with doctors via video or phone. Users input their symptoms, chose the format for the call, provide a mode of transaction, and get access to a list of providers based on location, price, ratings, insurance coverage, availability etc. Provider profiles have detailed biography, and feature dynamic pricing, making it an active health care marketplace. Patients can upload files in real time to share with the consulting doctor, and their EMR history is shown in a split screen on the provider side. Doctor notes are shareable, in both text and video formats.

RingMD has been an active telehealth provider in Singapore, Hong Kong, and other Asian countries, and is now ready to enter the US market. Mr. Fulcher visited Health 2.0 headquarters recently and shared his story with us.

Following is an excerpt from the interview:Continue reading…

Black Turtlenecks, Data Fiends and Code. An Interview with John Halamka

Jan 5, 2015• 36

By ROBERT WACHTER, MD

Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him in Boston on August 12, 2014.

Our conversation was very wide ranging, but I was particularly struck by what Halamka had to say about federal privacy regulations and HIPAA, and their impact on his job as CIO. Let’s start with that.

Halamka: Not long ago, one of our physicians went into an Apple store and bought a laptop. He returned to his office, plugged it in, and synched his e-mail. He then left for a meeting. When he came back, the laptop was gone. We looked at the video footage and saw that a known felon had entered the building, grabbed the laptop, and fled. We found him, and he was arrested.

Now, what is the likelihood that this drug fiend stole the device because he had identity theft in mind? That would be zero. But the case has now exceeded $500,000 in legal fees, forensic work, and investigations. We are close to signing a settlement agreement where we basically say, “It wasn’t our fault but here’s a set of actions Beth Israel will put in place so that no doctor is ever allowed again to bring a device into our environment and download patient data to it.”