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The Dual Online Identities of Physicians

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By GLENN LAFFEL, MD

Like everybody else, physicians are expanding their online personal identities. At the same time, they are trying to comply with codes of conduct that help consumers trust them and their profession.

There’s no problem so long as the personal online activities of physicians don’t jeopardize their obligations as professionals, which means that there is a problem, unfortunately.

In a recent study for example, 17% of all blogs authored by health professionals were found to include personally identifiable information about patients. Scores of physicians have been reprimanded for posting similar information on Twitter and Facebook, posting lewd pictures of themselves online, tweeting about late night escapades which ended hours before they performed surgery, and other unsavory behaviors.

As I mentioned Monday, medical students and younger physicians who grew up with the Internet have to be particularly careful, since they had established personal online identities before accepting the professional responsibilities that came with their medical degree.

Medical schools, residency programs and teaching hospitals can help young professionals manage their dual lives online. Some have implemented curricula and policies that foster appropriate use of social media, but surprisingly these programs are not widespread. In a recent study of medical schools that had experienced at least one incident in which a student used social media inappropriately, only 38% had adopted formal policies to handle future incidents. An additional 11% reported they were developing such policies. We can do better than this.

Non-teaching hospitals, CME providers and professional organizations like the American Medical Association can also help providers navigate the online world. The AMA’s recent guide to Professionalism in the Use of Social Media provides helpful guidance in this regard.

Continue reading…

Silicon Valley roars back…in healthcare too?

By Marco Smit

Recently, the Wall Street Journal has been writing article after article about how Silicon Valley is suddenly as hot again as in 1995. And anyone driving into San Francisco these days will have views of the city obscured with big “we’re hiring” billboards from the Groupons, Zyngas, Rockyous, and whathaveyous of the world.

In the past healthcare innovation and startups/new value creation has proceeded independent of that tech-scene and it has been much slower, dominated by buying behavior from giant incumbents who thought NIH stood for Not In Healthcare. But as my colleague and Health 2.0 co-founder Matthew Holt likes to put it: change starts at the edges. And we have seen Health 2.0 start small at the edges with the growth of patient communities, followed by other models connecting patients, payers, and providers in new ways (e.g. American Well, athenahealth, Castlight).

On May 18 SDForum is organizing a one-day event highlighting the change that is afoot in mainstream healthcare as a result of the innovation from the edges reaching the shores (and more) of mainstream health and wellness industries.

I am introducing the first keynote speaker (Holly Potter from Kaiser Permanente) and moderating a panel on one of my favorite topics: how data and innovation in analytics can make treatment and wellness decisions better, and hence create value, for all involved. While 80% of presenting companies are young (from only a few months in existence to 5 years from initial funding), there are also some pioneering established companies (Kaiser Permanente, Safeway, PAMF) who will touch upon topics like:

  • how ONC’s push for ‘data Liberacion’ is one of several forces helping to make health decisions more data-driven
  • how mobile/unplatforms, cloud-computing, and innovative use of analytics create new opportunities to understand patient behavior and introduce new, smart interventions
  • how chronic disease treatment is starting a transformation (funky billboards in LAX not withstanding, Lisa)
  • how new entrepreneurial energy is being backed by more and more funding (Healthtap is one of the companies who recently received funding and who will be on the panel that I moderate, Doximity is another company that fits that bill)

Finally, while some companies in general tech  or consumer markets seem to pursue growth without a business model, this event shows how companies in healthcare who get it right (e.g. Limeade), can grow fast, do good, and become financially viable businesses. Maybe one day the WSJ will report on the exciting IPO window of healthcare technology innovation companies for a change. In the meantime, come and see what the future will look like by hearing from those who are building it now.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

The Unbearable Lightness of Being Mitt

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By ROBERT REICH

One of my regrets in life is losing the chance to debate Mitt Romney and whip his ass.

It was the fall of 2002. Mitt had thundered into Massachusetts with enough money to grab the Republican nomination for governor. Meanwhile, I was doing my best to secure the Democratic nomination. One week before the Democratic primary I was tied in the polls with the state treasurer, according to the Boston Herald, well ahead of four other candidates. But my campaign ran out of cash. Despite pleas from my campaign manager, I didn’t want to put a second mortgage on the family home. The rest is history: The state treasurer got the nomination, I never got to debate Mitt, and Mitt won the election.

With Trump, Gingrich, Bachmann, and possibly Palin now in the race for the Republican presidential nomination, “GOP” is starting to mean Goofy, Outrageous, and Peculiar. Mitt would pose the most serious challenge to a second Obama term.

