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SaaS tiptoes into the hospital

By MATTHEW HOLT

As we prepare for the Health 2.0 conference in the Fall and get stuck into demo after demo, it’s interesting to step back and look at the bigger picture. Clearly the cloud/SaaS trend is going beyond the obvious places–consumer tools, online communities and the data utility layer–to those where client-server architecture has been dominant and successful, such as practice management. Carecloud and athenahealth are examples in that environment (and athenahealth offers a lot of services to go with their on-demand software) and of course the SaaS-based EMR space is burgeoning with not only web-native applications like Practice Fusion, Clearpractice and athenaclincals, but also several of the bigger players like GE with Centricity Advance, OptumpInsight’s Caretracker (United) and even eClinicalworks adding SaaS offerings into the mix. Even the AMA is in the game, with its Amagine service offering a fully hosted SaaS version of NextGen, as well as several other tools and packages.

But then we get up to the walls of the “enterprise.” In health care “enterprises” are called hospitals. Every week it appears that HISTalk is reporting that yet another hospital is uninstalling one client-server EMR product and going with another–almost always Epic. But–with the exception of an odd announcement I don’t understand from McKesson–there doesn’t seem yet to be the healthcare equivalent of large enterprises going with a Salesforce.com approach, where core parts of their infrastructure are put in the cloud. And every installation is a separate custom installation, leaving groups of users needing to be literally banded together by consultants to humbly petition the wizards of Madison County to make particular interface changes. (I’m not kidding–there really is at least one consultant putting together such a group of Epic users). Cloud-based systems of course can roll out these changes much more easily, and receive feedback from their users much more quickly.Continue reading…

The Economic Urgency of Health Care Reform

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By GOV. PETER SHUMLIN

Watching the events of the past several weeks in Washington has been sobering. Decades of failed fiscal policy have finally come home to roost and Congress is tied in knots trying to find a compromise solution and avoid American default. Americans rightly are scared that our leaders can’t find a way out of this muddle. But the really sobering part is this: the solutions under consideration don’t fix the problem. Even if Congress enacts the most draconian spending cuts advanced by the Tea Partiers, and all of the tax increases advanced by the liberals, we will not be out of the mess. The crisis will still loom. Why? Because health care costs continue to increase at an unsustainable rate, and health care spending is the single largest category of federal spending. Without real, sustained health care cost control, we still face a crisis, no matter what package of cuts and revenues the new “gang of 12” develops.

As a Governor, I can’t ignore this problem. Health care spending more than tripled in Vermont between 1992 and 2009. Between 2000 and 2009, health care spending as a share of our gross state product rose from 12.9 percent to 18.5 percent.

We come face to face with the impact of growing health care costs every year in our state budget process. Health care squeezes out all sorts of other priorities, and we (state government) aren’t even paying our fair share of the increase. The state can’t afford to sustain a rate of growth that far exceeds growth in our economy and growth in our tax revenues. So we shift costs from state health care programs to the private sector. The private sector can’t sustain the growth, either, so they cut jobs and reduce insurance coverage for their employees. That’s why, despite aggressive efforts to expand government-sponsored insurance coverage in Vermont, nearly one in ten Vermonters is uninsured, and nearly a quarter of our population is underinsured — they have coverage, but could still go bankrupt if they had a major illness.

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Quality Improvement Under the Microscope

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By MARYA ZILBERBERG, MD

So much media and journal space has been devoted to financial conflicts of interest, particularly within and related to pharma and device manufacturers, that to write any more about it may be redundant. On this site we have also intermittently addressed COI from other perspectives, such as financial interest of the members of the American College of Radiology in maintaining mammography screening status quo, thinly veiled in its own version of the pernicious “death panel” language. We have also spoken a bit about the non-financial COI. And even though we are so very much aware of COI’s potential to lurk around every corner, there are still some surprises.

Take the sacred cow of “quality improvement” in healthcare. Even the name, much like the “pro life” moniker, suggests that it is untouchable in its purity and nobility of purpose. So necessary is it because of the epic magnitude of morbidity and mortality attributed to healthcare itself, that the billions of dollars spent on it seem unquestionably justified. Indeed, much like our public education system, the QI movement garners higher and higher allocations simply due to the sheer face validity of the assumption that more of it is better.

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The bleak state of the (health care) economy

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By MATTHEW HOLT

Health care spending increased at 3.9%, its slowest rate for decades in 2010 following a slowdown in 2009. Merill Goozner has the play by play but it’s clear that the numbers are starting to reflect what Jeff Goldsmith said in his keynote at Health 2.0 last year.–even the health care industry can not grow geometrically forever.

But there’s something hiding in these data. Recently I gave an update for a talk that I’d given 15 years before at the Oregon Medical Association. I reviewed the 2010 year forecast I did for IFTF in 1997 and I was struck by how in our scenarios we had overestimated the per capita spend on health care, but underestimated its share of GDP. That meant while overall health spending didn’t grow as fast over the decade as we’d forecast, the economy grew much slower. And of course the big jumps in health care as share of GDP that we saw in 1991-4 and 2007-9 came when the economy tanked

As we enter the 7th year of our lost decade with the stock market starting to predict a double dip recession, and real unemployment in the high teens, we face the prospect of getting to 20% of the GDP going to health care via not a boom in spending brought on by the ACA or a rich economy making rational choices, but by default. Of course these days the loonies in the Tea Party are reminding us of  the other meaning of the word default!

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Not much fun with Pharma spend online

The other day Mark Bard (formerly of Manhattan Research) came by for a quick chat. Mark’s now running the Digital Health Coalition which is trying to get some voluntary agreement on guidelines as to what Big Pharma can and can’t do on sites that feature user-generated content. Pharma’s still tipping all its consumer advertising into TV when it would be much better off moving the 5% it spends online to 15-20%. But because Pharma’s scared of the FDA, and because–despite holding hearings in the 1990s and in 2010–the FDA is still not close to issuing guidelines, everyone is stuck. I saw Ben Lei who runs eMarketing at Genentech speak at a conference this week and he basically confirmed that they could do much more, but they won’t for now. And it may be that this is getting worse. This has real financial consequences. WebMD missed earnings badly last quarter and lost about 1/3 of its market cap because a bunch of pharma advertising was delayed/put on a longer regulatory review. If you want to dig into this, here’s a link to their earnings call Q&A in which Chairman Marty Wygod himself felt it important enough to come face the music–which is being provided by class action plaintiffs as we speak. In any event, I’m sure that the agencies, the online guys and the pharma marketing types are hoping that Mark can come up with something and soon!

CER Kills?

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By JOE FLOWER

According to the Pacific Research Institute recently, because of “Comparative Effectiveness Research” (CER) “under conservative assumptions, R&D investment in new and improved pharmaceuticals and devices and equipment would be reduced by about $10 billion per year over the period 2014 through 2025, or about 10-12 percent. This reduction in the advance of medical technology would impose an expected loss of about 5 million life-years annually, with a conservative economic value of $500 billion, an amount substantially greater than the entire U.S. market for pharmaceuticals and devices and equipment.” [Study available here.]

I haven’t read the study. I don’t need to, since it is so obviously true, if we just make certain assumptions, such as:

  • Every dime spent on R&D for drugs and devices is wisely spent, on advances that will save and improve lives.
  • Every dime spent on finding out whether those drugs and devices actually work as advertised, and don’t actually kill people, and do it better or cheaper than other drugs and devices, is a dime wasted. CER just slows down legitimate, helpful research.
  • Experience does not show us any examples of wasteful or unnecessary drugs or devices. Those multiple peer-reviewed research papers showing that we waste hundreds of billions of dollars every year on useless complex back surgeries, the 22% of  implanted defibrillators that are unnecessary, tens of millions of unnecessary scans, coronary stents put in people with stable heart disease and no heart pain, the heartburn surgeries that work no better than over-the-counter drugs—those studies are all false, wrong, some kind of mumbo-jumbo that we can safely ignore.

If we just make those few simple assumptions, the study has a valid point. If we don’t accept those assumptions, we have to wonder about the mental state, motivations, and personal finances of someone who would cook up such an obvious bit of flim-flam.