I say this not because Mitt’s mind is the sharpest of the likely contenders (Gingrich is far more nimble intellectually). Nor because his record of public service is particularly impressive (Tim Pawlenty took his governorship seriously while Mitt as governor seemed more intent on burnishing his Republican credentials outside Massachusetts). Nor because Mitt is the most experienced at running a business (Donald Trump has managed a giant company while Mitt made his money buying and selling companies.) Nor, finally, because he’s especially charismatic or entertaining (Sarah Palin can work up audiences and Mike Huckabee is genuinely funny and folksy, while Mitt delivers a speech so laboriously he seems to be driving a large truck).Continue reading…

Outrage is Easy. Solutions are Hard.

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By MERRILL GOOZNER

The inspector general of HHS reported this week that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote in his letter to Senators Charles Grassley (R-Ia.) and Herb Kohl (D-Wis.), who asked for the report.

Why is this happening? First, the medication patterns of the frail elderly are not monitored by the Centers for Medicare and Medicaid Services, which is afraid of a backlash from Capitol Hill where doctors and nursing home operators fiercely lobby to protect the hallowed doctor-patient relationship. The drug industry has also, in some cases, paid kickbacks to the pharmacy operators in nursing homes.

But at the root of the issue are the doctors who are faced with caring for these patients. Even though clinical trials have shown the drugs are likely to result in earlier deaths for some of these elderly patients, doctors prescribe them to reduce agitation, as Daniel Carlat, a practicing psychiatrist and purveyor of non-industry-funded continuing medical education, told the New York Times. “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” he said.

As someone who watched his father’s decline with dementia over a ten year period (usually from a distance), I can attest that shortening one’s lifespan is not the crucial issue, especially in the last few years when the personality in the shell of the human being that has survived the loss of cognition has largely disappeared. The first question is whether the anti-psychotics are effective in reducing the outbursts associated with severe dementia, and whether those benefits outweigh the side effects (catatonia?). The second question is whether families have been adequately informed about the risks and benefits of this approach. That the drug companies deploy their marketing arms to stoke sales in this situation is outrageous. But even eliminating their right to do so wouldn’t solve the underlying problem.

Google Health Put in Stasis

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By JOHN MOORE

About a year ago we posted a piece that basically summed up Google Health as on its death bed. Google, of course was quick to defend itself saying that Google Health was very much alive and well. We even had a long conversation with the senior leadership of Google Health who told us they were taking Google Health in a new direction, had been doing a significant rebuild of the underlying architecture which culminated in a “new” Google Health which had far greater focus on health and wellness. They even went so far, in very uncharacteristic fashion to give adoption numbers. Granted, those adoption numbers were only those from users of the Android App CardioNet, but hey, it was something.

Beginning in late March 2011, we started hearing the rumors of the impending demise of Google Health once again (is this becoming some sort of annual thing with Google Health?). We waited a few weeks to see if the rumors would die down, they did not. We put a call into Google Health to set up a briefing, get an update. Response back was slow (one yellow flag). When they did get back to us, they said it will be at least a couple of weeks (two yellow flags). Next, our Google contact told us by email that they were going to hand Chilmark’s inquiry off to Google’s PR department (screaming dark orange flag). And now today, we received an email from one of Google Health’s most visible spokespersons, Missy Krasner that she is leaving Google.

There is now no doubt in our mind that the Google Health development team has been dis-banded and Google Health has been placed in a cryogenic state until the moribund consumer adoption of such tools comes to life. It would be far to big a PR nightmare for Google to completely pull the plug on Google Health as they have done in the past with other less then stellar launches. No, they’ll put an engineer or two on Google Health to keep it up and running but don’t expect anything new out of Google Health for at least the next 5 years. This baby is frozen.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

Let’s Just Keep Killing and Maiming Them

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By PAUL LEVY

Old patterns die hard. Back in March 2010, I posted a chart from the ACHE that Jim Conway had sent me showing a decrease in the ranking of quality and safety among priorities reported by hospital executives.

Now comes an article in Health, Medical, and Science Updates about a study by the Beryl Institute, entitled “The State of Patient Experience in American Hospitals.” Of those places surveyed, 51% were individual hospitals and 49% were hospital groups or systems. There was an even mix of urban, suburban, and rural facilities.

As in the prior ACHE survey, 69% of hospital executives rank things other than quality and patient safety as top priorities.

Any way you look at it, this is quite simply a failure of leadership and governance in American hospitals. There is a strange adherence to the view that “these things happen,” an apparent belief that a certain level of harm that occurs to patients is just the way things should be. It is as though the medical profession, hospital administrators, and hospital trustees have decided that the current amount of harm is the statistically irreducible level.Continue reading…

Why We Should Think Twice About Getting A CT Scan

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By SHANNON BROWNLEE & SAM WAINWRIGHT

There’s an eerie video up on YouTube, shot by a Japanese journalist who ventured into the evacuation zone surrounding the Fukushima nuclear power plant, armed with a camera and a radiation meter. The video looks like b-roll footage from a low-budget zombie movie, with roving bands of stray dogs and a soundtrack of the radiation meter’s increasingly frantic beeping.