Joe is a healthcare speaker, writer, and consultant, working with clients ranging from the WHO, the Global Business Network, and the U.K. NHS, to the majority of state hospital associations. Joe writes at imaginewhatif.

Learning Hard Lessons from the RIM Story

By JONATHAN BUSH

One of our account managers sent me a link to this open letter written by a high-level employee to the leadership of Research in Motion or RIM, makers of the BlackBerry, laying out their concerns about the company. The company faces stiff competition in the smart phone market and recently announcedplans for 2,000 layoffs.

The account manager thanked me for what I have done to lead us in a way that has avoided this fate for athenahealth. So, thanks to him.

HOWEVER, I don’t think we are totally free of all eight concerns rattled off by one anonymous OG RIMMER. Here are some of her/his pleas to management and some of my thoughts on them as they apply here at athenahealth. (If you could see our internal blog version of this post, you’d see more than a dozen thoughtful comments from athenahealth employees on how they think we can learn from this story.)

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A Technology in Search of a Market

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By JOHN MOORE

PHRs are much like the tides, news about them ebbs and flows. Right now, with the relatively recent demise of Google Health, Dossia’s attempts at rebirth, and the significant inquiries we are receiving regarding meaningful use requirements to host a PHR (patient portal). But in and amongst all this Chilmark has heard on more than one occasion the following statement: “The problem with PHRs is that they are a technology in search of a market.”

This statement is simply wrong for the following reasons:

1) As we have said countless times before in previous posts, very few people are interested in a digital filing cabinet for their health records. Unfortunately, many PHRs in the market today are just that, digital filing cabinets. In this case it is not an issue of a technology in search of a market, it is just a bad product that really has no market.

2) Technology adoption does not occur for its own sake, it occurs when there is perceived value by the user that leads to adoption. PHRs, PHPs (personal health platforms), patient portals, etc., is certainly a technology, that when well-designed, and implemented can deliver significant value and subsequently see high adoption rates. Just look to Kaiser-Permanente’s instance of MyChart, where patient adoption is well over 40%. Up in the Pacific Northwest, the Group Health Collaborative (GHC) is seeing PHR adoption that is well over 50%. That’s a market!

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US Rumor and Hospital Report

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By PAUL LEVY

It has been almost four years since I commented on the annual hospital ranking prepared by US News and World Report.  I have to confess now that I was relatively gentle on the magazine back then.  After all, when you run a hospital, there is little be gained by critiquing someone who publishes a ranking that is read by millions.  But now it is time to take off the gloves.

All I can say is, are you guys serious?  Let’s look at the methodology used for the 2011-12 rankings:

In 12 of the 16 [specialty] areas, whether and how high a hospital is ranked depended largely on hard data, much of which comes from the federal government. Many categories of data went into the rankings. Some are self-evident, such as death rates. Others, such as the number of patients and the balance of nurses and patients, are less obvious. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.

Here are the details:

Survival score (32.5 percent). A hospital’s success at keeping patients alive was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2007, 2008, and 2009 with the number expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. Medicare Severity Grouper, a software program from 3M Health Information Systems used by many researchers in the field, made adjustments to take each patient’s condition into account.

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Self-tracking gets hip: Withings & more

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We’ve been watching self tracking at Health 2.0 for a little while, as it emerges from the world of the Quantified Self geeks to becoming a more mainstream set of shiny consumer gadgets. Today’s NY Times takes a look at just a few of the shiniest including Fitbit and the French company Withings. It has a Wi-Fi scale that sends your weight to the cloud and a beautiful (really!) blood pressure cuff that attaches to your iPhone-both of which I’ve been test driving and like. Also although the NY Times author Farhad Manjoo doesn’t seem to care–despite the fact he obviously has a young kid–a Withings baby monitor is on the way to market too. Many other players aren’t in this article, including sleep monitor Zeo, exerciser tracker BodyMedia and emerging data utility layer platform RunKeeper. But you won’t be surprised to hear that all four and more will be at the forthcoming Health 2.0 Conference on Sept 25-7

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