Shortly after the earthquake that damaged the plant, the Japanese government evacuated residents from a more than 1,000 square mile zone. Last week, they raised the severity level of the crisis at Fukushima to a 7 out of 7, making it the worst nuclear disaster since the complete meltdown of the reactor at Chernobyl, in 1986. In its wake, worldwide fear of nuclear power spiked. The German government shut down seven of its 17 nuclear reactors, and plans to eliminate nuclear power by 2020. In the U.S., a Fox News Poll conducted in early April found that 83 percent of respondents thought a similar disaster could happen to an American nuclear plant.

People fear radiation for good reason. All ionizing radiation passes unimpeded through cells of the body, mutating or destroying DNA along the way. The danger level depends on the dose and the length of exposure. We’re exposed to small amounts of radiation all the time — from cosmic rays to the normal radioactive decay of soil, rocks and building materials. Even the granite in the U.S. Capitol Building emits low levels of radiation. These levels are harmless, but a high dose can kill, and prolonged or repeated moderate exposure can lead to cancer.Continue reading…

Neither the Republicans Nor the Democrats Want to Face the Provider Cost Problem

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By ROBERT LASZEWSKI

A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction–it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.

What lies at the heart of Ryan’s Medicare difficulties is that he would all but abandon future seniors (those now under age-55) to a health care system whose age-adjusted premium support would increase each year only at a rate equal to the increase in the consumer price index while their health care costs would likely continue to increase far faster.

Simply, Ryan just shifts the future burden of uncontrolled Medicare health care costs from the federal government to the senior. That will solve a big part of our federal deficit problem but hardly help people.

Yes, he offers a defined contribution health care solution with the promise of invigorating the markets and making costs lower. But we have had a form of Medicare premium support and private competition for years (Medicare Advantage) and there isn’t a lot of evidence the market can get the cost control job done on its own. (See: Defined Contribution Health Care—The Conservatives’ Silver Bullet)Continue reading…

What If You Give a Party and No One Comes?

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By PAUL LEVY

Here is a short update on a post I put up about a month ago about CMS’ proposed regulations for setting up Accountable Care Organizations. The ACO proposal calls for shared savings and other incentives for providers, with a transition after a few years to a real risk contract. But Congress put a “poison pill” into the concept because it was afraid to limit customer choice. At the heart of my argument was this point: “How can you be held accountable, as a provider group, if you cannot control the management of care of your patients?”

The latest news, according to my sources, is that even the most advanced ACO-like organizations like Geisinger and Mayo are not interested in signing on to this proposition. The financial risks can come crashing down quickly and are just too great.

In a recent Boston Globe interview, consultant Marc Bard explains how it would have to work for providers to agree to share risk in an ACO network:

Q. Some consumers fear they won’t be able to go to the doctors or specialists they want in the new system. Is that a legitimate fear?

A. The answer is of course. We can’t be spending 17.5 percent of our gross national product on health care and allow everybody to broker his or her own health care. So ultimately there are going to have to be trade-offs made. The public’s going to have to make them. The delivery systems are going to have to make them. Absolutely there are going to be limitations.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and
front-line driven process improvement at Not Running a Hospital.

Health 2.0 Advisors at Tiecon 11

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By Marco Smit

At Health 2.0 Advisors we not only scan and analyze the healthcare innovation landscape incessantly, we also share our thoughts and insights with clients and at conferences at times. On that note, on May 13 at 10am I will be moderating a panel on cloud-computing in healthcare at Tiecon 2011. It is the first panel right after the ‘interesting’ Steve Case speaks – Marissa Meyer from Google closes on Saturday evening.

Cloud-computing is one of the topics that Health 2.0 Advisors will start sharing more perspective on in public this year, in addition to unplatforms/mobile, analytics, and care delivery innovation. What these topics all have in common is that they are forces rapidly changing the healthcare landscape (competitive landscape, business models, patient-provider dynamics, other) and companies are grappling where they all fit in with their strategies and business realities.

This Tiecon 2011 panel is a good reflection of that: cloud-based EMR-systems where a novelty 18 months ago, but the number of companies offering them (stand-alone or embedded in e.g. a practice management suite), has exploded since. But cloud-computing goes far beyond EMRs of course. That is why the panel will cover a range of experiences, struggles, and expectations for the future of the cloud from large (IBM, Kaiser Pemanente) and small – but rapidly growing (Practice Fusion, CareCloud) – companies that have cloud-computing in their DNA.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

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